The American College of Surgeons’ National Surgical
Quality Improvement Program
The Hospital’s Perspective
The American College of Surgeons’ (ACS) National Surgical Quality Improvement Program (NSQIP) is a surgical quality
improvement program that monitors a variety of patient and hospital data, including pre-, intra- and post- surgical
characteristics and outcomes across surgical specialties, and then synthesizes clinically risk-adjusted measures of
quality. Currently, 526 hospitals participate in the ACS NSQIP, with international representation from sites in Canada,
Lebanon, the United Kingdom, Saudi Arabia, the United Arab Emirates, the Philippines, and Australia.1,2
The ACS NSQIP is used by member hospitals to: measure and monitor surgical outcomes, often resulting in
reduced complications and improved safety; improve patient care by reducing associated mortality and morbidity
through prevention activities; achieve cost savings, the majority of which stems from reductions in complications
and hospital lengths of stay; and, improve decision-making for member-hospitals by providing reliable data on
which members can base quality improvement decisions.3
Online Calculator for Surgical
Complication Risk
Leveraging data from over one million patients, the ACS NSQIP
has created an online tool to estimate the risk of surgical complications and predict possible patient outcomes (e.g., length of
hospital stay) prior to surgeries. The Online Calculator for Surgical Complication Risk is based on 22 risk factors, such as age and
weight of patients.4 According to both hospital sites and surgeons,
this tool has enhanced shared decision making between surgeons
and patients during consultations.5,6 The tool can also be used
by hospital staff as they consider necessary resource allocation
within a site. Furthermore, in the coming years, the ACS plans to
enhance the tool by adding new outcomes data and releasing a
mobile-enabled version for use on tablets and smartphones.7
Future Considerations
Many hospital sites have noted that better integration with electronic medical records (EMRs) is needed to reduce the burden of
manual data entry. At present, data are collected by highly trained
Surgical Clinical Reviewers (SCRs), who are employed by the
hospital and trained entirely by the ACS. Their function is to enter
data directly into the secure, web-based the ACS NSQIP platform
at each hospital site. The ACS provides SCRs with continuing education and training as well as continuous support to ensure high
quality data collection. Additionally, SCRs must pass periodic
examinations to prove competency and understanding of the data
entry process. Though SCRs are effective in their role, the cost
for hospitals to support this work is significant, especially when
factoring in additional costs, including turn-over of hospital staff
(e.g., SCRs retire).
EMRs present a promising solution to these high costs. By integrating data collection with EMRs, hospitals will ensure that a
subset of common data elements (e.g., patient demographics, lab
values) are electronically transferred from hospitals to the platform without manual assistance, thus saving hospitals the costs of
labor and staff time, and reducing human errors.8
Hospital Spotlight
One teaching hospital, located in an urban area, has been a member of the ACS NSQIP since 2008. In its first year of membership,
the hospital discovered a high rate of morbidity for patients undergoing colorectal surgery. Hospital leadership, through a review
of the ACS NSQIP’s annual report and the hospital-specific data
report, identified the issue, and staff then confirmed it by analyzing the ACS NSQIP portal data.9
After its careful analysis, the hospital reported that morbidity was
associated with infectious complications during surgery. To improve patient outcomes, the hospital implemented a comprehensive unit-based safety program, a five-step quality improvement
strategy with an interdisciplinary team approach. As a result, the
The American College of Surgeons’ National Surgical Quality Improvement Program
overall rate of surgical site infection (a common complication for
colorectal surgery) has fallen from 27.3 percent to 18.2 percent,
a notable reduction of 33 percent over one year.10,11 In 2010, the
ACS NSQIP data showed that this hospital achieved greater than
50 percent reduction in morbidity.12
Citations
1
The American College of Surgeons National Surgical Quality
Improvement Program, Welcome to ACS NSQIP, available at:
http://site.acsnsqip.org/. Accessed, July 30, 2014.
2
The American College of Surgeons National Surgical Quality
Improvement Program, Participants, available at: http://site.
acsnsqip.org/participants/. Accessed on July 30, 2014.
3
The American College of Surgeons National Surgical Quality
Improvement Program, Common Ground for Health Care: ACS
NSQIP Increases Quality, Reduces Costs, available at: http://site.
acsnsqip.org/wp-content/uploads/2012/02/ACS-Policy1.pdf.
Accessed on July 31, 2014.
4
Bilimoria, K. et al. “Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator: A Decision Aid and
Informed Consent Tool for Patients and Surgeons.” Journal of
the American College of Surgeons, Vol. 217, 833-842, 2013.
5
Heltz, D. “Online Calculator Predicts Risk of Surgical Complications.” Released September 4, 2013. Yahoo! Health, available at: http://site.acsnsqip.org/news/online-calculator-predicts-risk-of-surgical-complications/. Accessed July 30, 2014.
6
Key informant interview, Summer 2014.
7
ACS NSQIP, New ACS NSQIP Surgical Risk Calculator Offers
Personalized, Accurate Estimates of Surgical Complications to
Patients and Surgeons, available at: http://site.acsnsqip.org/news/
new-acs-nsqip-surgical-risk-calculator-offers-personalized-accurate-estimates-of-surgical-complications-to-patients-and-surgeons/. Released August 14, 2013. Accessed July 30, 2014.
Key informant interview, Summer 2014.
8
Ibid.
9
Wick, E. et al. “Implementation of a Surgical Comprehensive
Unit-based Safety Program to Reduce Hospital Infections.”
Journal of the American College of Surgeons, Vol. 215(2), 193200, 2012.
10
ACS NSQIP, New Surgical Patient Safety Program Reduces
Surgical Site Infections by One-Third in Patients Who Undergo
Colorectal Operations, available at: http://site.acsnsqip.org/news/
new-surgical-patient-safety-program-reduces-surgical-site-infections-by-one-third-in-patients-who-undergo-colorectal-operations/ Released July 30, 2012. Accessed July 30, 2014.
11
Key informant interview, Summer 2014.
12
About the Authors
Jessica Winkler, M.P.H., is a senior associate at AcademyHealth.
She may be reached at jessica.winkler@academyhealth.org.
Emily Moore is a student at University of Michigan School of Public
Health. She was formerly a research assistant at AcademyHealth.
Acknowledgements
Sponsorship for this project was provided by The Kaiser
Permanente Institute for Health Policy. We thank our partners
at The Pew Charitable Trusts and all those interviewed for their
contributions to these resources. A special thank you to Clifford
Ko, Bruce Hall, Elizabeth Wick, and Laurent Glance for their
review and assistance.
This document represents a synthesis of information generated by a series of key informant interviews. Any views expressed are those of the interviewees.