ACS, CDC Team Up to Lower Surgical Site Infections
This spring, the American College of Surgeons (ACS) and the Centers for Disease Control and Prevention (CDC) announced a strategic partnership to improve surgical patient safety at the national level. The partners have entered into an initial three-year project to combine expertise, align definitions, pool data and jointly track, report and ultimately prevent surgical site infections (SSIs) and other negative outcomes among surgical patients.
This isn’t the first time the nation’s largest organization of surgeons has worked with the CDC to improve quality and patient outcomes. “We’ve collaborated with the CDC on a lot of initiatives going back over the years,” noted David B. Hoyt, MD, FACS, executive director of ACS. He added successful projects have included work centered on trauma including field triage, data collection and preventive care and the 2010 SSI measures developed jointly by the CDC and ACS for colon surgery. Those measures are now part of Medicare’s quality reporting programs.
“Partnering with the CDC speaks to our shared commitment to surgical patient safety, preventing complications and lowering costs,” Hoyt noted in announcing the collaborative project.
Daniel Pollock, MD, surveillance branch chief of CDC’s Division of Health Care Quality Promotion (DHQP), added, “This partnership will help close gaps that exist between direct patient care and public health. Bringing clinicians, surveillance experts and prevention leaders to the same table will help ensure we collect the right data in the right way so that patient safety can be maximized.”
Currently, ACS collects data on SSIs through the National Surgical Quality Improvement Program (NSQIP®), and the CDC maintains the National Healthcare Safety network (NHSN). Each proposed slightly different SSI outcome measures to the National Quality Forum (NQF). In turn, officials with NQF suggested ACS and CDC see if they could ‘harmonize’ definitions, data requirements and technical specifications in a manner that would allow data to easily transfer between ACS NSQIP and NHSN while maintaining the individuality of each reporting system.
Hoyt said both national organizations are deeply committed to trying to reduce infection incidence to the lowest possible level and also to address other noninfectious complications impacting surgical patients. Pneumonia, urinary tract infections (UTI), central line infections, and surgical wound site infections are among areas being scrutinized. “Many of them are what we consider preventable either by uniform technique or (using) a checklist at every step along the way,” Hoyt said. He added evidence-based best practices exist to reduce or eliminate most of the common SSIs, but those practices are not always followed.
That, he said, is where accurate, accessible data collection could make a difference at the bedside. “The use of a database like NSQIP to monitor surgical infections is so you know where you stand … because first you have to know where you are … and then to be able to compare yourself to others nationally. If your numbers are worse, then you can drill down and try to resolve the issues.”
He continued, “I think people have always been concerned about surgical infections, but they have not been able to accurately assess their own practice without good data.” Much like a ‘check engine’ light on a car dashboard provides a visual cue to drivers to have their automobiles fixed, Hoyt noted, national data benchmarks highlight areas of concern … and spotlight areas where a surgeon or facility is meeting or exceeding expectations.
A study published online in March in the Journal of Healthcare Quality by researchers at Johns Hopkins underscored the need for a standardized system. The researchers found only 21 states require public reporting of hospital data on SSIs, and the mechanisms and methodologies for collecting and analyzing data vary by state with results that often are difficult to access. The authors suggest a national system with standardized, accurate data would be an inexpensive way to capture, monitor and ultimately reduce such infections.
Hoyt said electronic health records (EHRs) could play an important role in the quest to improve standardized data collection and submission and ultimately to help providers with clinical decision support. In the future, the hope is that an EHR would seamlessly populate aggregate databanks including ACS NSQIP and NHSN.
Admittedly, Hoyt said, Medicare’s decision to withhold payment for additional services necessitated by healthcare-associated infections (HAIs) comes into play. “It’s certainly a motivator for people,” he said, “but it’s not the primary motivation.” When it comes to improving quality, he continued, “We’ve been doing this type of work for years because it’s just good for patients.”
The announcement of the ACS-CDC collaboration came just a few months after the NQF endorsed two outcomes-based measures from ACS NSQIP. The two measures, which focused on SSI and UTI, were developed by ACS with input from the CDC and Centers for Medicare and Medicaid Services (CMS) as possible national outcome measures that could be adopted by CMS as early as 2015. Five other ACS NSQIP outcomes-based measures have already been endorsed by NQF.