New research supports surgical quality verification program standards

Implementing a standardized quality verification program in hospitals can significantly enhance surgical care, as demonstrated by a review study published in the Journal of the American College of Surgeons (JACS). This review provides comprehensive evidence on the positive impact of team-based and disease-based clinical programs, compliance with hospital-level regulatory metrics, and their effect on patient outcomes.

A comprehensive approach to surgical quality

The ACS Quality Verification Program (ACS QVP) provides an evidence-based, standardized method for establishing, measuring, and improving hospital-wide quality infrastructure. Xane D. Peters, MD, an ACS Clinical Scholar in Residence and co-lead author of the study, emphasized the program's broad applicability and potential impact on surgical care across various specialties.

"The ACS Quality Verification Program is important and unique because it provides a holistic view of how surgery is delivered in a hospital and how it can be improved," Dr. Peters said. "By adopting these evidence-based standards, hospitals can systematically address and prevent issues, ensuring a higher standard of care for all surgical patients."

The study is the final installment in a three-part review aimed at synthesizing the evidence that supports the main principles of the ACS QVP. Previous publications focused on institutional administrative commitment, data surveillance, and systems for quality improvement. This final review examines the evidence for standardized team-based and disease-based clinical programs, compliance with hospital-level regulatory metrics, and their effect on patient outcomes.

Team-based processes focus on ensuring surgical quality, safety, and reliability in all five phases of care surrounding surgery. Disease-based clinical programs refer to the multidisciplinary management of specific diseases or procedures such as cancer care or colorectal surgery. Regulatory standards and accreditation from external sources like ACS can also improve patient outcomes.

Key findings from reviewed studies

• Standardized care protocols across multiple phases of surgical care significantly reduced the length of hospital stay by an average of 1.9 days. Additionally, hospital costs decreased by an average of $1,763 per admission.

• Multidisciplinary disease-based management programs demonstrated a reduction in in-hospital mortality for patients with native valve endocarditis from 25% to 13% and for patients with prosthetic valve endocarditis from 53% to 23%. Following multidisciplinary tumor board reviews, 23% of colorectal cancer patients had changes in their treatment plans.

• Compliance with external regulatory standards and accreditation programs was associated with an 18% reduction in surgical site infections.

"This study shows that hospitals who implement QVP demonstrably improve in a variety of areas when the program is faithfully implemented," said Clifford Y. Ko, MD, MS, MSHS, FACS, Director of Quality Programs at the ACS, "Because all hospitals are different, each is able to focus on individual priorities for improvement. What's clear is that QVP provides the roadmap and tools to make significant improvement, leading to better patient care and a more effective and efficient use of resources by a hospital."

Tailored recommendations for quality improvement

Hospitals participating in the ACS QVP receive customized reports with actionable recommendations tailored to their specific needs. These reports provide insights into leadership, safety culture, and standardization across the five phases of care: preoperative, immediate preoperative, intraoperative, postoperative, and post-discharge. The program offers two levels of verification, ACS QVP Focused and ACS QVP Comprehensive Verification, allowing hospitals to choose the level that best suits their current infrastructure and goals.

"QVP is a transformative initiative that ensures hospitals can deliver the highest standard of surgical care across all departments," said James W. Fleshman Jr., MD, FACS, FASCRS, member of the ACS Board of Regents and chairman of the department of surgery at Baylor University Medical Center. "It helps you build the culture, structures, and processes that lead to real and sustainable improvement. Hospitals want to deliver optimal care for their patients but, for any number of reasons, we can fall short. By implementing QVP, it gives us more opportunity to deliver high-quality surgical care for every patient, every time."

The ACS QVP represents a significant advancement in pursuing high-quality, safe surgical care, the authors note.

"This study serves as the keystone of our efforts to establish a robust evidence base for the ACS QVP standards," Dr. Peters noted. "Incorporating these standards will promote safety and quality for all surgical patients."

More information:
Chelsea F Cardell et al, Evidence Review for the American College of Surgeons Quality Verification Part III: Standardization, Protocols, and Achieving Better Outcomes for Patient Care, Journal of the American College of Surgeons (2024). DOI: 10.1097/XCS.0000000000001126

Provided by American College of Surgeons