Table 1

Example of interventions and changes in outcomes in ACS NSQIP hospitals/collaboratives

Hershey Medical Center, Penn State3519.3% SSI in patients with diabetes; 8% in patients without diabetes
VTE 3.4% (2008)
Glucose control protocol
VTE risk assessment and order set
Reduction of SSI O/E from 1.31 to 0.78
Reduction of VTE rate from 3.4% to 0.2% (2008–2009)
University of Virginia3717.6% SSI (national average 8.1%) in colorectal resections, high BMI was a risk factorProtocol for wound wicking for BMI >25 kg/m2, SCIP measures, glycaemic controlReduction of SSI from 17.6% to 11.2% (36% reduction)
Massachusetts General Hospital37Vascular surgery morbidity O/E ratio 1.19, (99% CI 0.93 to 1.48)
UTI rate 7.0% vs 4.7% (p<0.087)
Physician order entry templates, Foley catheter removal algorithm, silver-coated catheters for selected patients, identify procedures not requiring a catheter, educational campaign for cliniciansReduction of UTI from 7.0% to 1.8%
Morbidity O/E ratio decreased from 1.19 (99% CI 0.93 to 1.48) to 0.93 (99% CI 0.67 to 1.48) (76% reduction)
Hospital AIdentified a rise in organ space infectionsStandardised orders, proper antibiotic use, morbidity conference presentations, skin preparation changesOrgan space infection increase attributed to increased leak rates and identified surgical technique issues; improvements seen, but rate still high
Hospital BVTE 17.6%Risk stratification, best practices, standardised ordersVTE decreased from 17.6 to 2.3%; O/E decreased from 1.88 to 1.05
Hospital CUnplanned reintubation 3% (O/E 1.56)
Ventilator>48 h 3.84% (O/E 1.71)
Tracking tool, risk assessment, improved pulmonary hygiene interventionTBD
Hospital DVentilator use for >48 h 2.24% (O/E 1.7)Tracking tool, standardised orders, patient educationVentilator use for >48 h decreased from 2.24% to 1.19%
(O/E 1.7 to 0.83)
Hospital EOverall orthopaedic DVT rate 3.1%
Knee arthroplasty DVT rate 10.1%
Identified variations in DVT prophylaxis practice, surgeon-specific review, standardised careReduction of overall orthopaedic DVT rate from 3.1% to 1.1%
Reduction of knee arthroplasty DVT rate from 10.1% to 1.6%
  • Hospitals A–E are representative examples taken from the ACS NSQIP data portal website, accessed 13 December 2011. Reprinted by permission of American College of Surgeons NSQIP.

  • ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Project; BMI, body mass index; DVT, deep venous thrombosis; SCIP, Surgical Care Improvement Project; SSI, surgical site infection; TBD, to be determined; UTI, urinary tract infection; VTE, venous thromboembolism.