The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met virtually February 4–5. Following is a summary of key activities discussed. The information provided was current as of the date of the meeting.
ACSPA
As of January 10, during the 2022 election cycle (January 1, 2021–December 31, 2022), the ACSPA Political Action Committee (ACSPA-SurgeonsPAC) had raised more than $310,000 from more than 580 College members and staff and disbursed $255,000 to more than 90 congressional candidates, political campaigns, and other PACs. SurgeonsPAC continues to prioritize a balanced, nonpartisan disbursement strategy, including support for Democrats and Republicans, particularly health professionals; key congressional leaders; and members of US House and Senate committees with jurisdiction over healthcare legislation.
ACS
The Board of Regents reviewed reports from division directors, approved a policy statement on Physician Health Programs and Surgeon Well-Being in support of the Federation of State Medical Boards Policy on Physician Illness and Impairment: Toward a Model that Optimizes Patient Safety and Physician Health, and accepted resignations from six Fellows and changed the status from Active or Senior to Retired for 137 Fellows.
Office of Diversity, Equity, and Inclusion
The Board of Regents Anti-Racism Committee, ACS Office of Diversity, Equity, and Inclusion (DEI), and Board of Governors Diversity Pillar met in January to evaluate the progress made on the recommendations in the November 2020 Task Force on Racial Issues Report and the June 2021 DEI and Anti-Racism Retreat. The Task Force recommendations identified 12 critical enabling habits and reviewed the current status:
- Achieved: Creating a staff Office of DEI, establishing a Regental Anti-Racism Committee, and creating resources on the history of Black surgeons
- In process: Understanding underrepresented minorities baseline demographics, developing best practices and training programs, leveraging research and funding to improve URiM (underrepresented in medicine) access to care, and creating a business plan for action
- Near future: Defining new demographics goals and timelines on progress, promoting and disseminating a DEI plan, and catalyzing advocacy and legislative reform
- Longer term: Reassessing and amending bylaws and processes, forming private/public partnerships
Division of Education
The Division of Education reported on key activities.
Committee on Ethics
The Committee on Ethics is sponsoring several sessions at Clinical Congress 2022, including the John J. Conley Ethics and Philosophy Lecture with Martin Makary, MD, MPH, author of Unaccountable—What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. The Ethics Colloquium will be Can I Fire My Patient?...The Duty to Care and Limits of Accommodation.
The committee is sponsoring three panel sessions: Coping with Conflicted Commitment to Surgeon Health, Ethical Implications of Structured Racism, and Ethical and Moral Dilemmas in the Disclosure of Surgical Error. Meet-the-Expert sessions also are in development on Updates in Informed Consent, and the Value of Training in Surgical Ethics.
The committee also is sponsoring a Fellowship in Surgical Ethics through the MacLean Center for Clinical Medical Ethics at The University of Chicago, IL, for the 2022–2023 academic year.
SESAP
The Surgical Education and Self-Assessment Program® (SESAP®) remains the premier self-assessment and guided cognitive skills education program for practicing surgeons. SESAP 18 is scheduled for release October 2022 and SESAP 18 Advanced is set to release in 2023.
Division of Research and Optimal Patient Care
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement (CQI), including ACS research and the accreditation programs. In addition to a status report on current activities, a strategic analysis of the quality programs (registries, programs, policy, and research and development) was conducted in January 2022. The ACS has 19 hospital-based quality programs, along with the Surgeon Specific Registry (SSR). More than 4,000 participants in 2,500 hospitals participate in ACS Quality Programs, 100 countries participate in the Quality and Safety Conference, and 83 countries conduct Advanced Trauma Life Support® (ATLS®) courses.
Quality and Safety Conference
The 2022 ACS Quality and Safety Conference (QSC) will take place July 15−18 in Chicago, with limited in-person capacity because of ongoing COVID-19 safety concerns. Select sessions will be recorded during the in-person meeting and available on-demand a few weeks after the meeting. The program will encompass content from several ACS Quality Programs and feature an increased emphasis on enhancing the attendee experience with innovative engagement and networking experiences.
ACS Quality Improvement Course: The Basics
The ACS Quality Improvement Course: The Basics launched in November 2021 and is intended for surgeons and other QI staff interested in improving quality at their hospitals. The self-paced online course consists of six modules and an exam. Each module includes text, videos, interactive e-learning components, knowledge-check questions, and workbook activities. After completing the course, participants will understand the basic principles of surgical quality and safety. Attendees also will be able to apply a collection of tools and strategies to ensure success.
Optimal Resources for Surgical Quality and Safety
In 2017, the College released Optimal Resources for Surgical Quality and Safety, also known as the Red Book. More than 10,000 manuals have been distributed since its release. Additional marketing efforts are under way to broaden its reach and to better inform the national audience of its instructional and educational content.
The manual served as source material to develop new standards and the ACS Quality Verification Program (ACS QVP). The ACS QVP formally launched in July 2021, and multiple participation options are available to interested hospitals, with additional participation options for hospital systems and ACS National Surgical Quality Improvement Program (ACS NSQIP®) participants available in the future. The ACS QVP provides a proven, standardized method for establishing, measuring, and improving a hospital’s quality infrastructure across all surgical departments.
ACS NSQIP
A total of 850 hospitals participate in ACS NSQIP—699 in the adult option. The pediatric option represents 18% of overall participation. At present, 152 hospitals outside of the US participate in ACS NSQIP—approximately 18% of all participating facilities.
MBSAQIP
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is collaborating with the Centers for Medicare & Medicaid Services (CMS), having been selected by the Centers for Medicare and Medicaid Innovation (CMMI)’s Bundled Payment Care Initiative (BPCI) as the sole ACS registry to participate in this program. Along with four other medical and surgical associations, ACS MBSAQIP is the only registry among the five associations to introduce a novel verification measure in addition to clinical measures that are collected in the data registry.
Children’s Surgery Verification Program
The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring that pediatric surgery patients have access to quality care. A total of 151 centers participate in CSV. Approximately 35 of these centers are in various stages of verification; 41 of the active sites are fully verified as Level I children’s surgery centers. All 151 centers participate in ACS NSQIP Pediatric.
Geriatric Surgery Verification Program
The Geriatric Surgery Verification (GSV) Quality Improvement Program launched in 2019 to ensure that older surgical patients have access to high-quality care. At present, 52 hospitals have applied for one of the three levels of participation: Level 1 Verification—Comprehensive Excellence; Level 2 Verification—Focused Excellence; and Commitment Level. Hospitals seeking Level 1 or Level 2 Verification must demonstrate all 30 GSV Program standards are in place through a comprehensive site visit. These visits confirm that hospitals comply with the required structure, processes, and standards of care as outlined by the program. In all, 31 hospitals are enrolled at the verification level and are expected to demonstrate standards compliance within the first year of enrollment.
ISCR Program
The Agency for Healthcare Research and Quality (AHRQ) Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the ACS and the Johns Hopkins Armstrong Institute for Patient Safety and Quality in Baltimore, MD, continues to attract hospitals interested in implementing enhanced recovery practices. Hospitals participating in ISCR receive a ready-to-use pathway, access to education materials on implementing the pathway, access to experts in performance improvement and education to help with troubleshooting, and inclusion in a community of professionals rolling out the same pathway. Approximately 60% of enrolled hospitals participate in ACS NSQIP. More than 350 hospitals have participated in the program. Enrollment in ISCR is now closed to new sites, but the program will continue until December 2022.
Strong for Surgery
Strong for Surgery (S4S), a joint program of the ACS and the University of Washington, Seattle, is a quality initiative aimed at identifying and evaluating evidence-based practices to optimize the health of patients before surgery. The program empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective procedures. Since its release in 2017, S4S has more than 700 participating sites. The goal is to move the patient-facing version to an online platform for patients to complete before meeting with their surgeon.
SSR
The SSR allows surgeons to track their cases, measure outcomes, and comply with changing regulatory requirements. The SSR can be used to meet the requirements of CMS’s Quality Payment Program Merit-based Incentive Payment System, as well as the American Board of Surgery’s Continuous Certification Program requirements. The SSR has an active user base of approximately 7,000 surgeons, and more than 12.6 million case records have been entered in the SSR system since its release in 2017. The SSR now offers the SSR Practice Improvement Initiative (SSR PII) 2022—Quality Case Data Review and Reflection 2022 to allow surgeons to perform quality data assessment and CME.
ACS COVID-19 Registry
The ACS COVID-19 Registry launched in April 2020 in response to requests from ACS NSQIP participating sites to track COVID-19 patients. Participation in the registry is free to any hospital.
Hospitals participating in the ACS COVID-19 Registry enter data variables covering demographics, severity predictors, admission information, hospitalization information, therapies used, and discharge information. Participating hospitals capture data on all patients ages 18 and older and are tracked from hospital admission through discharge. Approximately 70 hospitals participate and have submitted more than 19,000 cases. Participating sites can download their data at any time to look for trends or areas for quality improvement.
Cancer Programs
The overarching mission of the College’s seven Cancer Programs is to improve care for cancer patients. Cancer Programs work together to achieve this mission by setting standards, monitoring compliance, accrediting sites, collecting and reporting vital statistics, and using vital statistics to drive quality improvement, research, optimization of staging, operative standards, and best practices. Integration plays an important role in ensuring that all Cancer Programs, the College, and member organization assets are engaged and deployed to improve the care of cancer patients and multiply the relative contribution of the ACS Cancer Programs to the larger cancer community.
In 2021, the Cancer Programs met the following strategic goals:
- Developed and introduced point-of-care synoptic operative reports
- Deployed the Rapid Cancer Reporting System to facilitate real-time cancer
- Improved abstraction/reporting
- Revised criteria for quality measure development and created a 30-measure portfolio
- Created and completed a national return to screening QI project
- Created and distributed cancer quality improvement educational material
- Reduced registry abstraction burden by reducing follow-up from lifetime to 15 years based on analytic value assessments
- Restructured American Joint Committee on Cancer (AJCC) cancer staging editorial processes to adapt away from print books to online protocols
- Introduced data-driven AJCC cancer staging categories by incorporating National Cancer Database (NCDB) statistics and analytics
- Created diverse content to support the 100-year anniversary of the Commission on Cancer (CoC)
- Adapted to fluctuating work conditions resulting from the pandemic
2022 Key Performance Indicators for the Cancer Programs include accrediting 2,200 programs, reporting on 1.5 million new cancer cases, and developing 6–10 new cancer staging and synoptic operative report protocols.
The CoC is commemorating its 100-year anniversary this year, and several events are planned to celebrate its history and accomplishments.
Trauma Programs
The Committee on Trauma (COT) launched its centennial celebration in 2022 with a series of activities highlighting its accomplishments, along with a new vision for the future. The Spring Meeting included a day of celebration, and additional programming will occur at ACS meetings throughout the year. To commemorate its history and accomplishments, representatives for the COT have authored a book, Looking to the Future through the Lens of Legacy, and are publishing a series of articles in the Bulletin.
In March 2022, the COT transitioned its leadership, with Jeffrey D. Kerby, MD, PhD, FACS, assuming the role of COT Chair for a 4-year term. Warren C. Dorlac, MD, FACS, COL USAF (Ret.), is now COT Vice-Chair and Chair of the Regional Committees on Trauma. Eileen M. Bulger, MD, FACS, transitioned from the COT Chair into the role of ACS Trauma Medical Director. Dr. Bulger replaces Ronald M. Stewart, MD, FACS, in this position.
The ATLS program continues to recover from the impact of the pandemic and is launching the 11th edition revision process this year and developing a new mobile application strategy for ATLS supporting all the trauma education programs. New editions of Advanced Trauma Operative Management and Advanced Surgical Skills for Exposure in Trauma have been completed and the College’s disaster management courses are in revision.
Launched at Clinical Congress 2019, the Future Trauma Leaders fundraising campaign (FTL100) was established to generate financial support for an initiative to coincide with the 100th anniversary of the COT in 2022. The FTL aims to recruit, mentor, provide program support, and reimburse travel expenses for eight future trauma leaders annually. The official fundraising campaign ended with the COT’s 2022 Spring Meeting, surpassing the initial fundraising target of $1 million.
The 2021 TQIP Annual Conference took place virtually November 15–17, with more than 3,600 registrants. The meeting platform offered attendees an integrated experience where they could view content, network with others, visit exhibitors, claim educational credit, and more, all in one place. The Spine Injury Guidelines were presented at the conference and were officially released earlier this year. The 2022 TQIP Annual Conference will take place December 11–13 in Phoenix, AZ.
The STOP THE BLEED® (STB) program continues to focus on empowering, educating, and informing individuals in bleeding control techniques. The STB program provides training, both virtually and in-person, on the importance of learning the lifesaving skills to deploy in a bleeding emergency. The STB program continues to promulgate the initiative globally, creating awareness throughout communities worldwide. As of January 2022, the STB program has a new vendor, North American Rescue, to help reduce the cost of the equipment and support ACS branding. In addition, STB will offer an ACS-branded Combat Application Tourniquet in all the kits and provide a link to the new STB Interactive Course. The Working for Equity STOP THE BLEED® has been developed to create a basis for community support that can be adapted to multiple areas of need and connect individuals through STB training. As of December 31, 2021, the STB program has trained 1.8 million individuals with 99,048 global instructors.
