The National Surgical Quality Improvement Program (NSQIP) was introduced by the American College of Surgeons in 2001 and was the first nationally validated, risk-adjusted outcomes–based program designed to measure and improve the quality of surgical care in the United States. We joined the Ontario collaborative in 2015. We have used the NSQIP procedure-targeted option and essentials option, collecting 1680 cases per year from our Divisions of General Surgery (colectomy, ventral hernia, appendectomy) and Orthopedic Surgery (total knee and total hip arthroplasties, hip fractures) to assess data to help focus quality-improvement efforts. The NSQIP-ON collaborative (the Ontario Surgical Quality Improvement Network) allows the sharing of information and quality-improvement measures to allow all participants access to each other’s insights, regardless of success. Our core team includes our Surgical Clinical Reviewer- Carmen Caloian, Surgical Program Director- Julie McBrien, and Surgeon Champion- Dr. Duncan Rozario. A key part of our success was the creation of an extended Surgical Quality Improvement Team (SQUINT) comprised of members from the surgical floors, emergency department, post-anesthesia recovery unit, operating room, anesthesia, infection control, physiotherapy, orthopedic and general surgery, and administration.
The adjusted OR percentiles are better estimates of true comparative rank than raw deciles. With increased confidence in the accuracy of rank, the “Exemplary” and “Needs Improvement” cutoffs have been changed to 1st and 4th adjusted quartiles (adjusted OR percentile ≤ 25%, and ≥ 76%, respectively).
· “Exemplary” is now assigned if the hospital is in the 1st quartile of adjusted OR percentiles.
· “Needs Improvement” is now assigned if the hospital is in the 4th quartile of adjusted OR percentiles.