Evidence Review for the American College of Surgeons Quality Verification Part III: Standardization, Protocols, and Achieving Better Outcomes for Patient Care

Abstract

Background: After decades of experience supporting surgical quality and safety by the American College of Surgeons (ACS), the ACS Quality Verification Program (ACS QVP) was developed to help hospitals improve surgical quality and safety. This review is the final installment of a 3-part review aimed to synthesize evidence supporting the main principles of the ACS QVP.

Study design: Evidence was systematically reviewed for 3 principles: standardized team-based care across 5 phases of surgical care, disease-based management, and external regulatory review. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical manner, extracted data, and summarized results in a narrative fashion. A total of 5,237 studies across these 3 topics were identified. Studies were included if they evaluated the relationship between the standard of interest and patient-level or organization measures within the last 20 years.

Results: After applying inclusion criteria, a total of 150 studies in systematic reviews and primary studies were included for assessment. Despite institutional variation in standardized clinical pathways, evidence demonstrated improved outcomes such as reduced length of stay, costs, and complications. Evidence for multidisciplinary disease-based care protocols was mixed, though trended toward improving patient outcomes such as reduced length of stay and readmissions. Similarly, the evidence for accreditation and adherence to external process measures was also mixed, though several studies demonstrated the benefit of accreditation programs on patient outcomes.

Conclusions: The identified literature supports the importance of standardized multidisciplinary and disease-based processes and external regulatory systems to improve quality of care.