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What we have learned
Just as these institutions have learned a great deal about
next steps in improving quality and safety, we have
learned a lot about the value of the Red Book and
what we can do to make it and the resultant standards and verification process more meaningful to
the full range of health care institutions.
First, we have been informed which chapters of
the Red Book are the most relevant to quality improvement leaders in hospitals. More specifically,
they find the information pertaining to the following areas of greatest practicality:
•The surgeon’s responsibility and leadership during
the five phases of care: preoperative evaluation and
preparation, immediate preoperative readiness, in-traoperative, postoperative, and postdischarge
•The value and responsibilities of the Surgical Quality Officer
•The importance of standard case review and peer
•Establishment of an operational infrastructure to
ensure quality, safety, and reliability
•Development of rigorous credentialing and privileging protocols to ensure that staff surgeons are
competent in the provision of optimal care
•Application of the principles of high reliability with
a supportive infrastructure
•Disease management and multidisciplinary care
•Surveillance and use of the data to improve outcomes
On these site visits, we have learned that some hospitals are performing some of these activities well, but
no hospital does all of them well.
As many individuals involved in quality improvement have said, it’s a journey, not a destination. Based
on the experiences of the pilot sites, the College will
continue to develop standards for verifying and accrediting health care centers that provide surgical care and
to develop a second edition of the Red Book. We ask
that surgeon champions continue to work with their
hospital leadership to institute policies and practices
that will lead to the provision of better quality and safer
patient care and to consider having an ACS site visit.
The ACS also is looking to bring its other accreditation and verification programs in trauma, cancer,
and bariatric surgery under the Red Book umbrella.
In other words, the ACS is practicing what it preaches:
Better coordination of activities and more inclusive
teams that lead to better quality.
If we perform surgery using the concepts of integrated practice units and work together as teams with a
focus on using data to address outliers, we will achieve
the College’s core mission: To improve the care of the
surgical patient and to safeguard standards of care
in an optimal and ethical practice environment. ♦
EXECUTIVE DIRECTOR’S REPORT
The article on page 16 of this issue of the Bulletin highlights
how two hospitals in Kentucky—one an academic
medical center, and the other a community hospital
seeking to improve outcomes—prepared for their site
visits and what they learned from this experience.