Safety, quality, and the national surgical quality improvement program

• Published in: The American surgeon 2006-11, Vol.72 (11), p.994-998
• Main Author: KHURI, Shukri F
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Clinical trials; Data collection; General aspects; General Surgery - standards; General Surgery - trends; Hospitals; Humans; Medical errors; Medical sciences; Mortality; Patient safety; Program Evaluation - trends; Quality Assurance, Health Care - standards; Quality of care; Risk factors; Safety; Studies; Surgeons; Surgery; United States
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313480607201103

The Institute of Medicine 1999 publication, To Err is Human, focused attention on preventable provider errors in surgery, and prompted numerous new national initiatives to improve patient safety. It is uncertain whether these initiatives have actually improved patient safety, mainly because of the lack of a quantitative metric for the assessment of patient safety in surgery. A 15-year experience with the National Surgical Quality Improvement Program, which originated in the Veteran's Administration in 1991 and was recently made available to the private sector, prompts the surgical community to place patient safety in surgery within a much larger conceptual framework than that of the Institute of Medicine report, and provides a quantitative metric for the assessment of patient safety initiatives. This conceptual framework defines patient safety in surgery as safety from all adverse outcomes (not only preventable errors and sentinel events); regards safety as an integral part of quality of surgical care; recognizes that adverse outcomes, and hence patient safety, are primarily determined by quality of systems of care; and uses comparative risk-adjusted outcome data as a metric for the identification of system problems and for the assessment and improvement of patient safety from adverse outcomes.