The National Surgical Quality Improvement Project (NSQIP) - using a risk-adjusted surgical outcomes database for performance improvement

The National Surgical Quality Improvement Project (NSQIP) of the American College of Surgeons provides risk adjusted surgical outcomes measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables, including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and eight complications is prepared twice a year. This article describes briefly the history of NSQP and how its report on surgical outcome can be used for performance improvement within a hospital system. In particular it describes the performance improvement driven by NSQIP around postoperative respiratory complications - a major factor of postoperative mortality. A collaborative of several participating NSQIP hospitals is also described. An example of developing a "Playbook" based on an outcome improvement project is presented.