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Introducing NSQIP: Ontario’s Newest Quality Improvement Program Launches This Month

Health Quality Ontario is issuing a call to hospitals to apply to take part in a new surgical quality improvement program.

A critical part of our provincial mandate is innovating and supporting quality improvement. This week I am excited to announce the launch of the National Surgical Quality Improvement Program - Ontario (NSQIP-ON) with a call to all Ontario hospitals to consider applying.

While relatively new to Ontario, NSQIP is a proven means of measuring and improving the quality of surgical care in the U.S. It is an internationally recognized program, developed by the American College of Surgeons, which allows hospitals to collect, measure, and compare data on surgical care, complication rates, and surgical outcomes.

Data is the cornerstone of quality improvement. To quote the U.S.-based National Quality Centre, “Only data can tell whether improvements are made.” With no national averages with which to compare surgical outcomes in the U.S., NSQIP was developed to change this landscape. You can read more about NSQIP’s history here.

The program provides surgeons and surgical teams with a useful view of their own data specific to their practice, and it allows providers to compare their performance with other hospitals participating in the NSQIP collaborative. As a result of this heightened focus on new best practices and quality, hospitals participating in the program report better outcomes, shorter patient hospital stays, and fewer surgical complications each year. In the U.S., NSQIP is responsible for preventing 250-500 surgical complications and saving 12-36 lives each year.i

It is for those reasons and more that I’m excited about bringing this internationally recognized program to the province. To jump-start the process we are holding an application process to select 10 hospital sites to participate in NSQIP-ON.

If your hospital organization would like to take part in NSQIP-ON, we’re inviting you to submit expressions of interest. Applications open on December 8. The application deadline is January 20, 2015. Click here for more details.

Here in Canada, NSQIP has already seen great success in British Columbia. A total of 24 hospitals across B.C. are now part of the network. And it’s working. Patients undergoing breast surgery at Surrey Memorial Hospital in Vancouver had a significantly lower rate of surgical site infections after the introduction of NSQIP. In fact, an estimated 75 infections were averted over the course of two years.

While data is necessary for quality improvement, it is not sufficient on its own. Quality improvement is a team game that relies on collaboration and sharing. One of the key success factors of NSQIP is the creation of a surgical network focusing on peer-to-peer support. Ontario is fortunate to already have some trailblazers, both in surgical and organizational leadership. Five hospitals have already joined the NSQIP-ON network, and their team leaders are working with our leadership team to steer the direction of this program. This group includes Dr. Timothy Jackson, our provincial NSQIP-ON lead (UHN), Dr. Avery Nathans (Sunnybrook Hospital), and Dr. David Schramm (The Ottawa Hospital). We appreciate their time and commitment.

HQO’s long-term goal is to bring NSQIP-ON to all hospitals in Ontario. The program can be adapted to fit multiple hospital sites, including academic, community and rural hospital settings.

I’d love to hear your thoughts on HQO bringing NSQIP to Ontario. Please join the discussion by following @HQOntario or myself @DrJoshuaTepper.

To find out more about the benefits of participating in the NSQIP-ON program, please click here, or contact us at

NSQIP – A Brief History

Before NSQIP, there were no national averages available with which to annually compare surgical outcomes in the U.S. In the mid to late 1980s, the quality of surgical care in 133 Veterans Affairs hospitals was called in question after Congress became concerned over the rates of operative mortality. They wanted to know if they were higher than those in the private sector. To address this need, Congress passed Public Law 99-196, which stipulated that the Department of Veterans Affairs (VA) had report the surgical outcomes of VA hospitals each year. And so the idea of a database came into play.

The program took hold across all 133 VA medical centres by 1994. Finally there was a national system in place to collect and report on risk-adjusted data for surgeries. Between 1991 and 2006, VA hospitals saw a 47 percent drop in post-operative mortality and a 43 percent drop in morbidity rates.ii By 1999, the private sector wanted in, and by 2001 the American College of Surgeons (which represents 77,000 surgeons worldwide) launched NSQIP as a pilot program in 18 private sector sites.

Today NSQIP is now available to all private sector hospitals. NSQIP is responsible for preventing 250-500 surgical complications and saving 12-36 lives each year.iii That means almost every day one to two people possibly avoid costly readmissions, and each week at least one person does not die from surgical complications. The American College of Surgeons says if every U.S. hospital adopted NSQIP, more than 10,000 lives could be saved, more than 2.5 million complications could be reduced, and health care costs could be cut by more than $25 billion – each year.iv

iHall, BL et al. “Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program", (2014). ACS NSQIP. [online] Available at: [Accessed 8 Dec. 2014].
iiiHall, BL et al. “Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program.”, (2014). ACS NSQIP. [online] Available at:[Accessed 8 Dec. 2014].
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