The American College of Surgeons (ACS), in collaboration with Johns Hopkins Medicine Armstrong Institute, is actively recruiting hospitals to participate in the next cohort of the Improving Surgical Care and Recovery (ISCR) program, which will focus on colorectal surgery and orthopaedic surgery.
ISCR, a collaborative program to enhance the recovery of the surgical patient, is designed to support hospitals in implementing multidisciplinary, perioperative, evidence-based pathways to improve clinical outcomes, reduce hospital length-of-stay, and improve the patient experience. ISCR is free and open to all hospitals in the U.S., Puerto Rico, and the District of Columbia. The program is funded and guided by the Agency for Healthcare Research and Quality (AHRQ).
Additional cohorts will start in 2019 and 2020, and gynecology, emergency general surgery, and bariatric pathways will be available then, in addition to colorectal and orthopaedic surgery. The first cohort—colorectal—launched in July 2017 and will run until the end of June 2018. At present, more than 175 hospitals are enrolled in the colorectal cohort. It is anticipated that at least 750 hospitals will participate across multiple areas over the course of the program.
One of the main goals of ISCR is to assist hospitals in the delivery of evidence-based, perioperative care to reduce unnecessary variability in care. Key components of the ISCR pathways include patient and family engagement, including counseling about expectations for surgery and recovery; state-of-the-art analgesia, minimizing the use of narcotics, and promoting multimodal analgesia; early mobility and restoration of functional status; avoidance of prolonged periods of fasting; and evidence-based best practices for surgical site infections (SSIs), venous thromboembolism (VTE), and catheter-associated urinary tract infections (CAUTI) prevention.
Participating hospitals will have access to pathways with supporting evidence reviews, tools to help with local implementation, access to national leaders in perioperative care, as well as opportunities to share and learn from others via monthly coaching calls and networking opportunities. To evaluate pathway implementation and effectiveness, dedicated registry modules are available to hospitals that participate in the ACS National Surgical Quality Improvement Program as well as those that do not participate in the program. The registry will include pathway-related process measures as well as outcomes. Reports will allow hospitals to benchmark performance against other hospitals in the program. Clinical support and implementation support are available.
For surgeons and other practitioners, the AHRQ Safety Program for ISCR aligns with the requirements under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015. More specifically, provider participation in ISCR may encompass certain Clinical Practice Improvement Activities (CPIA) under the Quality Payment Program that the Centers for Medicare & Medicaid Services (CMS) established to comply with MACRA.
For hospitals, the AHRQ Safety Program for ISCR aligns with five of the 11 Hospital Improvement Innovation Networks core areas targeted for improvement by the CMS, including reduction in opioid prescribing; prevention of SSIs, CAUTIs, and VTEs, as well as fostering a culture of safety and teamwork.
Hospitals with all types of experience with clinical pathways and enhanced recovery participate in ISCR, including the following:
- Hospitals with no prior enhanced recovery implementation experience
- Hospitals that have implemented enhanced recovery in one area and are looking to expand enhanced recovery to other units
- Hospitals that have attempted to implement enhanced recovery but did not experience significant improvements or were unable to sustain the program