Renewal of surgical quality and safety initiatives: a multispecialty challenge

The quality and safety movement in surgical specialty practice is gaining momentum. On the basis of risk-adjusted outcomes of coronary artery surgery and the improved risk assessment in the Veterans Affairs system, a growing array of surgical specialists has focused on recognition of legitimate risk factors, identification of performance measures that are valid surrogates for better practices, and refinement of risk-adjusted outcomes. Recognition of educational needs, personal practice patterns, and systems deficiencies now permits a broad-based application of long-standing primarily medical issues to elective surgical procedures in an organized and Integrated fashion. Approximately 85,000 patients per day undergo elective operations in the United States. A platform based on physician involvement and leadership has been tested in the Surgical Care Improvement Project, funded by a subcontract from the Centers for Medicare and Medicaid Services. This effort has defined factors worthy of further verification and provides a framework for an ethical and valid pay-for-performance scheme.