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surgical care [ 21 ]. When creating a curriculum, ACS NSQIP is a useful guide for the
development of educational content [ 36 ]. Users may evaluate their own institutional
outcomes against the national database using observed to expected ratios [ 1 , 5 , 27 ],
which rely on confidence intervals to determine if an outcome occurs more or less
often than expected. Confidence intervals for O/E ratios with lower limits >1 sug-
gest that patients at an institution experience an adverse event more often than
expected. In converse, if the upper limit of the confidence limit for an O/E ratio is
<1, this suggests that patients at an institution experience a particular complication
less often than expected [ 27 ].
When explaining the utility of ACS NSQIP, one author points out that the goal of
the database is not to identify and punish underperforming institutions but rather to
use reliable data that allows institutions to identify areas of weakness and generate
quality improvement measures in response [ 27 ]. Analysis of NSQIP data before and
after an intervention is implemented helps to determine its effectiveness [ 27 ].
The Agency for Healthcare Research and Quality (AHRQ), an agency within the
Department of Health and Human Resources, is another resource aimed at produc-
ing guidelines improving quality of healthcare through research. The AHRQ pro-
duces a variety of literature, and continuing education materials that are widely
accessible cover a wide variety of healthcare topics. In addition, the AHRQ website
contains data reports that may allow comparison of hospital or practice data to those
at the state or national level [ 40 ].
The Joint Commission Surgical Care Improvement Project (SCIP) uses large
multicenter data sets to power a series of projects aimed at reducing surgical com-
plications. The Joint Commission is an independent, not-for-profit organization that
is responsible for accreditation and certification of healthcare organizations in the
United States. Measures within SCIP include VTE prophylaxis guidelines and
appropriate perioperative antibiotic use. Knowledge of patient safety standards out-
lined the Joint Commission by residents, and program directors will not only
improve patient safety but ensure institutional accreditation [ 41 ].
The Institute for Healthcare Improvement (IHI) is an independent, not-for-profit
organization that aims to improve healthcare worldwide through an array of educa-
tional resources, including the IHI Open School. The IHI Open School is a collec-
tion of online modules in QI/PS, including a full curriculum, available to the general
public, as well as professional and academic groups. This program is utilized by
undergraduates, medical students, residents, and practicing physicians and offers a
flexible, organized method to learn about QI/PS. The Open School also offers
courses in experiential learning that help learners [ 42 ].
Examples of specialty-specific resources are those provided by the American
Urological Association (AUA). Some of these include a detailed list of best prac-
tice clinical guidelines written and reviewed by leading experts. The AUA offers
an AUA Quality Registry (AQUA), which extracts quality metrics from the medi-
cal record to generate quality metrics for urologists across the United States.
There are also a number of educational resources provided by a department within
the AUA focused on patient safety and improved quality of care measures. This
department organizes an evolving list of quality improvement guidelines and
E.L. Ferguson and C.P. Sundaram