Nurse Training

The central premise of the ACS NSQIP process is the importance of reliable data collection. This is why participating medical centers are required to commit at least one full-time Surgical Clinical Nurse Reviewer to the process of data collection. The Nurse Reviewers must have substantial clinical experience to perform the kind of thorough case assessment necessary to assure reliable data. Classes are provided by QCMetrix to educate new Nurse Reviewers.

QCMetrix’s training program for Surgical Clinical Nurse Reviewers consists of intensive initial classes supported by ongoing education during the first year of participation in the ACS NSQIP. To maintain program knowledge, annual tests are administered and additional learning takes place through continuing education conferences and seminars.

Initial Training

All new Surgical Clinical Nurse Reviewers attend a 2-day training class at the American College of Surgeons headquarters in Chicago. The classes are led by Janet Steeger, QCMetrix’s Director of Private Sector Nurse and Education Development. The curriculum includes:

• Introduction to the ACS NSQIP
• History & background
• Reports
• Improvements in the VA
• ACS NSQIP in the private sector
• Role & Responsibility of the Surgical Clinical Nurse Reviewer
• What is needed to perform the job
• Setting up an efficient data collection system
• Important hospital contacts
• Data Collection Process
• Variables collected for the program
• Case Selection
• Randomization Process
• Program Variables & Definitions
• Demographics
• Preoperative Risk Factors
• Operative Data
• Postoperative Occurrences
• Discharge Data
• ACS NSQIP Website
• Online tour through the website
• Data Entry
• Data Transmission
• Online Reports
• Assuring the Reliability of the Data
• Competence Module
• Inter-rater Reliability Testing
• Continuing Education
• Communication within the program
• Key Contacts
• Methods of Communication
• Who’s involved in this program and what do they do
• ACS
• QCMetrix
• Denver Data Analysis Center
• Case Studies
• Questions & Answers

An ungraded test of case studies is administered at the initial training to give the nurse reviewers a taste of what the data collection and application of data definitions is like.

Prerequisite for the initial training is that the nurse reviewer is an RN (PA is acceptable too) with experience in surgery, either the OR, ICU, or surgical ward.

Ongoing Training

• Week 1: A graded test (level I) is administered to the new nurse reviewers one week after the initial training. A score of 80% or better is expected.
• Month 2: Ongoing training and testing (level II) occurs at 2 months after initial training with continued emphasis on the program and data definitions along with more advanced case studies.
• Month 4: Ongoing training and testing (level III) occurs at 4 months after initial training with continued emphasis on the program and data definitions along with more advanced case studies.
• Month 6: Six months after the initial training (and annually thereafter), an inter-rater reliability (IRR) site visit is performed to verify data validity. This is a further opportunity for the nurse coordinator to provide continuing education to specific issues of concern noted from the inter-rater reliability findings.

Annual Testing and Continuing Education

• Annual IRR Test: Annually, an inter-rater reliability test via an extensive case study is given to the nurse reviewers. A score of 85% or better is expected on these exams. This IRR test is a two-fold educational opportunity. First, the test identifies individual nurse reviewers that may be having problems with specific variable definitions. Second, the test can identify problems across the sites with variable definitions. This identification brings about improvements in the definitions and their consistent application.
• Annual National Nurse Conference: Also annually, the ACS NSQIP provides a national nurse conference to all nurse reviewers in the program. This weeklong conference reviews program guidelines and definitions as well as provides program updates. It also emphasizes clinical education to support and strengthen understanding and application of data definitions.
• Continuing Education: Frequent communication occurs on the weekly nurse reviewer conference calls and on the website with weekly case studies. Each week, the online case study addresses a different program variable and tests the nurse reviewer’s understanding of the application of the program definition. Answer(s) are submitted online by the nurse reviewer and explanations to the answers are then provided to further strengthen comprehension of definition application.