By Helen Larios, Project Director, Clinical, Department of Standards and Survey Methods
In recent years, the field of spine surgery has made great progress in performing this type of surgery in the ambulatory setting. However, quality and safety issues continue related to limitations with:
- clinical practice guidelines
- standardized care pathways
- measurement of clinical outcomes
- tracking complications of care
- variations in the identification and confirmation of the correct spinal level
New Program Collaboration
To help address these issues, The Joint Commission is excited to offer Advanced Certification for Spine Surgery (ACSS), beginning July 1, 2021.
ACSS was developed in collaboration with the American Academy of Orthopaedic Surgeons (AAOS) and will be available to all ambulatory surgery centers (ASCs) regardless of whether they are accredited by The Joint Commission or another accreditor, or are not accredited.
The new spine surgery certification:
- targets quality and safety issues
- provides an in-depth assessment of an organization’s spine surgery program
- promotes consistent communication and collaboration among all health care providers involved in the care of the patient from the initial spine surgery consultation through the follow-up visit after discharge
A technical advisory panel composed of clinical experts with specific knowledge of this type of care, including clinical leadership from the American Spine Registry (ASR) and a partnership between the American Association of Neurological Surgeons (AANS) and AAOS, provided feedback that informed development of the program and ensured that the standards supported the delivery of safe, quality care. A major goal was to provide compelling benefits to patients and staff to justify a return on investment.
The standards incorporate the latest research, best practices, and federal regulations to improve quality and safety for spine surgery patients and address various areas related to spine surgery, such as:
- program structure
- delivery of care
- care coordination
- performance measurement
ACSS integrates clinical practice guidelines into the requirements to promote high-quality, evidence-based spine surgery care. ASCs will be expected to demonstrate their application of clinical practice guidelines and professional recommendations, which may include those from the following organizations:
- American Academy of Orthopaedic Surgeons (AAOS)
- American Society of Anesthesiologists (ASA)
- National Association of Orthopaedic Nurses (NAON)
- North American Spine Society (NASS)
ACSS standards also incorporate these four standardized measures adopted from the ASR:
- surgical site infection rates
- new neurological deficits
- unplanned return visit to the operating room
- pre- and post-operative patient-reported outcomes
Steps Toward Certification
Organizations pursing this certification will be expected to collect data for these measures four months prior to the initial certification review visit. Organizations must also be an active participant of the ASR and use the data collected from the registry to analyze and improve processes.
As a first step to prepare for achievement of ACSS, evaluate how your current spine surgery program aligns with the following key concepts of the new certification program:
- program composition/collaboration among providers
- interdisciplinary specialized care team
o physician engagement (medical director)
o standardization of care - evidence-based protocols/checklists (order sets, transitions of care, wrong-site surgery)
- preoperative optimization
o assessment/accuracy of diagnosis
o imaging/level confirmation - performance measures reporting of data from (ASR)
The standards are currently available on The Joint Commission’s ACSS webpage and will publish online in the spring 2021 E-dition® update to the Comprehensive Certification Manual for Disease-Specific Care (DSC).
Further details regarding the standardized performance measures, including measure descriptions, specifications and education for abstracting the measures, are forthcoming. More information regarding the measures can be found by the American Spine Registry.
If you are interested in pursuing ACSS, please contact to learn more.
Helen Larios is Project Director–Clinical, in the Department of Standards and Survey Methods (DSSM) at The Joint Commission. In her role, she is responsible for maintaining and developing standards across multiple programs. Ms. Larios has over 15 years of clinical nursing experience, including quality improvement, outcomes and project management. Prior to joining The Joint Commission, Ms. Larios held various managerial roles in surgical services with a specialized focus in orthopedics and spine in both acute inpatient and outpatient settings.