Nurse Maria Forbes believes the Surgical Quality Improvement Program ‘empowers patients’ and improves surgical care

Maria Forbes
Registered nurses Maria Forbes, surgical clinical nurser reviewer, (left) with Francesca Rake, post anesthesia recovery unit and day surgery, Dartmouth General Hospital.

“I love this program. The potential of it is huge.”

Registered nurse Maria Forbes gets excited when she talks about the National Surgical Quality Improvement Program (NSQIP) and what it means for patients.

As a former recovery room and operating room nurse, the Dartmouth General Hospital nurse has long been an advocate for surgical patients. 

She has supported surgical safety checklists and many other quality initiatives in her career and jumped at this latest opportunity to improve surgical care.

Eleven Nova Scotia hospitals qualified to join the American College of Surgeons’ (ACS) program in 2017 and Forbes is one of a dozen surgical clinical nurse reviewers (SCNRs) hired to make the program possible.

Forbes and her colleagues pull information from patient charts about things like documented complications. 

They also follow-up with chart reviews, surgeons’ offices, primary care providers and reach out to patients for brief conversations about their recovery from their procedure. 

They ask patients questions like: 

Did you have any breathing problems or lung infections after your surgery? And when you left the hospital did they tell you where to go or who to contact if you had any complications?

Patient participation is voluntary, but the information they supply can play a big role in helping NSHA improve surgical care.

The information gathered is then inputted into the NSQIP database ensuring patient confidentiality. 

From there data is risk-adjusted and can be compared with the results from hundreds of other participating sites worldwide.  

This program provides semi-annual reports that allow the NSQIP staff to assess how Nova Scotia Health Authority (NSHA) can improve patient care and where their strengths are.  

Implementation of the program is supported by a team involving Forbes and her fellow coders, along with surgeon champions, perioperative leaders, anesthesiologists, quality team members and others. 

The idea behind NSQIP is simple. 

By better tracking our outcomes and comparing our data with other jurisdictions, we have the potential to reveal trends in surgical care. 

These trends can flag areas of concern requiring a closer look and interventions, as well as strengths that present opportunities to spread best practices. 

“Patients have been so receptive when they find out the hospital is calling back to check in with them,” said Forbes.  “They feel they have been heard. I really feel it empowers patients and enhances our relationship with them.”

While there are set questions nurse reviewers are prompted to ask patients for the database, she knows there are many lessons in the things patients share about their experience. 

She is helping pass along these additional insights to other team members and has recently started a kudos board on the Surgical Unit at Dartmouth General Hospital. 

“It completes the cycle. It is a way for us to celebrate and encourage the things we do that are making a difference for patients,” she said.

Forbes has embraced her newest role in the same way she has every one she has held since graduating from the former St. Martha’s Hospital School of Nursing in Antigonish in 1989. 

Outside her contributions to surgical care and recovery at Dartmouth General Hospital, she has also provided inpatient care, worked in the emergency department, intensive and coronary care units and in research.

“Every area in nursing is so unique. Each gives you a chance to gain a new perspective and have an impact on patient care. It’s exciting that after two years of planning we now have data we can begin using to take action for our patients. Our team is up for the challenge.” 

For more information on NSQIP visit