Surgical Care Improvement Project—An important initiative

Surgical Care Improvement Project—An important initiative

Patient Safety First JUNE 2006, VOL 83, NO 6 PATIENT SAFETY FIRST Surgical Care Improvement Project—An important initiative T he Surgical Care ...

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Patient Safety First

JUNE 2006, VOL 83, NO 6




Surgical Care Improvement Project—An important initiative


he Surgical Care Improvement Project (SCIP) is a national quality initiative focused on safe, high-quality patient care. The initiative addresses a number of evidence-based interventions that can significantly reduce complications associated with surgery.1 One study found that postoperative complications accounted for up to 22% of preventable deaths among patients. These complications resulted in 2.4 million additional hospital days and $9.3 billion in excess charges for related care.2 The SCIP proposes that when health care clinicians work together to make surgical care improvements, patients can benefit in significant ways.1 The goal of the effort is to reduce the incidence of surgical complications nationally by 25% by the year 2010, thus improving the health outcomes of individuals undergoing surgery.3 The SCIP serves as an extension of Surgical Infection Prevention Project that focused on reducing surgical complications through performance measurement and quality improvement efforts.4 Building on these efforts, SCIP focuses on the prevention of cardiovascular events, surgical site infections, postoperative pneumonia, and venous thromboembolism.5 The SCIP identifies and defines process and outcome measures for each of the four target areas (Table 1) as well as overall measures (ie, global measures) related to surgical care. The global measures are mortality within 30 days of surgery and readmission within 30 days of surgery.6 A steering committee composed of AORN, the Agency for Healthcare Research and Quality, the American College of Surgeons, the American Hospital Association, the American Society of Anesthesiologists, the Centers for Disease Control and Prevention, the

Suzanne C. Beyea, RN

Centers for Medicare and Medicaid Services (CMS), the Institute for Healthcare Improvement, the Joint Commission on Accreditation of Healthcare Organizations, and the Veterans Health Administration guides the overall efforts of the SCIP.7 Numerous other organizations including professional associations, health care organizations, and health care facilities have signed on as supporting partners.8 The goal of the A technical expert panel addresses each of the four Surgical Care target areas and reviews the pertinent research to Improvement identify SCIP measures.9 Hospital clinicians are Project is to beginning to identify and pilot test intervenreduce the tions and evidencebased protocols.10 incidence of


surgical complications, thus improving the health outcomes of surgical patients.

The Medicare Quality Improvement Community (MedQIC) web site (ie, sponsored by CMS provides information about the SCIP as well as a number of resources to assist clinicians in their efforts to improve surgical care. The web-based resources include tools, an annotated review of the literature and research, improvement stories, measures, presentations, and links to other materials. For example, the web site offers a number of change strategies and clinical improvements that clinicians can implement in their efforts to reduce the incidence of surgical site infections. These include resources for redesigning processes,



Patient Safety First

JUNE 2006, VOL 83, NO 6


Examples of Surgical Care Improvement Project Process and Outcome Measures1 Focus area

Example of process measure

Example of outcome measure


Surgical patients receiving prophylactic antibiotic within one hour before surgical incision

Postoperative wound infection diagnosed during index hospitalization (ie, the specific hospitalization during which surgery was performed)

Venous thromboembolism

Surgical patients with recommended venous thromboembolism prophylaxis ordered

Intraoperative or postoperative deep vein thrombosis diagnosed during index hospitalization and within 30 days of surgery


Surgical patients whose medical record contained an order for a ventilator weaning program (ie, clinical pathway or protocol)

Postoperative ventilator-associated pneumonia diagnosed during index hospitalization


Surgical patients on beta blocker before arrival who received a beta blocker during the perioperative period

Intraoperative or postoperative acute myocardial infarction diagnosed during index hospitalization and within 30 days of surgery

1. “Other resource: About the project. SCIP process and outcome measures,” MedQIC ResourcesTemplate&c=OtherResource (accessed 19 April 2006).

transforming organizational culture, measuring and reporting performance, and adopting health information technology.11 Similar resources are provided for the other target areas. Various other groups and organizations also provide resources or narratives about efforts related to SCIP. For example, the Institute for Healthcare Improvement recently published an improvement report related to best safety practices to prevent postoperative myocardial infarction and venous thromboembolism.12 Some of the reported changes in practices include development of standardized guidelines and treatment recommendations for venous thromboembolism prophylaxis, use of perioperative beta blockers, and global education for all clinicians


providing care to at-risk populations. The Colorado Foundation for Medical Care (CFMC) provides technical and professional guidance to SCIP efforts within Colorado. The CFMC web site also provides information about collaborative efforts within Colorado as well as a complete listing of the SCIP measures.13

WHY NURSES SHOULD LEARN ABOUT THE SCIP Perhaps the most compelling reason for learning about the SCIP is that nurses want to provide the highest quality patient care. When health care teams do not provide the highest quality care, patients are at increased risk for complications. Those complications can result in prolonged hospital stays and overall increased costs to the

health care system. The SCIP provides an important focus for efforts related to improving the quality of care for all patients undergoing surgery. The SCIP measures eventually could be linked to CMS pay-for-performance initiatives.14 In this way, quality patient care would be linked to reimbursement. Eventually, outcome measures related to the SCIP will provide patients with data related to key performance measures so they can make informed decisions about where to receive care.15 Hospitals also will be able to benchmark against other health care facilities by using a common set of clinical outcomes.16 By focusing on patient outcomes, organizations have an opportunity to use data as a focus for quality improvement. By identifying best practices and standardizing clinical

Patient Safety First

processes with clinical pathways and practice protocols, health care organizations can provide more reliable care. Perioperative nurses should learn more about SCIP and identify opportunities to participate in efforts related to improving surgical care. Information about participating in the SCIP is available on the MedQIC web site.10 Serious complications can be avoided when members of the health care team work together to improve surgical care. ❖ SUZANNE C. BEYEA RN, PHD, FAAN DIRECTOR OF NURSING RESEARCH DARTMOUTH-HITCHCOCK MEDICAL CENTER LEBANON, NH

NOTES 1. SCIP Project information, MedQIC, /dcs/ContentServer?cid=112290493 0422&pagename=Medqic%2FCon tent%2FParentShellTemplate& parentName=Topic&c=MQParents (accessed 19 April 2006). 2. C Zhan, M R Miller, “Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization,” JAMA 290 (October 2003) 1868-1874. 3. “Other resource: About the project,” MedQIC 495755695&pagename=Medqic%2F OtherResource%2FOtherResources Template&c=OtherResource (accessed 19 April 2006).

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4. “Other resource: About the project. From SIP to SCIP presentation,” MedQIC, 495755695&pagename=Medqic%2F OtherResource%2FOtherResources Template&c=OtherResource (accessed 25 April 2006). 5. “Other resource: About the project. SCIP target areas,” MedQIC, /dcs/ContentServer?cid=113649575 5695&pagename=Medqic%2FOther Resource%2FOtherResourcesTemplate &c=OtherResource (accessed 19 April 2006). 6. “Measures: SCIP project information,” MedQIC, http://www 1122904930422&pagename=Medqic %2FMeasure%2FMeasuresHome& parentName=Topic&level3=Mea sures&c=MQParents (accessed 19 April 2006). 7. “Other resource: SCIP partnership. Steering committee,” MedQIC, /dcs/ContentServer?cid=113432234 5403&pagename=Medqic%2FOther Resource%2FOtherResourcesTem plate&c=OtherResource (accessed 19 April 2006). 8. “Other resource: SCIP partnership. Supporting partners,” MedQIC, /dcs/ContentServer?cid=113432234 5403&pagename=Medqic%2FOther Resource%2FOtherResourcesTem plate&c=OtherResource (accessed 19 April 2006). 9. “Other resource: SCIP partnership,” MedQIC, 322345403&pagename=Medqic%2F OtherResource%2FOtherResources Template&c=OtherResource (accessed 19 April 2006). 10. “Other resource: Hospital participation,” MedQIC, http://

?cid=1134322334625&pagename= Medqic%2FOtherResource%2FOther ResourcesTemplate&c=OtherResource (accessed 19 April 2006). 11. “Infections,” MedQIC, http:// cid=1089815967030&pagename= Medqic%2FContent%2FParentShell Template&parentName=Topic&c=M QParents (accessed 19 April 2006). 12. Baystate Medical Center, “Improvement report. SCIP: Best safety practices to prevent post operation myocardial infarction and venous thromboembolism,” Institute for Healthcare Improvement, /PatientSafety/SafetyGeneral/Improve mentStories/SCIPBestSafetyPractices toPreventPostOperationMyocardial InfarctionandVenousThromboembo lism.htm (accessed 19 April 2006). 13. “Surgical Care Improvement Project (SCIP),” Colorado Foundation for Medical Care, http:// .htm (accessed 19 April 2006). 14. “Overview: Medicaid and SCHIP quality practices—General information,” Centers for Medicare & Medicaid Services, http:// QualPrac (accessed 25 April 2006). 15. “Evidence-based care: Medicaid and SCHIP evidence-based care and quality measurement,” Centers for Medicare & Medicaid Services, /MedicaidSCHIPQualPrac/02_evi dencebasedcard.asp (accessed 25 April 2006). 16. “Pay for performance initiatives, Herb Kuhn, director, Center for Medicare Management, Senate Committee on Finance,” (July 27, 2005) Centers for Medicare & Medicaid Services, /media/press/testimony.asp?Counter =1537 (accessed 25 April 2006).

Congress Lost and Found Items Available at Headquarters


everal items that were lost at this year’s Congress in Washington, DC, were turned in to AORN

Headquarters. To inquire whether an item you lost was found, call Sandy Abbott at (800) 755-2676 x 209.