How Do We Compare?

What is the Surgical Care Improvement Project (SCIP)?

Surgical Care Improvement Project (SCIP) - Quality Measures
Measure:	Memorial Results Jan to Mar 2009 (Actual/Total)	Colorado Average Oct 2007 to Sep 2008‡	National Average Oct 2007 to Sep 2008‡‡	Top 10% National Minimum Score Oct 2007 to Sep 2008†
Met all measures	74% (302/408)	No data provided	No data provided	No data provided
Received antibiotics within one hour prior to the surgical incision being made	96% (281/293)	89%	86%	98%
Received appropriate prophylactic antibiotics	98% (321/326)	94%	92%	99%
Received last preventive antibiotic doses within 24 hours of surgery	91% (264/290)	87%	84%	98%
Blood glucose in all heart surgery patients	82% 69/84	78%	85%	100%
Hair removal with a safer method, not a razor	97% (395/408)	94%	95%	100%
Ordered treatments to prevent blood clots after surgery	86% (78/91)	88%	84%	98%

KEY:

(‡) This is the most current data available for average Colorado hospital quality performance according to the Joint Commission.
(‡‡) This is the most current data available for average national hospital quality performance according to the Joint Commission.
(†) This is the most current data available for the minimum quality performance score of any national top 10% hospital according to the Joint Commission.

NOTE: Memorial results are highlighted in the blue column of data and annotated with one of the following quality indicators:

 = Achieved the best possible results
 = Above national average performance
 = At or near national average performance
 = Below national average performance

What is the surgical care improvement project (SCIP) and why is it important?

The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications. It is a unique partnership that promises to be a transformational undertaking in health care.

Memorial Health System is a participating partner in SCIP, and we believe that a meaningful reduction in surgical complications depends on surgeons, anesthesiologists, perioperative nurses, pharmacists, infection control professionals, and hospital executives working together to intensify their commitment to making surgical care improvement a priority.

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What is pre-operative antibiotic timing and why is it important?

Surgical site infections affect approximately 500,000 persons per year according to a Centers for Disease Control and Prevention (CDC) report. Numerous factors such as age and general health status of persons undergoing surgery can affect rates of infection at any given hospital.

For decades antibiotics have been given prior to surgery to reduce the risk of surgical site infection. Research exploring the practice of giving pre-operative antibiotics appeared in The American Journal of Surgery (June, 1996; 171: 548-552) and demonstrated the importance of antibiotic timing for prevention (prophylaxis) of surgical infections.

According to The Joint Commission's Surgical Infection Prevention Core Performance Measures, patients undergoing surgical procedures such as heart, hip, colon, and vascular surgeries should receive an antibiotic within one hour prior to the incision being made to prevent surgical site infection.

While the ideal timing of antibiotic administration for every surgical procedure has not been studied, the one-hour timing for antibiotics is recommended by the National Surgical Infection Prevention Project team as the standard for surgical procedures that require preventive antibiotic therapy.

Because there are numerous drug-resistant bacteria today, it is important to use antibiotics sparingly. The goal for antibiotic use with surgical procedures is to prevent surgical site infections and thereby reduce overall antibiotic use.

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What are prophylactic antibiotics and why are they important?

The term "prophylactic" basically means "preventative." Certain antibiotics are recommended to help prevent wound infection for particular types of surgery.

Infections continue to be the main preventable complication of most surgical procedures. Antibiotics are medicines to prevent and treat infections. By following the standard guidelines for timing and giving you the correct antibiotic drug, hospitals can reduce your risk of getting a wound infection after surgery.

The risk of wound infection after surgery is reduced by making sure patients get the right medicines at the right time on the day of their surgery.

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What is post-operative antibiotic timing and why is it important?

Adequate levels of antibiotic medication must be maintained in the body during and immediately after high-risk (for infection) surgeries to prevent surgical site infection. However, antibiotics given to prevent infection should be discontinued after 24 hours according to an advisory statement in The American Journal of Surgery (April, 2005; 189(4): 395-404).

If antibiotics are continued past 24 hours, normal, healthy bacteria in the body may be destroyed, which can lead to the over-growth of unhealthy microorganisms (harmful bacteria and yeast) and super infection (a new infection that may not respond to antibiotics). However, antibiotics may need to be continued for certain individuals, such as those with weakened immune systems or with signs of existing infection.

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What is blood glucose and why is it important?

A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods. It is the main source of energy used by the body. Insulin is a hormone that helps your body's cells use the glucose. Insulin is produced in the pancreas and released into the blood when the amount of glucose in the blood rises. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can cause health problems.

For patients who have heart surgery, keeping their blood sugar under good control after surgery lowers the risk of infection and other problems. "Under good control" means their blood sugar should be 200 mg/dL or less when checked first thing in the morning. All heart surgery patients get their blood sugar checked after surgery. Any patient who has high blood sugar after heart surgery has a greater chance of getting an infection. This measure tells how often the blood sugar of heart surgery patient was kept under good control in the days right after their surgery.

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What is hair removal and why is it important?

Preparing a patient for surgery may include removing body hair from skin in the area where the surgery will be done. Medical research has shown that shaving with a razor can increase the risk of infection. It is safer to use a method such as electric clippers. Hair removal should also be performed immediately prior to the surgery as extended time between hair removal and use of razors contributes to infections after surgery. Razors can create small nicks in the skin, through which bacteria can enter. This measure tells how often one of the safer methods was used (such as electric clippers).

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What are blood clots and why are they important?

Blood clots occur when the blood hardens from a liquid to a solid. A clot can limit blood flow, causing swelling, redness and pain. Most commonly, clots occur in the legs, thighs, or pelvis.

If a part or all of the clot breaks off from where it was formed, it can travel through the veins. The part that breaks off is called an embolus. If the embolus lodges in the lung, it is called a pulmonary embolism, a serious condition that can cause death.

A number of factors can increase a patient’s risk of developing blood clots, but doctors can order preventive treatments to reduce the risk. This may include blood thinning medications, elastic support stockings, or mechanical air stockings that promote circulation in the legs. This measure tells us how often treatment(s) to prevent blood clots are given at the right time to prevent blood clots from forming after selected surgeries.

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RELATED INFORMATION:

Centers for Disease Control and Prevention (CDC)
www.cdc.gov

Infectious Diseases Society of America (IDSA)
www.idsociety.org

The Joint Commission
www.jointcommission.org

National Surgical Infection Prevention Project (NSIP)
http://acsnsqip.org

Institute for Healthcare Improvement (IHI)
http://ihi.org

Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov

American Medical Association (AMA)
www.ama-assn.org

Association of periOperative Registered Nurses (AORN)
www.aorn.org

Centers for Medical and Medicaid Services (CMS)
www.cms.hhs.gov

National Institutes of Health (NIH)
www.nih.gov

National Quality Forum (NQF)
www.qualityforum.org

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