Surgical Care Improvement Project: A Valuable Initiative in Surgery. R. Taylor Ripley January 23, 2012
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2 Surgical Care Improvement Project: A Valuable Initiative in Surgery R. Taylor Ripley January 23, 2012
3 Learning by presenting errors at a morbidity and mortality conference is a part of which of the following ACGME core competencies: A: Patient Care B: Medical Knowledge C: Practice-based learning and improvement D: System-based practice Schwartz s ABSITE and Board Review Ninth Edition
4 The number of medical errors which kill patients in the United States is the equivalent of one jumbo jet crashing every: A: Day B: Week C: Month D: 3 months Schwartz s ABSITE and Board Review Ninth Edition
5 Every Day!
6 Is This Photo Dramatic? Not Compared to What the Lay Press Reports
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8 Medical Errors Do we have a perception problem: Absolutely. Do we have too many errors: Absolutely How can we decrease these errors in Surgery? Reduction in Surgical Infections!
9 Which of the following is the most effective dosing of antibiotics in a patient undergoing elective colon surgery: A: Single dose within 30 min prior to incision B: A single dose given at the time of skin incision. C: A single pre-operative dose + 24 hrs of postoperative antibiotics D: A single preoperative dose + 48 hrs of postoperative antibiotics Schwartz s ABSITE and Board Review Ninth Edition
10 Surgical Care Improvement Project (SCIP)
11 SCIP: Outline Introduction Data Compliance data Patient outcome data Morbidity and surgical site infections. Future directions Implementation of the methods to add additional clinical relevant details. Risk stratification.
12 SCIP: Introduction Institute of Medicine Quality of Healthcare: To Err is Human, Focused on patient safety. Crossing the Quality Chasm, Focused on improvement of delivery systems.
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14 SCIP: Introduction Centers for Medicare and Medicaid Services: Goal: To standardize treatment protocols with intent of improving patient outcomes. 2002: Steering committee formed of medical society and governmental regulatory members. 2003: Surgical Care Improvement Project (SCIP) formed.
15 SCIP: Introduction Process measures developed for three most common surgical complications: Surgical site infections Venous thromboembolism Cardiac events
16 SCIP: Introduction Venous thromboembolism and cardiac events haven t been developed or reported fully. Surgical site infections: Received bulk of efforts and reporting 6 process measures, but 4 reported publicly.
17 SCIP: Introduction Reported SCIP measures: SCIP-1: Antibiotics within 1 hr of incision. SCIP-2: Appropriate antibiotic prophylaxis. SCIP-3: Discontinuation of antibiotics within 24 hrs of an operation. SCIP-6: Appropriate hair removal.
18 SCIP: Introduction Non-reported SCIP measures: SCIP-4: Compliance with 6 am blood glucose control in cardiac surgical patients. SCIP-5: Rate of post-operative infection diagnosed during index hospitalization.
19 Surgical Care Improvement Project Is SCIP Valuable? YES!
20 How is SCIP Valuable? Process: Mandatory Compliance with measures. Patient Outcome: Reduction in Surgical Site Infections.
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24 SCIP: Data Number of reporting institutions very high secondary to reimbursements linked to the reports. Driven by CMS.
25 SCIP: Data The methodology results in significant compliance which will enable collection and study of data. Does SCIP result in lower morbidity or surgical site infections?
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29 SCIP: Data Appropriate antibiotic administration is highly significant with a reduction in surgical site infections. Other individual measures approach statistical significance for overall morbidity and infections. Do we have additional data that may be more convincing?
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31 Individual measures of SCIP-1 and SCIP-2 show a reduction in surgical site infections. SCIP-1: Antibiotics within one hour. SCIP-2: Appropriate antibiotic administration. The intent of SCIP is that collectively these measures result in reduction of infections. Does adherence with several impact infections?
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33 The collective implementation of the SCIP measures results in a significant reduction surgical site infections.
34 SCIP: Data Does the surgical community believe this data? Do dissenting opinions about the value of SCIP exist? Yes! But they are Neglecting their own Data!
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37 The Conclusion is not supported by their data!
38 Surgeon Perspective: Mandatory reporting of these measures does not improve patient outcome.
39 The Public Perspective:
40 SCIP: Future Directions The methodology should serve as a model that adds additional variables and discontinues non-significant measures. Risk adjustment models can improve interpretation and implementation of SCIP.
41 Now Reporting Additional Variables
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43 How Are We Doing?
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47 Conclusion: SCIP is Valuable CMS mandatory reporting has resulted in significant compliance with regulations. SCIP has resulted in fewer surgical site infections. Individual SCIP measures better than others. SCIP is valuable model to implement other measures as deemed clinically relevant.
48 Thank You
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