Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center |
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Authors: | Bruce Potenza Michelle Deligencia R.N. Brenda Estigoy R.N. Eema Faraday M.P.H. Andrea Snyder R.N. Niren Angle M.D. Alexandra Schwartz M.D. Leon Chang M.D. James Hackett M.D. Anushirvan Minokadeh M.D. Michael Madani M.D. Kathryn MacAulay M.D. Sonia Ramamoorthy M.D. Lynn Blaner R.N. Charles James Pharm.D. Vishal Bansal M.D. Francesca Torriani M.D. Raul Coimbra M.D. Ph.D. |
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Affiliation: | Division of Trauma, Critical Care & Burns, University of California, San Diego, 200 W. Arbor Dr., San Diego, CA 92103-8896, USA |
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Abstract: | BackgroundThe Surgical Care Improvement Project (SCIP) was designed to reduce perioperative complications. We describe our institutional experience in 6 major areas: surgical site infection, venous thromboembolism prevention, use of perioperative β-blockade, serum glucose level greater than 200 mg/dL, normothermia, and the use of electric razors for hair removal.MethodsThis was a retrospective review of surgical cases. Evidence-based training and standardization of system and process were undertaken. Compliance with SCIP guidelines was determined.ResultsOverall SCIP compliance improved from 80% to 94% over a 2-year period. Standardized antibiotic dosing times improved compliance to more than 90%. Appropriate preoperative antibiotic choice improved to 100%. Cessation of antibiotics postoperatively within 24 hours remains a difficult task. Venous thromboembolism prophylaxis has been difficult to achieve because of postoperative bleeding concerns. Administration of β-blockers has remained one of the most difficult problems to correct because of the multiplicity of avenues by which a patient may arrive to the operating suite.ConclusionsAchievement of the SCIP goals is a formidable, but achievable, process requiring individual, cultural, systems, and institutional changes to achieve success. |
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Keywords: | Surgical care infection project Surgical site infection Patient safety Performance improvement quality measures |
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