Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center.

Abstract

BACKGROUND:

The 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 beta-blockade, serum glucose level greater than 200 mg/dL, normothermia, and the use of electric razors for hair removal.

METHODS:

This was a retrospective review of surgical cases. Evidence-based training and standardization of system and process were undertaken. Compliance with SCIP guidelines was determined.

RESULTS:

Overall 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 beta-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.

CONCLUSIONS:

Achievement of the SCIP goals is a formidable, but achievable, process requiring individual, cultural, systems, and institutional changes to achieve success.

• Authors: Bruce Potenza, Michelle Deligencia, Brenda Estigoy, Eema Faraday, Andrea Snyder, Niren Angle, Alexandra Schwartz, Leon Chang, James Hackett, Anushirvan Minokadeh, Michael Madani, Kathryn MacAulay, Sonia Ramamoorthy, Lynn Blaner, Charles James, Vishal Bansal, Francesca Torriani, Raul Coimbra
• Journal: American journal of surgery (Am J Surg) Vol. 198 Issue 6 Pg. 881-8 (Dec 2009) ISSN: 1879-1883 [Electronic] United States
• PMID: 19969146 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Blood Glucose

Topics

• Academic Medical Centers
• Adrenergic beta-Antagonists (therapeutic use)
• Blood Glucose (analysis)
• Body Temperature
• California
• Humans
• Outcome and Process Assessment, Health Care
• Postoperative Complications (prevention & control)
• Program Evaluation
• Retrospective Studies
• Surgical Procedures, Operative (standards)
• Surgical Wound Infection (prevention & control)
• Venous Thromboembolism (prevention & control)