Improving Surgical Site Infections: Using National Surgical Quality Improvement Program Data to Institute Surgical Care Improvement Project Protocols in Improving Surgical Outcomes

BACKGROUNDThe Surgical Care Improvement Project bundle emphasizes operative infection prevention practices. Despite implementing the Surgical Care Improvement Project bundle in 2008, spinal fusion surgical site infections (SF-SSI) continued to be prevalent for this low-volume, high-risk surgery.OBJECTIVETo design a combined pre-, peri-, and postoperative bundle (PPPB) that would lead to sustained reductions in SF-SSI rates.DESIGNQuality improvement project, before-after trial with cost-effectiveness analysis.SETTINGChildren’s hospital.PATIENTSAll spinal fusion patients, 2008–2015.INTERVENTIONA multidisciplinary team developed the PPPB composed of Surgical Care Improvement Project elements plus improved wound care practices, nursing standard of care, dedicated nursing unit, dermatology assessment tool and consultation, nursing education tool using “teach back” technique, and a “Back Home” kit. SF-SSI rates were compared before (2008–2010) and after (2011-February 2015) implementation of PPPB. PPPB compliance was monitored.RESULTSA total of 224 SF surgeries were performed from 2008 to February 2015. Pre-PPPB analysis revealed median time to SF-SSI of 28 days, secondary to skin and bowel flora. Mean 3-year pre-PPPB SF-SSI rate per 100 SF surgeries was 8.2 (8/98) (2008: 13.3 [4/30], 2009: 2.7 [1/37], 2010: 9.7 [3/31]). Mean SF-SSI rate after PPPB was 2.4 (3/126) (January 2011-February 2015); there was a 71% reduction in mean SSI rate (P=.0695). No SF-SSI occurred in neuromuscular patients (P=.008) after PPPB. Compliance with PPPB elements has been 100%.CONCLUSIONSPPPB led to sustained improvement in SF-SSI rates over 50 months. The PPPB could be reproduced for other surgeries.Infect Control Hosp Epidemiol 2016;37:527–534

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Adherence to Surgical Care Improvement Project Measures and Post-Operative Surgical Site Infections

Surgical Infections ◽

10.1089/sur.2012.131 ◽

2012 ◽

Vol 13 (4) ◽

pp. 234-237 ◽

Cited By ~ 117

Author(s):

Samir S. Awad

Keyword(s):

Surgical Care ◽

Surgical Site Infections ◽

Improvement Project ◽

Surgical Care Improvement Project ◽

Care Improvement

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The Surgical Care Improvement Project Redux: Should CMS Revive Process of Care Measures for Prevention of Surgical Site Infections?

Infection Prevention ◽

10.1007/978-3-319-60980-5_11 ◽

2017 ◽

pp. 103-112

Author(s):

Deborah S. Yokoe

Keyword(s):

Surgical Care ◽

Surgical Site Infections ◽

Process Of Care ◽

Improvement Project ◽

Surgical Care Improvement Project ◽

Care Improvement

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Quality and Safety

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch002 ◽

2015 ◽

pp. 16-35

Author(s):

Daniel Rubin ◽

Avery Tung

Keyword(s):

Quality Improvement ◽

Surgical Care ◽

Large Database ◽

Improvement Project ◽

Quality Improvement Process ◽

Quality Programs ◽

Improvement Programs ◽

Surgical Care Improvement Project ◽

Care Improvement ◽

Quality Improvement Programs

Quality improvement is a goal of all institutions but effective quality improvement programs have been difficult to create and sustain. Cardiac surgery has long been a pioneer in the quality improvement process through protocolization, large database analysis, and evidence based research. This chapter will discuss the theoretical foundation for quality improvement in medicine, and address current quality improvement strategies in the cardiothoracic ICU including care bundles, large database review, and externally promulgated quality programs such as the Surgical Care Improvement Project (SCIP) or the Physician Quality Reporting Initiative (PQRS). Controversies from national quality improvement programs including SCIP, extended staffing, and the value of quality culture will be discussed.

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Surgeon compensation: “Pay for performance,” the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations

Surgery ◽

10.1016/j.surg.2005.08.015 ◽

2005 ◽

Vol 138 (5) ◽

pp. 829-836 ◽

Cited By ~ 70

Author(s):

R. Scott Jones ◽

Cynthia Brown ◽

Frank Opelka

Keyword(s):

Quality Improvement ◽

Pay For Performance ◽

Surgical Care ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

American College Of Surgeons ◽

Care Improvement

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Should Compliance with the Surgical Care Improvement Project (SCIP) Process Measures Determine Medicare and Medicaid Reimbursement Rates?

The American Surgeon ◽

10.1177/000313481207800617 ◽

2012 ◽

Vol 78 (6) ◽

pp. 653-656 ◽

Cited By ~ 4

Author(s):

Nicole Garcia ◽

Sandy Fogel ◽

Christopher Baker ◽

Stephen Remine ◽

Jim Jones

Keyword(s):

Prophylactic Antibiotic ◽

Surgical Care ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Improvement Program ◽

Improvement Project ◽

Medicaid Reimbursement ◽

Time Period ◽

Surgical Care Improvement Project ◽

Care Improvement

The Surgical Care Improvement Project (SCIP) is aproject that focuses on improving surgical care by reducing surgical morbidity and mortality by 25 per cent by 2010. Starting in 2011, SCIP compliance affects Medicare and Medicaid reimbursement rates. Although SCIP reinforces better practices in surgical care, does compliance with SCIP measures actually result in a decrease in surgical morbidity and mortality? This study examined compliance with the SCIP surgical site infection (SSI) module (prophylactic antibiotic received within 1 hour before surgical incision) during 2009 to 2010 (n = 703) to determine whether patients compliant with SCIP data had a correlation with SSI rates as reported by National Surgery Quality Improvement Program (NSQIP) data for the same time period. We found no statistically significant association in patients that have failed SCIP INF1 in the years 2009 to 2010 (n = 43) and the rates of SSI (n = 0) for the same time period. These data suggest that SCIP compliance should not be used to determine Medicare and Medicaid reimbursement rates because there is no correlation between failure of SCIP INF1 and SSI. Instead, further effort should be placed on developing tools designed to acknowledge outcome measures that result in decreased morbidity/mortality and change practices accordingly such as NSQIP.

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