The Surgical Care Improvement Project (SCIP) was established in 2006 with the goal of reducing surgical complications by 25% in 2010.1 Of the 9 performance measures, 6 are related to surgical site infection prevention.1 Efforts to reduce surgical site infection are important because this complication results in significant morbidity and additional resource use. To this end, the SCIP was designed to improve adherence for prophylactic antibiotic administration, as well as processes related to glucose control, hair removal from the surgical site, and intraoperative normothermia, in patients undergoing elective surgical procedures. It has achieved this goal to the extent that hospitals have successfully implemented these processes. However, what evidence exists demonstrating that improved adherence has achieved the goal of reducing surgical complications?
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"The Hospital Compare mea - sures are processes of care related to preventing surgical complications , as developed for the Surgical Care Improvement Program ( SCIP ) . Although these measures were selected because of clinical trials linking them to better outcomes , there is growing evidence that these processes do not account for hospital‐level variations in important surgical outcomes , such as complica - tions and mortality ( Hawn 2010 ) . The composite measures described in this study would be much better at helping patients and payers identify low‐ mortality hospitals for high - risk surgery . "
[Show abstract][Hide abstract] ABSTRACT: To assess the value of a novel composite measure for identifying the best hospitals for major procedures.
We used national Medicare data for patients undergoing five high-risk surgical procedures between 2005 and 2008.
For each procedure, we used empirical Bayes techniques to create a composite measure combining hospital volume, risk-adjusted mortality with the procedure of interest, risk-adjusted mortality with other related procedures, and other variables. Hospitals were ranked based on 2005-2006 data and placed in one of three groups: 1-star (bottom 20 percent), 2-star (middle 60 percent), and 3-star (top 20 percent). We assessed how well these ratings forecasted risk-adjusted mortality rates in the next 2 years (2007-2008), compared to other measures.
For all five procedures, the composite measures based on 2005-2006 data performed well in predicting future hospital performance. Compared to 1-star hospitals, risk-adjusted mortality was much lower at 3-star hospitals for esophagectomy (6.7 versus 14.4 percent), pancreatectomy (4.7 versus 9.2 percent), coronary artery bypass surgery (2.6 versus 5.0 percent), aortic valve replacement (4.5 versus 8.5 percent), and percutaneous coronary interventions (2.4 versus 4.1 percent). Compared to individual surgical quality measures, the composite measures were better at forecasting future risk-adjusted mortality. These measures also outperformed the Center for Medicare and Medicaid Services (CMS) Hospital Compare ratings.
Composite measures of surgical quality are very effective at predicting hospital mortality rates with major procedures. Such measures would be more informative than existing quality indicators in helping patients and payers identify high-quality hospitals with specific procedures.
Preview · Article · Oct 2012 · Health Services Research
[Show abstract][Hide abstract] ABSTRACT: Recently, multiple regulations and recommendations for safe infection control practices and safe injection and medication vial utilization have been implemented. These include single dose and multi-dose vials for a single patient and regulations. It is a well known fact that transmission of bloodborne pathogens during health care procedures continues to occur because of the use of unsafe and improper injection, infusion, and medication administration. Multiple case reports have been published illustrating the occurrence of infections in interventional pain management and other minor techniques because of lack of safe injection practices, and noncompliance with other precautions. However, there are no studies or case reports illustrating the transmission of infection due to the use of single dose vials in multiple patients when appropriate precautions are observed. Similarly, the preparation standards for simple procedures such as medial branch blocks or transforaminal epidurals have not been proven to be essential. Further, the effectiveness or necessity of surgical face masks and hats, etc., for interventional techniques has not been proven.
To assess the rates of infection in patients undergoing interventional techniques.
A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009.
An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
All patients presenting for interventional techniques from May 2008 to December 2009 are included with documentation of various complications related to interventional techniques including infection.
May 2008 to December 2009 a total of 3,179 patients underwent 12,000 encounters with 18,472 procedures. A total of 12 patients reported suspicion of infection. All of them were evaluated by a physician and only one of them was a superficial infection due to the patient's poor hygienic practices which required no antibiotic therapy.
Limitations include the nonrandomized observational nature of the study.
There were no infections of any significance noted in approximately 3,200 patients with over 18,000 procedures performed during a 20-month period in an ambulatory surgery center utilizing simple precautions for clean procedures with the use of single dose vials for multiple patients and using safe injection practices.
[Show abstract][Hide abstract] ABSTRACT: Much effort has been put into the Surgical Care Improvement Project (SCIP) in an effort to reduce surgical complications with a significant emphasis on reducing the rate of surgical site infections. The causes and the prevention of surgical site infections are complex and multifactorial. By the nature of its size and scope, SCIP is naturally somewhat oversimplified and incomplete. Nevertheless, all the measures are supported by strong prospective evidence. Stulberg et al. examine the association between adherence to SCIP infection measures and the occurrence of surgical site infections in a large administrative database and conclude that while the individual measures for the most part do not appear to be associated with a lower surgical site infection risk, the performance of all relevant measures does.
No preview · Article · Dec 2010 · Future Microbiology