Surgical Care Improvement Program

Can we get to ZERO preventable surgical complications?

Under our Quality Improvement Organization (QIO) contract with Medicare, Qualis Health is continuing to work with Idaho and Washington hospitals in an effort to prevent surgical infections and other complications of surgery, such as venous thromboembolisms (VTE) and cardiac events.

Our current projects build upon the work we have done via Medicare's QIO program since 2002. Eliminating preventable surgical complications is also a priority for the Institute for Healthcare Improvement (IHI) and an important component of the IHI's 5 Million Lives Campaign.

This level of attention to surgical care has created numerous successes, perhaps the most important being the raising of the nation's awareness—no longer are infections and blood clots considered an acceptable risk of surgery. Together, we are working to eliminate all preventable surgical complications.

Resources
While our individualized consultation is limited to the participating organizations, any hospital is welcome to use the tools posted here.

SCIP Best Practices Change Package
This material was prepared by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, as part of its Surgical Care Improvement Project (SCIP) Best Practices Initiative. Download the package.

National E-list for SCIP-Related Discussions
A very active list with more than 2,200 subscribers, the SCIP nationwide e-list is a good source for real-world tips (for example, see the beta blocker tracking idea, below) and up-to-the-moment discussions about the latest news and techniques related to improving surgical care. Learn how to join the e-list.

SCIP Measures
Brief descriptions of each SCIP measure

Current and archived versions of CMS' specification manual for inpatient quality measures

Training related to abstracting SCIP measures (Idaho & Washington hospitals only; for hospitals located in any other state, please contact your local QIO.)

Individual hospital's scores are available on the HospitalCompare website.

Nationwide Benchmarks
View the most recent benchmarks for each of Medicare's publicly reported quality measures, including SCIP.

The Agency for Healthcare Research and Quality developed the "Achievable Benchmarks of Care" (ABC) methodology that Medicare uses to calculate the nationwide benchmarks. Learn more about how ABC rates are derived.

Pocket Card Guide for VTE Prophylaxis
A quick reference for identifying the VTE prophylaxis needs for various types of surgery (according to guidelines for discharges 10-01-08 to 03-31-09).

Tip for Tracking Beta Blockers
This idea was shared on the national SCIP e-list (see details about the e-list, above). It was submitted by Karen Pittman, RN, of the Bert Fish Medical Center in New Smyrna Beach, FL.

"Our anesthesia department has taken over the beta blocker issue. We developed a pre-op beta blocker sheet that prints with every OR packet.

The top has the question: Is patient currently on a beta blocker at home? Then there is a list of beta blockers; the pre-op nurse will circle the appropriate one if indicated. We then have a space for the pre-op nurse to write in the date and time the beta blocker was last taken.

The bottom section is for anesthesia to fill out: Is the beta blocker due during the intraoperative period? If yes, was it given? Med______ Time______ If not given, why?

Due in part to using this form, we have consistently scored in the 90-100% range for beta blocker measures."

Antimicrobial Dosing Suggestions for Surgical Prophylaxis
A quick reference outlining the suggested initial dose and time to re-dosing for antimicrobials commonly used for surgical prophylaxis, originally published in the journal Clinical Infectious Diseases.

Compilation of SCIP-Related Tools
The QualityNet website, which is maintained by Medicare Quality Improvement Organizations (QIOs) nationwide, also stores a number of useful tools and presentation recordings.

Presentations

SCIP CARD 2
Session recorded 12/16/09     Help with WebEx files  
Speaker Biography Lee Fleisher, MD FAAC FAHA Learn how to improve success with the SCIP CARD 2 measure.

How to Meet the SCIP VTE 1 & 2 Measures
Session recorded 11/23/09     Help with WebEx files  
Speaker Biography for Dale Bratzler, DO MPH Learn how to improve success with the VTE 1 & 2 measures.

VTE Prophylaxis for the Hospitalized Patient
Session recorded 9/16/09     Help with WebEx files  
Speaker Biography for Michael Cox, MD FACP FCCP Among the hospitals that are participating in Qualis Health's SCIP project, some have reached 100% on the VTE1 and VTE2 measures, while others are finding this process improvement challenging. In this presentation, best practices related to VTE prophylaxis and updates regarding the pending VTE measures are shared.

CARD-2 Measure Reporting
Session recorded 9/8/09      Help with WebEx files  
Speaker Biography for Ted Gibbons, MD Mandatory reporting to CMS' clinical data warehouse for the SCIP CARD-2 indicator began with Quarter 1, 2009 submissions. This presentation will provide information on the CARD-2 measure, expected impact on perioperative cardiac complications, and best practices to make improvements in the measure.

CMS National Patient Safety Initiative for Surgical Care and Heart Failure:
Ongoing Opportunities for Improvement
Session recorded 3/16/09    Help with WebEx files
Speaker Biography for Dale Bratzler, DO MPH The session provides an overview of CMS’s national priorities for patient safety improvement; national SCIP performance measures; and a systems-based approach to improved safety.

Countdown to 2010: SCIP Partnership Gains Momentum
Session recorded 2/19/09    Help with WebEx files  
Speaker Biography for Dale Bratzler, DO MPH This presentation provides information on the future of SCIP, the rational behind the performance measures and examines the consequences of failing to follow evidence-based medicine.

Antibiotic Use and Controversy
Session recorded 1/8/09    Help with WebEx files
Speaker biography for Robert Brooks, MD PhD MBASurgical care quality improvement has been an area of emphasis in hospitals for quite some time; however, certain identified best practices remain controversial and/or inconsistently implemented, creating barriers for hospital personnel committed to decreasing surgical complications. This presentation is intended to provide practical strategies for administration of prophylactic antibiotics, especially for orthopedic, urologic, and certain high-risk patient groups.

The WHO and SCOAP Checklist Initiatives: Safe Surgery Saves Lives
Session recorded 12/18/08    Help with WebEx files
Speaker biography for David Flum, MD MPHThis teleconference explored the use of checklists as a tool to reduce the number of common, deadly, and preventable safety errors in the operating room. View the surgical checklists piloted by the World Health Organization, Surgical Care and Outcomes Assessment Program, and the University of Washington Medical Center.

Several publications have reported on the checklist initiative. Read coverage in the New England Journal of Medicine, Seattle Times and the Washington Post.