Postoperative infection is a major cause of patient injury, mortality and health care cost. An estimated 2.6 percent of nearly 30 million operations are complicated by surgical site infections each year. Infection rates of up to 20 percent are reported for certain types of operations. Each infection is estimated to increase a hospital stay by an average of seven days and add over $3,000 in charges.
Appropriate administration of prophylactic antibiotics is an effective method of preventing postoperative infections. Three quality measures have been identified by the Centers for Medicare & Medicaid Services (CMS) as key to decreasing post-operative infections. These three measures are part of a larger measure set contained in the Surgical Care Improvement Project (SCIP) Infection (Inf) module. All hospitals that participated in the fiscal year (FY) 2007 Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU), now known as the Hospital Inpatient Quality Reporting Program, were required to collect data on the three measures and submit it for public reporting.
- SCIP-Inf 1 Prophylactic antibiotic received within one hour prior to surgical incision
- SCIP-Inf 2* Prophylactic antibiotic selection for surgical patient
- SCIP-Inf 3 Prophylactic antibiotic discontinued within 24 hours after surgery end time (prophylactic antibiotic discontinued within 48 hours after cardiac surgery end time)
*Required for participation in the FY2008 RHQDAPU only
The National Quality Forum and the Hospital Quality Alliance have also endorsed two additional SCIP measures to address venous thromboembolism (VTE). All hospitals that participated in the FY 2008 RHQDAPU* were required to collect and submit data for public reporting on these additional measures:
- SCIP-VTE 1 Surgery patients with recommended VTE prophylaxis ordered
- SCIP-VTE 2 Surgery patients who received appropriate VTE prophylaxis within 24 hours prior to surgery to 24 hours after surgery
* Measures required beginning with first quarter 2007 discharges and forward
Hospital Inpatient Quality Reporting Program participants collect data on SCIP quality measures using an ORYX vendor tool or the free CMS Abstraction and Reporting Tool (CART) and submit the data to the Quality Improvement Organization (QIO) Clinical Warehouse via the secure QualityNet Web site. NMMRA provides free technical assistance on CART.
The Surgical Care Improvement Project (SCIP)
The Surgical Care Improvement Project (SCIP) partnership’s goal is to reduce surgical complication in the United States by 25 percent. Partners in SCIP believe that a meaningful reduction in complications requires that surgeons, anesthesiologists, perioperative nurses, pharmacists, infection control professionals and hospital executives work together to make surgical care improvement a priority.
To achieve hospital transformation in surgical care, partners will focus on reducing perioperative complications in areas where the incidence and cost of complications are high. All partners will concentrate on:
Additionally, some hospitals have elected to expand their focus to include:
In addition to the reporting requirements, SCIP partners collect data on the following quality measures:
- SCIP-Inf 4 Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose
- SCIP-Inf 6 Surgery patients with appropriate hair removal
- SCIP-Inf 7 Colorectal surgery patients with immediate postoperative normothermia
NMMRA provides technical and professional guidance and support for SCIP participants in New Mexico as well as a variety of tools and resources.