he Surgical Care ImprovementProject (SCIP) is a nationalquality initiative focused onsafe, high-quality patient care.The initiative addresses a

number of evidence-based interven-tions that can significantly reducecomplications associated with surgery.1

One study found that postoperativecomplications accounted for up to 22%of preventable deaths among patients.These complications resulted in 2.4 mil-lion additional hospital days and $9.3billion in excess charges for relatedcare.2 The SCIP proposes that whenhealth care clinicians work together tomake surgical care improvements,patients can benefit in significant ways.1

The goal of the effort is to reduce theincidence of surgical complicationsnationally by 25% by the year 2010,thus improving the health outcomes ofindividuals undergoing surgery.3

The SCIP serves as an extension ofSurgical Infection Prevention Projectthat focused on reducing surgical com-plications through performance meas-urement and quality improvementefforts.4 Building on these efforts, SCIPfocuses on the prevention of cardiovas-cular events, surgical site infections,postoperative pneumonia, and venousthromboembolism.5 The SCIP identifiesand defines process and outcome meas-ures for each of the four target areas(Table 1) as well as overall measures (ie,global measures) related to surgical care.The global measures are mortality with-in 30 days of surgery and readmissionwithin 30 days of surgery.6

A steering committee composed ofAORN, the Agency for HealthcareResearch and Quality, the AmericanCollege of Surgeons, the AmericanHospital Association, the AmericanSociety of Anesthesiologists, the Centersfor Disease Control and Prevention, the

Centers for Medicare and MedicaidServices (CMS), the Institute forHealthcare Improvement, the JointCommission on Accreditation ofHealthcare Organizations, and theVeterans Health Administration guidesthe overall efforts of the SCIP.7 Numer-ous other organizations including pro-fessional associations, health care organ-izations, and health carefacilities have signed onas supporting partners.8

A technical expert paneladdresses each of the fourtarget areas and reviewsthe pertinent research toidentify SCIP measures.9

Hospital clinicians arebeginning to identifyand pilot test interven-tions and evidence-based protocols.10

WHERE TO FINDINFORMATION

The Medicare QualityImprovement Commu-nity (MedQIC) web site(ie, http://www.medqic.org)sponsored by CMS pro-vides information aboutthe SCIP as well as anumber of resources toassist clinicians in theirefforts to improve surgi-cal care. The web-basedresources include tools,an annotated review of the literatureand research, improvement stories,measures, presentations, and links toother materials. For example, the website offers a number of change strate-gies and clinical improvements thatclinicians can implement in theirefforts to reduce the incidence of surgi-cal site infections. These includeresources for redesigning processes,

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Surgical Care ImprovementProject—An important initiative

P A T I E N T S A F E T Y F I R S T

Suzanne C.Beyea, RN

TThe goal of theSurgical CareImprovementProject is toreduce the

incidence of surgical

complications,thus improving

the health outcomes of

surgical patients.

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JUNE 2006, VOL 83, NO 6 Patient Safety First

transforming organizationalculture, measuring andreporting performance, andadopting health informationtechnology.11 Similarresources are provided forthe other target areas.

Various other groups andorganizations also provideresources or narratives aboutefforts related to SCIP. Forexample, the Institute forHealthcare Improvementrecently published animprovement report relatedto best safety practices to pre-vent postoperative myocar-dial infarction and venousthromboembolism.12 Some ofthe reported changes in prac-tices include development ofstandardized guidelines andtreatment recommendationsfor venous thromboembolismprophylaxis, use of perioper-ative beta blockers, and glob-al education for all clinicians

providing care to at-risk pop-ulations. The ColoradoFoundation for Medical Care(CFMC) provides technicaland professional guidance toSCIP efforts within Colorado.The CFMC web site also pro-vides information about col-laborative efforts withinColorado as well as a com-plete listing of the SCIPmeasures.13

WHY NURSES SHOULDLEARN ABOUT THE SCIP

Perhaps the most com-pelling reason for learningabout the SCIP is that nurseswant to provide the highestquality patient care. Whenhealth care teams do not pro-vide the highest quality care,patients are at increased riskfor complications. Those com-plications can result in pro-longed hospital stays andoverall increased costs to the

health care system. The SCIPprovides an important focusfor efforts related to improv-ing the quality of care for allpatients undergoing surgery.

The SCIP measures eventu-ally could be linked to CMSpay-for-performance initia-tives.14 In this way, qualitypatient care would be linkedto reimbursement. Eventually,outcome measures related tothe SCIP will provide patientswith data related to key per-formance measures so theycan make informed decisionsabout where to receive care.15

Hospitals also will be able tobenchmark against otherhealth care facilities by using acommon set of clinical out-comes.16 By focusing on patientoutcomes, organizations havean opportunity to use data as afocus for quality improvement.By identifying best practicesand standardizing clinical

TABLE 1Examples of Surgical Care Improvement Project

Process and Outcome Measures1

Focus area Example of process measure Example of outcome measureInfection

Venous thromboembolism

Respiratory

Cardiac

1. “Other resource: About the project. SCIP process and outcome measures,” MedQIC http://www.medqic.org/dcs/ContentServer?cid=1136495755695&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource (accessed 19 April 2006).

Surgical patients receiving prophy-lactic antibiotic within one hourbefore surgical incision

Surgical patients with recommendedvenous thromboembolism prophy-laxis ordered

Surgical patients whose medicalrecord contained an order for a venti-lator weaning program (ie, clinicalpathway or protocol)

Surgical patients on beta blockerbefore arrival who received a betablocker during the perioperativeperiod

Postoperative wound infection diag-nosed during index hospitalization(ie, the specific hospitalization dur-ing which surgery was performed)

Intraoperative or postoperative deepvein thrombosis diagnosed duringindex hospitalization and within 30days of surgery

Postoperative ventilator-associatedpneumonia diagnosed during indexhospitalization

Intraoperative or postoperative acutemyocardial infarction diagnosed during index hospitalization andwithin 30 days of surgery

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processes with clinical path-ways and practice protocols,health care organizations canprovide more reliable care.

Perioperative nursesshould learn more about SCIPand identify opportunities toparticipate in efforts relatedto improving surgical care.Information about partici-pating in the SCIP is avail-able on the MedQIC website.10 Serious complicationscan be avoided when mem-bers of the health care teamwork together to improvesurgical care. ❖

SUZANNE C. BEYEARN, PHD, FAAN

DIRECTOR OF NURSING RESEARCH

DARTMOUTH-HITCHCOCK MEDICAL CENTER

LEBANON, NH

NOTES1. SCIP Project information,MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents(accessed 19 April 2006).2. C Zhan, M R Miller, “Excesslength of stay, charges, andmortality attributable to med-ical injuries during hospitaliza-tion,” JAMA 290 (October 2003)1868-1874.3. “Other resource: About theproject,” MedQIC http://www.medqic.org/dcs/ContentServer?cid=1136495755695&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource (access-ed 19 April 2006).

4. “Other resource: About theproject. From SIP to SCIP presen-tation,” MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1136495755695&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource(accessed 25 April 2006).5. “Other resource: About theproject. SCIP target areas,”MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1136495755695&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource (accessed 19April 2006).6. “Measures: SCIP project infor-mation,” MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1122904930422&pagename=Medqic%2FMeasure%2FMeasuresHome&parentName=Topic&level3=Measures&c=MQParents (accessed 19April 2006).7. “Other resource: SCIP part-nership. Steering committee,”MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1134322345403&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource (accessed19 April 2006).8. “Other resource: SCIP partner-ship. Supporting partners,”MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1134322345403&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource (accessed19 April 2006).9. “Other resource: SCIP partner-ship,” MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1134322345403&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource(accessed 19 April 2006). 10. “Other resource: Hospitalparticipation,” MedQIC, http://www.medqic.org/dcs/ContentServer

?cid=1134322334625&pagename=Medqic%2FOtherResource%2FOtherResourcesTemplate&c=OtherResource(accessed 19 April 2006).11. “Infections,” MedQIC, http://www.medqic.org/dcs/ContentServer?cid=1089815967030&pagename=Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents (accessed 19 April 2006). 12. Baystate Medical Center,“Improvement report. SCIP: Bestsafety practices to prevent postoperation myocardial infarctionand venous thromboembolism,”Institute for Healthcare Improve-ment, http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/ImprovementStories/SCIPBestSafetyPracticestoPreventPostOperationMyocardialInfarctionandVenousThromboembolism.htm (accessed 19 April 2006).13. “Surgical Care ImprovementProject (SCIP),” Colorado Foun-dation for Medical Care, http://www.cfmc.org/hospital/hospital_scip.htm (accessed 19 April 2006).14. “Overview: Medicaid andSCHIP quality practices—Generalinformation,” Centers for Medi-care & Medicaid Services, http://www.cms.hhs.gov/MedicaidSCHIPQualPrac (accessed 25 April 2006).15. “Evidence-based care: Medi-caid and SCHIP evidence-basedcare and quality measurement,”Centers for Medicare & MedicaidServices, http://www.cms.hhs.gov/MedicaidSCHIPQualPrac/02_evidencebasedcard.asp (accessed 25April 2006).16. “Pay for performance initia-tives, Herb Kuhn, director,Center for Medicare Manage-ment, Senate Committee onFinance,” (July 27, 2005) Centersfor Medicare & Medicaid Ser-vices, http://www.cms.hhs.gov/apps/media/press/testimony.asp?Counter=1537 (accessed 25 April 2006).

Several items that were lost at this year’s Con-gress in Washington, DC, were turned in to AORN

Headquarters. To inquire whether an item you lost wasfound, call Sandy Abbott at (800) 755-2676 x 209.

Congress Lost and Found Items Available at Headquarters