The University of Toledo Medical Center has made strides in heightening patient safety measures defined by a national initiative called Surgical Care Improvement Project (SCIP).
Established in 2005 by the Centers for Medicare and Medicaid Services, the SCIP goal is to achieve a 25 percent reduction in surgical complications by the end of this year. Research has shown that a significant percentage of post-surgical complications, such as infections and deep vein blood clots, can be prevented by following evidence-based procedures outlined in SCIP recommendations.
“Although some complications are unavoidable, surgical care can be improved through better adherence to evidence-based practice recommendations and by designing systems of care with safeguards,” said Barbara Hankenhof, clinical performance improvement coordinator at UTMC.
Other national partners in the SCIP initiative include the American Hospital Association, the Centers for Disease Control and Prevention, the Institute for Healthcare Improvement and the Joint Commission.
SCIP has identified several critical areas in which adhering to quality processes can significantly reduce surgical complications during patients’ pre-operative, intra-operative and post-operative care, with focus on three key areas of prevention: infection, cardiovascular complications and venous thromboembolism.
Recently, UT Medical Center achieved 100 percent compliance in the following areas targeted by SCIP:
• Antibiotic selection;
• Glucose control;
• Appropriate hair removal;
• Venous thromboembolism (VTE) prophylaxis; and
• Colorectal post-op normothermia.
UTMC scored well in a handful of other indicators, including antibiotic post-op discontinuation (97 percent), timely antibiotic pre-op administration (96 percent) and peri-operative beta blockers (95 percent).
“It’s all about patient safety practices,” Hankenhof said. “In some cases, it was just a matter of educating our staff to better document what we’ve already been doing.”
Studies indicate that the following basic measures are vital in preventing complications targeted in SCIP:
• Timely administration of antibiotics just before surgical incisions are made decrease the risk of infection.
• Continuing to administer beta blocker medication reduces strain on the heart.
• Appropriate administration of VTE prophylaxis after surgery reduces the risk of blot clots forming in the lungs and deep veins.
UTMC’s performance was measured by analyzing a sample of surgical charts in the following major surgery categories: colon surgery, hysterectomy, cardiac surgery, vascular surgery, and total hip and total knee replacement. This sampling allows administrators to trace the processes of care in each patient’s case from pre-op through the initial post-op phase.
UTMC has created a multidisciplinary SCIP committee to review processes and procedures, target potential areas for improvement, and provide feedback to surgical caregivers. Hankenhof has conducted continuing educational programs for all staff involved in surgical patient care, attended department meetings and educational conferences, and performed on-the-spot patient care reviews.
“It says a lot about the collaboration among every member of our patient care teams, from nursing, to physicians, to pharmacy staff and others who perform clinical care, that we’ve been able to improve our compliance so significantly,” she noted. “It shows our commitment to exemplary patient safety.”
Hankenhof said adherence to procedures outlined in SCIP and other quality performance programs is expected to affect reimbursement practices in the future. Working within the SCIP guidelines will allow UTMC to remain competitive in the greater Toledo area, benefit the organization financially, and bolster public confidence.
UTMC will continue to monitor its performance and quality standards in 2010. SCIP has identified new areas for evaluation, including:
• Prompt post-surgical urinary catheter removal, which reduces the risk for urinary tract infections.
• Body temperature regulation, which reduces the risk for surgical infections.
For more information about UTMC’s participation in the SCIP initiative, contact Hankenhof at 419.383.6193 or e-mail barb.hankenhof@utoledo.edu.