Patient Safety / Quality

Teaming up to improve the quality of surgical care

Pay based on performance is coming to health care. The Centers for Medicare and Medicaid Services is developing and implementing pay-for-performance initiatives to increase the quality of care for its beneficiaries. And private insurers will surely follow suit.

So how will third-party payers measure our performance? When it comes to surgical patients, some or all of the quality indicators may come from the Surgical Care Improvement Project (SCIP), a national partnership of organizations focused on improving the care of surgical patients by improving outcomes and safety and reducing surgical complications.

Assessing quality of care

SCIP measures quality by assessing processes of care and outcome measures (quality indicators) in four broad areas: surgical infections, cardiovascular complications, venous thromboembolism (VTE), and respiratory complications, such as postoperative pneumonia. SCIP quality indicators are based on research, standards of care, and evidence-based practice.

Keep in mind that SCIP applies only to certain surgical procedures, such as abdominal and vaginal hysterectomy; hip and knee arthroplasty; cardiac, colon, and coronary artery bypass graft surgery; and vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass. Some urologic and neurologic (spinal and intracranial) procedures are included in the VTE process and outcome measures.

How we use SCIP


At the facility where I work, we are using an interdisciplinary team approach to implement SCIP guidelines, meet process and outcome measures, and evaluate our performance. Our core team meets monthly, and four SCIP project teams—one for each broad area—meet periodically.

All teams include management, staff nurses, anesthesiologists, nurse anesthetists, physicians, surgeons, pharmacists, administrators, respiratory therapists, infection-control specialists, and quality-improvement personnel. Team members provide ongoing education on SCIP to other staff members via in-services, hospital publications, posters, and individual discussions. We’ve presented information on the project’s evidence-based practice guidelines, process and outcome measures, data collection results and analysis, and specific process changes.

The four project teams meet to analyze the data collected by our quality improvement department and determine the effectiveness of our processes. Team members collaborate to determine if we need to change our surgical-care processes. All changes are based on SCIP’s evidence-based practice guidelines, published research studies, standards of care, literature, analysis of our collected data, and input from all team members and staff.

Our physician champions are the first to integrate the guidelines, process, and outcome measures into their practices. Then, they then gain support from other physicians. After we implement a process change, we evaluate its effectiveness based on input from team members and staff as well as on concurrent and retrospective data collection and analysis, using specific quality indicators.

Evaluating our process changes

Currently, we are evaluating the process changes made to our preoperative and postoperative surgical standing orders. Our physician champions developed the changes, which serve as guidelines for physicians when ordering antibiotics, continuing beta blocker therapy, and ordering VTE prophylaxis during the perioperative period.

For several process changes, our retrospective and concurrent data collection and analysis have improved performance on all nine quality indicators. Our goal is to meet 100% of the quality indicators and thus continue our efforts to provide safe quality patient care and good outcomes.

Join the team

Learning the SCIP guidelines and applying them to your practice can allow you to work with others to provide safe quality care. And that means fewer complications and better outcomes for your patients. Plus, you’ll make yourself more valuable to your facility as the pay-for-performance era approaches.

Selected references

Centers for Medicare and Medicaid Services. www.cms.hhs.gov. Accessed March 17, 2008. Specifications Manual Version 2.2. QualityNet. www.qualitynet.org/dcs/ContentServer?cid=1141662756099&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page. Accessed March 17, 2008.

Specifications Manual Version 2.3. QualityNet. www.qualitynet.org/dcs/ContentServer?cid=1141662756099&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page. Accessed March 17, 2008.

Surgical Care Improvement Project. medqic.org/dcs/ContentServer?cid=1089815966976&pagename=Medqic/Content/ParentShellTemplate&parentName=Set ting&c=MQParents. Accessed on March 17, 2008.

Visit www.AmericanNurseToday.com/journal for a complete list of selected references.

Rhoda A. Owens is a Home Health/Hospice Coordinator and former Staff Educator and SCIP Core Team Leader at Trinity Health in Minot, N.D.

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