Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center.
BACKGROUND
The Surgical Care Improvement Project (SCIP) was designed to reduce perioperative complications. We describe our institutional experience in 6 major areas: surgical site infection, venous thromboembolism prevention, use of perioperative beta-blockade, serum glucose level greater than 200 mg/dL, normothermia, and the use of electric razors for hair removal.


METHODS
This was a retrospective review of surgical cases. Evidence-based training and standardization of system and process were undertaken. Compliance with SCIP guidelines was determined.


RESULTS
Overall SCIP compliance improved from 80% to 94% over a 2-year period. Standardized antibiotic dosing times improved compliance to more than 90%. Appropriate preoperative antibiotic choice improved to 100%. Cessation of antibiotics postoperatively within 24 hours remains a difficult task. Venous thromboembolism prophylaxis has been difficult to achieve because of postoperative bleeding concerns. Administration of beta-blockers has remained one of the most difficult problems to correct because of the multiplicity of avenues by which a patient may arrive to the operating suite.


CONCLUSIONS
Achievement of the SCIP goals is a formidable, but achievable, process requiring individual, cultural, systems, and institutional changes to achieve success.
Potenza
Bruce
B
Division of Trauma, Critical Care & Burns, University of California, San Diego, 200 W. Arbor Dr., San Diego, CA 92103-8896, USA. bpotenza@ucsd.edu
Deligencia
Michelle
M
Estigoy
Brenda
B
Faraday
Eema
E
Snyder
Andrea
A
Angle
Niren
N
Schwartz
Alexandra
A
Chang
Leon
L
Hackett
James
J
Minokadeh
Anushirvan
A
Madani
Michael
M
MacAulay
Kathryn
K
Ramamoorthy
Sonia
S
Blaner
Lynn
L
James
Charles
C
Bansal
Vishal
V
Torriani
Francesca
F
Coimbra
Raul
R
D000046:Academic Medical Centers; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature; D002140:California; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D015397:Program Evaluation; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000517:prevention & control; D054556:Venous Thromboembolism / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose