title: Lessons learned from the institution of the Surgical Care Improvement Project at a teaching medical center.
abstract: 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.
authors.affiliation: Division of Trauma, Critical Care & Burns, University of California, San Diego, 200 W. Arbor Dr., San Diego, CA 92103-8896, USA. bpotenza@ucsd.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Potenza
authors.forename: Michelle
authors.initials: M
authors.lastname: Deligencia
authors.forename: Brenda
authors.initials: B
authors.lastname: Estigoy
authors.forename: Eema
authors.initials: E
authors.lastname: Faraday
authors.forename: Andrea
authors.initials: A
authors.lastname: Snyder
authors.forename: Niren
authors.initials: N
authors.lastname: Angle
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schwartz
authors.forename: Leon
authors.initials: L
authors.lastname: Chang
authors.forename: James
authors.initials: J
authors.lastname: Hackett
authors.forename: Anushirvan
authors.initials: A
authors.lastname: Minokadeh
authors.forename: Michael
authors.initials: M
authors.lastname: Madani
authors.forename: Kathryn
authors.initials: K
authors.lastname: MacAulay
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: Lynn
authors.initials: L
authors.lastname: Blaner
authors.forename: Charles
authors.initials: C
authors.lastname: James
authors.forename: Vishal
authors.initials: V
authors.lastname: Bansal
authors.forename: Francesca
authors.initials: F
authors.lastname: Torriani
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose