title: Surgical Process Improvement: Impact of a Standardized Care Model With Electronic Decision Support to Improve Compliance With SCIP Inf-9.
abstract: The absence of standardization in surgical care process, exemplified in a "solution shop" model, can lead to unwarranted variation, increased cost, and reduced quality. A comprehensive effort was undertaken to improve quality of care around indwelling bladder catheter use following surgery by creating a "focused factory" model within the cardiac surgical practice. Baseline compliance with Surgical Care Improvement Inf-9, removal of urinary catheter by the end of surgical postoperative day 2, was determined. Comparison of baseline data to postintervention results showed clinically important reductions in the duration of indwelling bladder catheters as well as marked reduction in practice variation. Following the intervention, Surgical Care Improvement Inf-9 guidelines were met in 97% of patients. Although clinical quality improvement was notable, the process to accomplish this-identification of patients suitable for standardized pathways, protocol application, and electronic systems to support the standardized practice model-has potentially greater relevance than the specific clinical results.
authors.affiliation: Mayo Clinic, Rochester, MN cook.david@mayo.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cook
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Thompson
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Suri
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Prinsen
mesh_terms: D006348:Cardiac Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000592:standards* / Q000706:statistics & numerical data; D014546:Urinary Catheterization / Q000592:standards / Q000706:statistics & numerical data
keywords: SCIP; Surgical Care Improvement Project; decision support; focused factory; urinary catheter