Surgical Care Improvement Project Addresses Patient Safety

Hospital-acquired infections remain the cause of extended hospitalizations, and even death, for thousands of patients nationwide every year. They merit every hospital’s attention and effort.

A range of healthcare organizations have coalesced around this issue in an effort to improve patient safety by reducing post-surgical complications. Ten national healthcare organizations are spearheading the effort, including the Centers for Medicare & Medicaid Services (CMS), American College of Surgeons, American Society of Anesthesiologists and American Hospital Association, among others.

Working under the CMS National Patient Safety Initiative, Medicare Quality Improvement Organizations (QIOS) across the United States are also providing technical assistance to thousands of hospitals, to help them improve performance on eight quality measures related to infection control, cardiac care and venous thromboembolism prophylaxis. The performance of clinicians at hospitals from throughout the U.S. has shown improvement: on one measure (giving antibiotics within 60 minutes of the first incision), the national rate has gone from 56% in 2001 to well above 90% today.

IPRO, the QIO for New York State, has been working under contract with CMS since August 2008 to help 26 New York hospitals improve peri-operative care as part of the national Patient Safety Theme. IPRO has focused its interventions on educating providers on clinical guidelines and best practices, as well as on helping hospitals establish standardized processes that have been demonstrated to promote better outcomes. Mentors from high-performing hospitals have been key to this effort, as they have conducted grand rounds at numerous hospitals on their best practices. To date, participating New York hospitals have shown improvement on all measures.

Public reporting is an important part of this initiative, and CMS has posted hospitals’ performance on Surgical Care Improvement Project (SCIP) measures to the Hospital Compare site. You may have read the recent JAMA study that found a poor correlation between hospital performance on individual SCIP process measures for infection prevention and actual patient infection rates. The authors’ analysis, however, showed a statistically significant correlation between lower infection rates and a composite measure that included all of the SCIP infection measures.

It is important to remember that, to develop the SCIP measures, CMS used an evidence-based approach that is consistent with best practice guidelines from professional organizations such as the American College of Surgeons, American College of Cardiology and American College of Chest Physicians. SCIP measures have gone through a rigorous review and endorsement process by the National Quality Forum and other standard-setting groups.

There are many processes of care, patient variables and surgeon-specific variables that influence surgical outcomes and that are not measured – nor would it be feasible to measure all of them. This does not mean that hospitals and their medical staff should fail to adopt and consistently employ processes of care that have been proven to reduce the risk of infections and other surgical complications.

To learn more about IPRO’s SCIP project, or to get evidence-based tools for surgical care improvement, visit

This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 9SOW-NY-THM6.2-10-80