Compliance with SCIP core measures and the Impact on Surgical Site Infections

Transcription

1 Compliance with SCIP core measures and the Impact on Surgical Site Infections Using NSQIP to Evaluate Patient Outcomes and Reimbursement Guidelines Rickesha L. Wilson, MD July 28, ACS NSQIP National Conference University of Connecticut Surgery Residency Saint Francis Hospital & Medical Center

2 Overview NSQIP SCIP core measures CMS guidelines, reimbursement Objective Results Conclusions Future Implications

3 National Surgical Quality Improvement Project Risk-adjusted, outcomes database Measures surgical outcomes to improve surgical care NSQIP trained personnel collects data on a rolling basis 2007 SFHMC joined NSQIP

4 Surgical Care Improvement Project

5 Center for Medicare and Medicaid Services Hospital Value Based Purchasing Financial Incentives Improvement from baseline Higher performance compared to other institutions Clinical processes of care Patient experience

6 Objective Compliance with SCIP measures Surgical Site Infection Rate

7 Methods Retrospective review of 215 colorectal cases Data collected according to NSQIP guidelines May 2011 to October day SSI outcomes documented IBM SPSS was used for statistical analysis

8 SCIP Antibiotic Guidelines Administer antibiotics within 1 hour of skin incision 2 hours for Vancomycin or Fluoroquinolones Colon Surgery Cefotetan, Cefoxitin, Ampicillin/Sulbactam or Ertapenem OR Cefazolin or Cefuroxime + Metronidazole Allergies: Clindamycin + Aminoglycoside or Quinolone or Aztreonam OR Metronidazole + Aminoglycoside or Quinolone

9 Data SSI Rate = 17.7% 30 day follow up in 95.8% Overall Compliance SCIP-1 = 83.7% SSI rate = 16.1% SSI rate = 25.7% with non-compliance SCIP-2 = 74.3% SSI rate = 16.4% SSI rate = 21.8% with non-compliance Compliance with both = 18%

10 SSI Categories 7.9% 34.2% 39.5% Superficial Deep Organ Space Wound Disruption 26.3%

11 SSI % Patient Risk Factors Yes No ASA 3 DM Smoker BMI 30 Intraop Sepsis Intraop Transfusion

12 SSI % 35 Perioperative Factors Yes No 5 0

13 SSI % 90 Postoperative Events Yes No 0 0

14 Conclusions The rates of surgical site infections were lower with SCIP compliance, clinically significant Are SCIP measures sufficient to impact outcomes significantly and eliminate postoperative morbidity?

15 Future Implications Compliance with SCIP measures may not lead to improved patient outcomes CMS reimbursement: outcomes outweigh process measures Databases, National registries as tools for federal reporting?

16 References Berenguer et al. Improving Surgical Site Infections: Using National Surgical Quality Improvement Data to Institute Surgical Care Improvement Program Protocols in Improving Surgical Outcomes. J Am Coll Surg 2010; 210: EP Dellinger et al. Hospitals collaborate to decrease surgical site infections. The American Journal of Surgery 2005; 190: 9-15 Rosenberger et al. The Surgical Care Improvement Project and the prevention of post-operative infection, including surgical site infection. Surgical Infections 2011; 12: Awad. Adherence to Surgical Care Improvement Project measures and post-operative surgical site infection. Surgical Infections 2012; 13:4: DJ Anderson et al. Strategies to prevent surgical site infections in acute care hospitals. Infection Control and Hospital Epidemiology 2008; 29: S51-61 Wick EC et al. Readmission rates and cost following colorectal surgery. Lutfiyya et al. A colorectal care bundle to reduce surgical site infections in colorectal surgeries: a single-center experience. Perm J 2012 Summer 16 (3): Schilling PL et al. Prioritizing quality improvement in general surgery. Ingraham et al. Quality improvement in surgery. The American College of Surgeons National Surgical Quality Improvement Program approach. Brendle TA. The Surgical Care Improvement Project and the perioperative nurse s role. Wick EC et al. Surgical site infections in a high outlier institution: are colorectal surgeons to blame? Pastor C. et al. An increase in compliance with the Surgical Care Improvement Project measures does not prevent surgical site infections in colorectal surgery. Blumenthal et al. Hospital Value-Based Purchasing. Journal of Hospital Medicine 2013, 8:5,