Quality Measures

The SCIP Quality Measures

SCIP is targeting four areas where the incidence and cost of surgical complications are high. While IPRO encourages hospitals to focus on all four areas, we require that hospitals participating in the SCIP IPG focus on two specific areas: Surgical Site Infections (SSI) and Venous Thromboembolism Prophylaxis (VTE).

Surgical Site Infections (SSIs)

SSIs account for 20 percent of hospital infections. Research shows that by reducing SSIs, hospitals on average could recognize a savings of $3,152 and reduction in extended length of stay by seven days on each patient that develops an infection.

IPRO will work with your institution to assess and develop opportunities to improve your processes to reduce the incidence of post-operative wound infection. Listed below are processes of care that are scientifically based and are the focus of IPRO's SSI work.

SCIP INF 1: Prophylactic antibiotic received within one hour prior to surgical incision
SCIP INF 2: Prophylactic antibiotic selection for surgical patients
SCIP INF 3: Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac patients)
SCIP INF 4: Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose (= 200mg/dL)
SCIP INF 5: Postoperative wound infection diagnosed during index hospitalization (OUTCOME)
SCIP INF 6: Surgical patients with appropriate hair removal
SCIP INF 7: Colorectal surgical patients with immediate postoperative normothermia

Venous Thromboembolism (VTE)

Deep venous thromboembolism (DVT) occurs after approximately 25 percent of all major surgical procedures performed without prophylaxis, and pulmonary embolism (PE) occurs in 7 percent of surgeries conducted without prophylaxis. More than 50 percent of major orthopedic procedures are complicated by DVT and up to 30 percent by PE if prophylactic treatment is not instituted. Despite the well-established efficacy and safety of preventive measures, studies show that prophylaxis is often underused or used inappropriately.

IPRO will work with your institution to assess and develop opportunities to improve your processes to reduce the incidence of postoperative venous thromboembolism. Listed below are processes of care that are scientifically based and are the focus of IPRO's work.

SCIP VTE 1: Surgical patients with recommended venous thromboembolism prophylaxis ordered
SCIP VTE 2: Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery
SCIP VTE 3: Intra- or postoperative pulmonary embolism (PE) diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)
SCIP VTE 4: Intra- or postoperative deep vein thrombosis (DVT) diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)

The following lists the categories of surgical procedures included under the VTE module and the recommended prophylaxis for each.

VTE Prophylaxis Selection for Surgery


Surgery, Level of Risk	Recommended Prophylaxis
General surgery, moderate - high risk (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Low-dose unfractionated heparin (LDUH) 5000 units bid or tid Low molecular weight heparin (LMWH) LDUH or LMWH combined with IPC or GCS
General surgery with high risk for bleeding (based on physician documentation of bleeding risk) (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Graduated Compression stockings (GCS) Intermittent pneumatic compression (IPC)
Gynecologic surgery (Open surgical procedure > 30 minutes and requiring hospital stay > 24 hours postop)	Any of the following: Low-dose unfractionated heparin (LDUH) 5000 units bid or tid Low molecular weight heparin (LMWH) Intermittent pneumatic compression devices (IPC) LDUH or LMWH combined with IPC or GCS
Urologic surgery (Open surgical procedure > 30 minutes requiring hospital stay > 24 hours postop)	Any of the following: Low-dose unfractionated heparin (LDUH) 5000 units bid or tid Low molecular weight heparin (LMWH) Intermittent pneumatic compression devices (IPC) Graduated compression stockings (GCS) LDUH or LMWH combined with IPC or GCS
Elective total hip replacement (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following started within 24 hours of surgery: Low molecular weight heparin (LMWH) Fondaparinux 2.5 mg Adjusted-dose warfarin (INR target 2.5, range 2.0-3.0)
Elective total knee replacement (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Low molecular weight heparin (LMWH) Fondaparinux 2.5 mg Adjusted-dose warfarin (INR target 2.5, range 2.0-3.0) Intermittent pneumatic compression devices (IPC)
Hip fracture surgery (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Low molecular weight heparin (LMWH) Fondaparinux 2.5 mg Adjusted-dose warfarin (INR target 2.5, range 2.0-3.0) Low-dose unfractionated heparin (LDUH)
Hip fracture surgery or elective total hip replacement with high risk for bleeding (based on physician documentation of bleeding risk) (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Graduated Compression stockings (GCS) Intermittent pneumatic compression (IPC)
Elective spinal surgery (With additional risk factors such as advanced age, known malignancy, presence of a neurologic deficit, previous VTE, or an anterior surgical approach) (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: Low-dose unfractionated heparin (LDUH) Low molecular weight heparin (LMWH) Intermittent pneumatic compression devices (IPC) Graduated compression stockings (GCS) IPC combined with GCS LDUH or LMWH combined with IPC or GCS
Intracranial neurosurgery (Open surgical procedure > 30 minutes requiring in hospital stay > 24 hours postop)	Any of the following: IPC with or without GCS Low-dose unfractionated heparin (LDUH) Postoperative Low molecular weight heparin (LMWH) LDUH or LMWH combined with IPC or GCS

Adverse Cardiac Events (Optional)

Postoperative cardiac complications occur in 2 to 5 percent of patients undergoing non-cardiac surgery and as many as 34 percent of patients undergoing vascular surgery. Certain perioperatiave cardiac events, such as myocardial infarction, are associated with a mortality rate of 40 to 70 per event, prolonged hospitalization and higher costs. Current studies show that nearly half of the fatal cardiac events could be preventable with beta-blocker therapy.

IPRO will work with your institution to assess and develop opportunities to improve your processes to reduce the incidence of postoperative cardiac events. Listed below are processes of care that are scientifically based and are the focus of IPRO's work.

SCIP Card 2: Surgical patients on a beta-blocker prior to arrival that received a beta-blocker during the perioperative period
SCIP Card 3: Intra- or postoperative acute myocardial infarction (AMI) diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)

Postoperative ventilator-related pneumonia (Optional)

Postoperative ventilator-related pneumonia occurs in 9 to 40 percent of patients and has an associated mortality rate of 30 to 46 percent. Many of the risk factors for this event respond to medical intervention and thus are preventable. A conservative estimate of the potential savings from the reduced hospitalization due to postoperative pneumonia is $22,000 to $28,000 per patient admission.

IPRO will work with your institution to assess and develop opportunities to improve your processes to reduce the incidence of postoperative ventilator-related pneumonia. Listed below are processes of care that are scientifically based and are the focus of IPRO's work.

SCIP Resp 1: Number of days ventilated surgery patients had documentation of the Head of the Bed (HOB) being elevated from recovery end date (day zero) through postoperative day seven.
SCIP Resp 2: Patients diagnosed with postoperative ventilator-associated pneumonia (VAP) during index hospitalization (OUTCOME)
SCIP Resp 3: Number of days ventilated surgery patients had documentation of stress ulcer disease (SUD) prophylaxis from recovery end date (day zero) through postoperative day seven.
SCIP Resp 4: Surgical patients on a ventilator who are placed on a ventilator weaning protocol

Global Measures

SCIP Global 1: Mortality within 30 days of surgery
SCIP Global 2: Readmission within 30 days of surgery

Surgical Procedures Selection Criteria

The following information and table guides SCIP IPG participants to use the appropriate ICD-9-CM Tables and determine which cases to include when calculating their SCIP process measures.

Eligibility for SCIP Project Measures

Table 5.10 defines major surgery ICD-9-CM codes eligible for one or more SCIP measures (all modules).

Eligibility for Infection Module

Tables 5.01-5.08 define the procedures of interest for SCIP-Inf 1, 2, and 3 (formerly SIP-1, 2, and 3)
Table 5.09 defines the diagnoses that are excluded from SCIP-Inf 1, 2, 3, 4, and 7 - Table 5.11 defines cardiac surgery cases included for SCIP-Inf 4 (cardiac surgery patients with controlled postoperative serum glucose)
Table 5.12 defines colorectal surgery cases included for SCIP-Inf 7 (colorectal surgery patients with immediate postoperative normothermia)
Table 5.14 (Burns) excludes cases from SCIP-Inf 4 and 7
Table 5.15 (Transplants) excludes cases from SCIP-Inf 7

Eligibility for Venous Thromboembolism (VTE) Measures

Tables 5.17-5.24 define the procedures for the VTE measures only. The Technical Expert Panels selected these surgeries to apply to the recommendations for VTE.


Table	Applicable Measures
5.01 Coronary Artery Bypass Graft (CABG)	SCIP-Inf-1, 2, 3
5.02 Other Cardiac Surgery	SCIP-Inf-1, 2, 3
5.03 Colon Surgery	SCIP-Inf-1, 2, 3
5.04 Hip Arthroplasty	SCIP-Inf-1, 2, 3
5.05 Knee Arthroplasty	SCIP-Inf-1, 2, 3
5.06 Abdominal Hysterectomy	SCIP-Inf-1, 2, 3
5.07 Vaginal Hysterectomy	SCIP-Inf-1, 2, 3
5.08 Vascular Surgery	SCIP-Inf-1, 2, 3
5.09 Infection	SCIP-Inf-1, 2, 3, 4, 7
5.10 Major Surgery	All SCIP Measures
5.11 Cardiac Surgery	SCIP-Inf-4
5.12 Colorectal Surgery	SCIP-Inf-7
5.13 Non-cardiac (vascular) surgery	SCIP-Card-1
5.14 Burns	SCIP-Inf-4, 7
5.15 Transplants	SCIP-Inf-4
5.16 Coronary Artery Disease	SCIP-Card-1
5.17 Intracranial Neurosurgery	SCIP-VTE-1, 2
5.18 Elective Spinal Surgery	SCIP-VTE-1, 2
5.19 General Surgery	SCIP-VTE-1, 2
5.20 Gynecological Surgery	SCIP-VTE-1, 2
5.21 Urological Surgery	SCIP-VTE-1, 2
5.22 Elective Total Hip Replacement	SCIP-VTE-1, 2
5.23 Elective Total Knee Replacement	SCIP-VTE-1, 2
5.24 Hip Fracture Surgery	SCIP-VTE-1, 2