While compliance to Surgical Care Improvement Project (SCIP) measures might make a hospital look good on the federal government's Hospital Compare website, it's not necessarily a sign that the hospital will have fewer surgical site infections.
In fact, there is no relationship between SCIP compliance rates and post-op infection rates, according to an article published in the June 23 issue of the Journal of the American Medical Association. "Our findings are unable to suggest that the improvements in SCIP compliance have been associated with a reduction in infection rates," write the authors, from Case Western University in Cleveland and other medical facilities in Ohio.
The goal of SCIP, which began in 2006, is to decrease hospital complication rates by 25% before the end of 2010. The program is voluntary, although the Centers for Medicare and Medicaid Services reduces its reimbursement by 2% for hospitals that don't report the SCIP performance measures.
The researchers looked at 405,000 surgical patients from 398 hospitals from July 2006 through March 2008. During that period, there were 3,996 post-op infections (9.8 per 1,000 patients). None of the individual SCIP measures were associated with a decrease in infections. In fact, as adherence to SCIP measures climbed, so did the infection rate, write the authors.
What does seem to work, the authors found, is complying with all 6 of the infection control measures, which include proper administration and discontinuation of antibiotics and maintaining normothermia. Among hospitals that complied with all 6 infection control measures, the post-op infection rate dropped slightly, from 14.2 to 6.8 infections per 1,000 patients.
"Complication rates are likely influenced by many factors independent of these measures," write the authors. "The skill and knowledge of the surgical team, a safe and clean working environment, and a general culture of quality surrounding patient care are likely to be at least as important to the assessment of hospital quality."
During the study period, SCIP adherence varied between 80% and 94%. However, more than a quarter of the patients only had 1 SCIP measure recorded. Most often the measure reported was appropriate hair removal, according to the JAMA article.
"It appears that investing resources in SCIP reporting is no longer cost effective," writes Mary T. Hawn, MD, a surgeon at the University of Alabama, in an editorial in the same issue of JAMA.
Kent Steinriede
