The Surgical Care Improvement Project (2004), and Finally Some Progress

Excerpt

In 2004–2005, there was a cooperative effort for a number of surgical organizations to work jointly for quality improvement in many aspects of surgery, which resulted in the creation of the Surgical Care Improvement Project (SCIP). Among the simplest measures was the decision to routinely administer systemic antibiotics for clean-contaminated operations and to others at risk within an hour before the operation; to repeat the dose of antibiotics if the operation was prolonged; and, finally (and most importantly), to discontinue antibiotics within a day or two postoperatively. That quickly became the norm. This is something the senior author (Polk) had worked on since 1969 and came to pass, led primarily by the American Academy of Orthopedic Surgery and the American College and Obstetrics and Gynecology. Other aspects of the SCIP have been less clear. The goal was to improve the quality metrics by 25% in a 10-year period. One can take any part of surgery and see whether or not those improved factors were achieved. Millions of dollars were spent, nurses with clipboards were everywhere, and awareness was achieved; improvement—perhaps not. A key and interesting point is the overt conflicts of interest involved with this on the part of people who are frequently consultants, even stockholders, in the companies that benefit from new recommendations or stronger enforcement. That is entirely another story. The article by Lee et al. has a very simple focal point, i.e. on lessening the routine amount of narcotics that are sent home with patients after modest, often outpatient, oncologic surgery. …