Surgical care improvement project

One way to evaluate the care of patients receiving surgery is to look at the percentage of patients receiving the timely and effective care measures that are appropriate for them. The goal is 100 percent.

The graph shows the percentage of eligible Mayo Clinic hospital patients receiving surgery who received all of the appropriate care measures.

The surgical care improvement project involves the review of measures that ensure quality care is given. These measures focus on reducing the incidence of four kinds of complications that can occur following surgery:

  • Surgical site infection
  • Adverse cardiac events
  • Deep vein thrombosis
  • Postoperative pneumonia

Timely and effective care

The table below reflects the timely and effective care measures for managing patients undergoing surgery in a hospital setting.
Timely and effective care for surgical care improvement project Explanation of this care
Percent of patients given preventive antibiotic within one hour before the surgical incision Research has shown that receiving an antibiotic within the hour before surgery ensures the lowest incidence of postoperative infection.
Percent of patients for whom the appropriate antibiotic was selected

The goal of selecting the appropriate antibiotic is to select one that is safe, cost-effective and works for most of the potentially infectious agents for the specific operation.

Each surgery type has specific antibiotics that are acceptable to use.

Percent of patients for whom the selected antibiotic was stopped within 24 or 48 hours after surgery Research has shown that continuing antibiotics beyond 24 hours (48 hours for cardiac surgery) offers no additional benefit to the surgical patient.
Percent of cardiac surgery patients with controlled blood glucose 18 to 24 hours after surgery ends. (Added 1Q2008)

High blood sugar postoperatively increases the risk of infection in both diabetic and nondiabetic patients.

Studies also demonstrate that the incidence of deep wound infection in diabetic patients undergoing cardiac surgery was reduced by controlling the blood sugar levels in the immediate postoperative period.

Percent of surgery patients for whom the urinary catheter was removed on postoperative day one or postoperative day two (day of surgery is day zero). (Added 1Qtr2010) It's well established that the risk of catheter-associated urinary tract infection (UTI) increases with prolonged use of an indwelling urinary catheter.
Percent of surgery patients on beta blocker therapy prior to arrival who received a beta blocker during the perioperative period (Added 1Qtr2009)

Beta blockers are a type of medication that is primarily used in the treatment of certain heart conditions and hypertension.

It's important that surgery patients who are on beta blocker therapy before coming to the hospital receive a beta blocker 24 hours before surgery and throughout the recovery period.

Percent of surgery patients given an appropriate preventive against blood clots within 24 hours prior to the surgical incision time to 24 hours after the surgery end time

Research has shown that appropriately used preventives in select surgical procedures reduce the risk of blood clots after surgery. Examples include:

  • Compression stockings or pneumatic compression devices
  • Low dose of a blood thinner (heparin)

The 24-hour time frame was chosen in order to establish a time frame that would encompass most procedures.

Appropriate care measure (ACM) The ACM is a pass-fail measure at the individual patient level that asks whether an eligible patient has received all of the appropriate care for the condition for which he or she is being treated.
For additional information and data visit Medicare Hospital Compare. May 31, 2014