Surgical Care Improvement Project

One way to evaluate the care of patients receiving surgery is to look at the percentage of eligible patients who meet surgical care guidelines. The goal is 100 percent.

The graph shows the percentage of eligible Mayo Clinic hospital patients receiving surgery whose care met the standards of care guideline.

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

Standards of care

The quality measures listed in the table below are known as the "standards of care" for managing patients undergoing surgery in a hospital setting. This list includes the medical care widely accepted as the most appropriate care guidelines for the majority of patients undergoing surgery in a hospital.

Standards of 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, is 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 a controlled 6 a.m. blood glucose on postoperative day one and postoperative day two (day of surgery being day zero). (Added 1Qtr08) 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 with appropriate surgical site hair removal. No hair removal or hair removal with clippers or hair removal cream is considered appropriate. Shaving is considered inappropriate. (Added 1Qtr08) Research shows that shaving causes multiple skin abrasions that later may become infected. It has been reported that clippers use on the morning of surgery has resulted in reduced surgical site infections.
Percent of surgery patients who had the urinary catheter removed on postoperative day one or postoperative day two (Day of surgery is day zero.) (added 1Qtr10) It is well established that the risk of catheter-associated urinary tract infection (UTI) increases with prolonged use of an indwelling urinary catheter.
Percent of patients who either were actively warmed during the operative period to maintain normal body temperature or had a normal body temperature (36 C or greater) around anesthesia end time (added 1Qtr12) Patients who had a temperature outside normal range during the surgical time frame were at higher risk of complications and adverse outcomes, such as impaired wound healing, surgical site infections and prolonged hospital stay.
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 medicine primarily used in the treatment of certain heart conditions and high blood pressure. It is important, prior to hospitalization, that surgery patients receive a beta blocker 24 hours before surgery and throughout the recovery period.
Percent of surgery patients receiving an appropriate blood clot preventive therapy ordered anytime from hospital arrival to 48 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:
  • Compression stockings or pneumatic compression devices
  • Low dose of heparin (blood thinner)
Percent of surgery patients who receive an appropriate blood clot preventive therapy within 24 hours before the surgical incision time to 24 hours after the surgery end time The 24-hour time frame was chosen in order to establish a time frame that would encompass most procedures.

Other factors to consider

Surgical care management efforts at Mayo Clinic have reduced the infection rate and other complications related to surgery. All Mayo Clinic facilities have instituted quality projects that focus on the issues related to improving the processes that ensure quality care. These efforts include developing new hospital orders sets that include appropriate care measures and establishing electronic systems to remind care providers of crucial documentation for these care measures.