外科监护治疗改良方案 Surgical Care Improvement Project课件.ppt

Surgical Site Infections The Medicare Quality Improvement Organization for Arizona What is SCIP? Surgical Care Improvement Project Evolved from SIP Encompasses additional aspects of surgical care Reduce/prevent: Cardiac events, emboli, and ventilator-associated pneumonia Opportunities to Improve Care SSI: occurs in 14%–16% surgical patients 40%–60% of SSIs are preventable Cardiac: 2%–5% noncardiac surgery, 34% in vascular, AMI mortality rate as high as 70% DVT/PE: without prophylaxis: general surgery cases 25%, 7% orthopedic cases, 50% DVT, 30% PE VAP: occurs 9%–40%, with associated mortality rates of 30%–46% SCIP Goals Reduce postoperative mortality and morbidity by 25% over 5 years A Closer Look at SSI SSI in a 51-case day 7.65 patients at risk for infection 4.59 of those infections are preventable Insert Organizational Data SCIP in the News Newsweek, December 12, 2005 6 Keys to Safer Hospitals USA Today ABC News 20/20 More Killed Annually Than by Auto Accidents and Homicides (10-14-2005) SCIP Support American College of Surgeons American Society of Anesthesiology American Hospital Association CDC JCAHO AORN Veterans Administration AHRQ Evidence Based “Evidence-based medicine is the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.” “Evidence-based medicine is about asking questions, finding and appraising the relevant data, and harnessing that information for everyday clinical practice.” BMJ 1995;310:1122-1126 (29 April) William Rosenberg, Anna Donald Evidence-based Medicine: An Approach to Clinical Problem-solving SSI Quality Measures 1: Prophylactic antibiotic received within 1 hour prior to surgical incision 2: Prophylactic antibiotic selection for surgical patients 3: Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac patients) 4: Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose SSI Quali