Division of Trauma, Critical Care & Burns, University of California, San Diego, 200 W. Arbor Dr., San Diego, CA 92103-8896, USA.
Am J Surg. 2009 Dec;198(6):881-8. doi: 10.1016/j.amjsurg.2009.08.015.
The Surgical Care Improvement Project (SCIP) was designed to reduce perioperative complications. We describe our institutional experience in 6 major areas: surgical site infection, venous thromboembolism prevention, use of perioperative beta-blockade, serum glucose level greater than 200 mg/dL, normothermia, and the use of electric razors for hair removal.
This was a retrospective review of surgical cases. Evidence-based training and standardization of system and process were undertaken. Compliance with SCIP guidelines was determined.
Overall SCIP compliance improved from 80% to 94% over a 2-year period. Standardized antibiotic dosing times improved compliance to more than 90%. Appropriate preoperative antibiotic choice improved to 100%. Cessation of antibiotics postoperatively within 24 hours remains a difficult task. Venous thromboembolism prophylaxis has been difficult to achieve because of postoperative bleeding concerns. Administration of beta-blockers has remained one of the most difficult problems to correct because of the multiplicity of avenues by which a patient may arrive to the operating suite.
Achievement of the SCIP goals is a formidable, but achievable, process requiring individual, cultural, systems, and institutional changes to achieve success.
外科手术改进项目 (SCIP) 的设计目的是减少围手术期并发症。我们描述了我们在 6 个主要领域的机构经验：手术部位感染、静脉血栓栓塞预防、围手术期使用β受体阻滞剂、血清葡萄糖水平大于 200mg/dL、体温正常和使用电动剃须刀脱毛。
这是一项对手术病例的回顾性研究。进行了循证培训和系统与流程的标准化。确定了对 SCIP 指南的遵守情况。
在两年内，SCIP 的总体合规性从 80%提高到 94%。标准化的抗生素给药时间提高了超过 90%的合规性。适当的术前抗生素选择提高到 100%。术后 24 小时内停止使用抗生素仍然是一项艰巨的任务。由于术后出血的担忧，静脉血栓栓塞预防一直难以实现。由于患者可能通过多种途径到达手术室，β受体阻滞剂的使用仍然是最难纠正的问题之一。
实现 SCIP 目标是一个艰巨但可实现的过程，需要个人、文化、系统和机构的变革才能取得成功。
