Surgical care measures show significant progress

New data collected by Joint Commission-accredited hospitals show significant progress in compliance with evidence-based care processes linked to improved outcomes for surgical patients. The Joint Commission’s 2012 annual report, Improving America’s Hospitals, shows that the 2011 surgical care result is 97.6 percent, up from 82.1 percent in 2005. This change represents an improvement of 15.5 percentage points.

Known as “accountability measures,” the surgical composite includes:

  • Antibiotics within one hour before the first surgical cut
  • Appropriate prophylactic antibiotics
  • Stopping antibiotics within 24 hours
  • Cardiac patients with 9:00 am postoperative blood glucose
  • Patients with appropriate hair removal
  • Beta-blocker patients who received beta-blocker perioperatively
  • Prescribing venous thromboembolism (VTE) medicine/treatment
  • Receiving VTE medicine/treatment
  • Urinary catheter removed

These evidence-based measures are important in the prevention of common postsurgery issues such as surgical site infections and postoperative sepsis, as well as cardiovascular and thromboembolic complications. The nine measures, including the newly added measure for urinary catheter removal, which was added as an accountability measure in August 2011, address a very large number of different types of patients who undergo various surgical procedures.

The percentage of hospitals achieving composite rates greater than 90 percent for the accountability measures related to surgical care also has dramatically improved. In 2007, only 42.1 percent of hospitals achieved surgery-related composite rates greater than 90 percent. In 2011, the rate rose to 97.7 percent. Composite measures combine the results of all individual process measures on a similar medical condition into a single percentage rating calculated by adding up the number of times recommended evidence-based care was provided to patients and dividing this sum by the total number of opportunities to provide this care.

SURGICAL CARE MEASURE RESULTS
Performance measure 2007 2008 2009 2010 2011 Improvement since inception
(percentage points)
Surgical care composite 88.9% 93.5% 95.8% 96.4% 97.6% 15.5%
Antibiotics within one hour before the first surgical cut 89.5 93.5 96.2 97.4 98.2 16.4
CABG surgery 89.5 94.0 96.8 97.8 98.4 13.2
Cardiac surgery (other than CABG) 89.0 93.7 96.6 97.6 98.4 14.6
Colon surgery 82.4 87.6 91.8 94.7 96.5 24.3
Hip joint replacement surgery 89.4 93.4 96.3 97.5 98.2 16.9
Hysterectomy surgery 89.8 93.7 96.4 97.5 98.3 15.9
Knee joint replacement surgery 92.5 95.3 97.2 98.0 98.6 13.5
Vascular surgery 85.3 90.6 94.6 96.0 96.9 21.8
Appropriate prophylactic antibiotics 94.9 96.8 97.7 97.8 98.5 3.5
CABG surgery 97.8 98.7 99.5 99.6 99.7 1.9
Cardiac surgery (other than CABG) 96.2 99.1 99.7 99.8 99.8 3.6
Colon surgery 75.7 84.3 87.8 91.4 93.2 17.5
Hip joint replacement surgery 98.0 98.7 99.2 99.5 99.6 1.6
Hysterectomy surgery 93.7 96.1 96.3 94.5 96.3 2.7
Knee joint replacement surgery 98.2 98.8 99.3 99.5 99.7 1.5
Vascular surgery 95.3 96.6 97.8 98.2 98.6 3.3
Stopping antibiotics within 24 hours 85.6 90.5 93.5 95.7 97.0 23.5
CABG surgery 89.7 93.6 95.5 97.1 97.9 28.2
Cardiac surgery (other than CABG) 89.7 92.6 94.8 96.5 97.6 34.9
Colon surgery 74.8 80.4 84.9 90.8 93.6 32.1
Hip joint replacement surgery 84.0 89.8 93.6 95.9 97.2 28.0
Hysterectomy surgery 90.2 92.8 94.8 96.3 97.2 9.3
Knee joint replacement surgery 85.4 91.3 94.7 96.7 97.7 28.2
Vascular surgery 77.0 83.0 88.2 91.9 93.8 28.8
Cardiac patients with 9:00 am postoperative blood glucose N/A 89.9 92.7 94.1 95.3 5.4
Patients with appropriate hair removal N/A 97.4 99.2 99.7 99.8 2.4
Beta-blocker patients who received beta-blocker perioperatively N/A 92.0 91.5 94.4 96.4 4.3
Prescribing VTE medicine/treatment 87.2 92.1 93.7 95.2 97.8 10.6
Receiving VTE medicine/treatment 83.2 89.6 91.9 93.7 96.9 13.7
Urinary catheter removed N/A N/A N/A 91.3 94.1 2.8

Surgical care measure results

In the table above the overall measure and rates are indicated in color; the stratified measures (by specific surgical procedures) are indicated in regular type. The first three overall measures listed—antibiotics within one hour before the first surgical cut, appropriate prophylactic antibiotics, and stopping antibiotics within 24 hours—include rates on seven specific surgical procedures, as well as the overall measure rate.

Beginning in 2012, all Joint Commission-accredited hospitals are required to meet a performance improvement standard that establishes an 85 percent composite compliance target on all of the hospital’s selected accountability measures. In addition to surgical care, the accountability measures include heart attack, heart failure, pneumonia, and children’s asthma care core measure sets. Most hospitals choose the surgical core measure set as one of their reported core measure sets.

For more information about the surgical and other accountability measures, visit The Joint Commission. The Joint Commission’s 2012 annual report is also available for download.

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