DNP 840 Discuss a health care policy or practice that has been advanced through lobbying efforts at the national level Re: Topic 7 DQ 2

The roots of the quality improvement movement can be traced back to the work of epic figures such as Ignaz Semmelweis, the 19th-century obstetrician who championed the importance of hand washing in medical care. In addition, Florence Nightingale, the English nurse, identified the association between poor living conditions and high death rates among soldiers treated at army hospitals. The modern quality movement has since transformed to include a wide variety of stakeholders, a range of unique and modified approaches, and an evolving set of goals. The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. Several years later along the healthcare quality timeline, in 2003, the Surgical Care Improvement Program (SCIP) was established. SCIP is a voluntary multidisciplinary partnership of organizations that was created based on the Surgical Infection Prevention (SIP) program and the NSQIP model, and aimed at reducing surgical complications and mortality.

In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) to increase compliance with a bundle of SSI prevention and other quality improvement measures. SCIP was a Joint Commission initiative, which included a set of publicly reported evidenced-based antimicrobial guideline compliance metrics primarily targeting high-risk surgeries in five specialties, such as cardiac bypasses and orthopedic total joint replacements [5]. Public reporting of SCIP metrics required resource-intense manual review by a trained reviewer as part of the VA’s External Peer Review Program (EPRP) to assess compliance with the antimicrobial administration metrics. Following implementation of active reporting, VA compliance with guideline-concordant preoperative antimicrobial use (SCIP INF-1) and prompt discontinuation of antimicrobials postoperatively (SCIP INF-3) exceeded 95% [6,7,8]. After this high level of compliance was achieved, SCIP was retired in 2015, as the measurement and reporting process was felt to be costly with limited additional expected benefit. Since the program’s retirement, no studies have examined if the practice changes achieved through the active SCIP program were sustained, or if improvements spread beyond the originally targeted surgeries to procedures not included under the umbrella of the original program.

Branch-Elliman, W., Elwy, A.R., Lamkin, R.L. et al. Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol. Implement Sci Commun 3, 47 (2022). https://doi.org/10.1186/s43058-022-00288-0

Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. (2017).  Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784–91. https://doi.org/10.1001/jamasurg.2017.0904.