"But it's really hard to show that adhering strictly to these processes of care is able to have any real influence on reducing these infections or VTE events," Hawn says. That's because the measures themselves have been "dumbed down," and lack specificity.
For example, the VTE SCIP measure to prevent pulmonary embolism or deep vein thrombosis, "is a very blunt measure. It looks at the first or second day to see if the patient got VTE prophylaxis. It doesn't look at whether they got it for the entire hospitalization, or whether they got it after discharge, or whether they were stratified into a high risk group."
She adds that while these measures are written in a way to make them simple for hospital surgical teams to report, they don't measure whether the team "tailored the measure to the complexity of the patient."
In an invited commentary, Elizabeth Hechenbleikner, MD, and Elizabeth Wick, MD, surgeons at Johns Hopkins Hospital, agreed, saying that these measures "are more complex to execute well than it may seem."
Hawn says the "focus needs to be on really assessing readiness and criteria for discharge, figuring out who the high risk patients are, and maybe doing more wrap-around services with those patients, with home health, and see if those strategies an reduce complications."
She adds, "We need to study every readmission of a surgical patient in the light of their previous admission, and ask, 'Okay. Was there something— anything—we could have done differently?' "