National Academy of Medicine

Surgical Complexity Initiative

By Robert A. Petzel
March 09, 2012 | Commentary

A basic aim of effective and efficient health care is ensuring the right match between the patient’s condition and the setting for the patient’s care. With that aim in mind, the U.S. Department of Veterans Affairs (VA) recently implemented the Surgical Complexity Initiative to further improve the safety and quality of care for Veterans. This is the first national effort to align the complexity of surgical procedures performed by a Veterans Health Administration (VHA) facility with that facility’s demonstrated infrastructure (e.g., ICU critical care coverage, professionals trained in necessary specialties). The new initiative ensures that VHA surgical programs practice within the scope of their available resources, thereby avoiding potential complications often associated with “surgical mission creep.”

The initiative was developed in response to patient incidents at a facility in 2007, in which the root cause was determined to include the performance of surgical procedures without the necessary supporting infrastructure. To address this issue, VHA’s efforts centered around three basic steps. The first step was to develop two matrices, the Procedure Infrastructure Matrix and the Surgical Complexity Matrix. The Procedure Infrastructure Matrix designates the in-frastructure requirements for a VHA facility with an inpatient surgical program as one of three levels: standard, intermediate, or complex. The Surgical Complexity Matrix uses the same designations to categorize surgical procedures based on Current Procedure Terminology (CPT) code.


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