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Enhancing Compliance with Medicare Guidelines for Surgical Infection Prevention (SIP)- An Institutional experience with a cross disciplinary quality improvement team.
Laurence E McCahill1, John Ahern2, Linda Gruppi2, Jim Limanek1, Jessica Sussman2, Gail Dion2, Christina McCaffrey2, Richard Single1
1University of Vermont, Burlington, VT;2Fletcher Allen Health Care, Burlington, VT
Objectives: To evaluate compliance with nationalized Surgical Infection Prevention (SIP) process measures.
Design: Prospective Observational Study
Setting: Tertiary Care Hospital
Patients: All patients undergoing the following operations: 1) CABG 2) Other cardiac 3) Vascular 4) Hysterectomy 5) Colon 6) Hip arthroplasty 7) Knee arthroplasty from July 2004 through Dec 2005 were monitored for compliance with SIP process measures
Intervention: A cross disciplinary team including: surgeon, anesthesiologist, nurses (pre-operative, OR, floor), pharmacist, quality improvement and operations specialists was created in July 2004. Policy and responsibility for SIP processes were defined, standardization of physician orders was created, antibiotic access improved, and communication/education for health care professionals was enhanced.
Main Outcome Measures:
Compliance with three SIP measures over three consecutive periods of 6 months each:
1) % patients receiving antibiotics within 1 hour of surgical incision
2) % patients with appropriately selected antibiotics
3) % patients with prophylactic antibiotics discontinued (D/C) within 24 hours
Results: 849 patients were monitored.
Compliance for measure #1 improved from 72.3% to 83.8% (p<.001, Cochran-Armitage trend test); improvement was demonstrated in 3/7 services, and is > 90% in 2 better performing services.
D/C antibiotics improved from 54.5% to 87.2% (p<.001) and improvement was seen in 5/7 services.
Appropriate selection of antibiotic remains uniformly high (98%) and has been unchanged.
Conclusion: A cross disciplinary quality improvement team can address the many disciplines/processes involved with the delivery and discontinuation of prophylactic antibiotics in a timely fashion. This model has been successful in improving compliance with SIP measures at our institution.
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