Strategies to help track infections after discharge
Don’t miss post-discharge complications
When you gather data about surgical wound infections, are many of these infections going unrecognized because they’re not apparent until after the patient is discharged? Here are successful strategies for this data collection challenge.
"Our information management department generates a monthly report based on particular charges associated with surgical procedures, which is converted to an Excel spreadsheet," says Lisa N. Tyson, RN, COHN-S, director of employee health & infection control at J. Arthur Dosher Memorial Hospital in Southport, NC.
Tyson is able to sort the list by patient name, date, or surgeon. "I always check the list against the OR logs just to make sure no one was missed, since the charges are entered manually," she says.
After sorting the table once more by surgeon, Tyson copies it to a template with a checkbox for the surgeon to note whether anyone developed an infection after discharge within 30 days of the operative procedure. Tyson sends the cover letter, form, and Centers for Disease Control and Prevention (CDC) definitions out the first of each month for procedures done at least 30 days prior to that date. "If the form hasn’t been returned to me by the time the next list is due to be sent, I’ll call the office manager and ask her to investigate," says Tyson. "So far, our return rate has been great with this method.
"I also request additional comments on the form for anyone who is identified," says Tyson. "If I receive a form that identifies a possible post-discharge surgical-site infection, I always contact the physician’s office for the visit notes that document the surgeon’s findings." Although CDC definitions are included with the cover letter and form, some surgeons have identified a stitch abscess as a surgical-site infection, which isn’t consistent with CDC definitions, notes Tyson. "If the infection does not meet CDC criteria, it is excluded," she says. "This rarely occurs anymore."
Like most hospitals, OR nurses call surgical patients the following day to check for complications. Depending on the seriousness of concerns voiced by the patient, the OR nurse either calls the surgeon’s office or refers the patient to their surgeon. The organization has a very low infection rate, but each one is reviewed closely with an in-depth investigation, including chart review and interviews with staff, says Tyson.
At Memorial Health University Medical Center in Savannah, GA, various tools are used to collect surgical infection data, including phone calls to patients, letters mailed, and interviews with surgeons’ office staff, says Mary M. McNally, RN, MHA, CIC, CHS, nurse epidemiologist and director of the organization’s Center for Infectious Diseases.
"Depending on the patient to give you accurate feedback on complications is tenuous because you have to rely on their understanding of definitions of infection, reliable temperature taking, and descriptions of wound sites," says McNally.
Establish a relationship with the surgeon’s office personnel, since this can help you obtain accurate information on post-operative complications, McNally recommends.
"They are examining the patient and can give you the most reliable description," she says. "You can also ensure appropriate culturing of questionable post-op wounds."
At Memorial, patients are called the day after surgery to check on their progress, but McNally recommends follow-up calls one week post-surgery to check for additional complications.
Letters also are sent to surgeons at the end of the month asking them to identify which patients experienced a post-operative complication. "We have an 80% to 85% return rate," says McNally. "We also interview surgeon’s staff if we detect an infection from a positive culture or a patient is readmitted with post-operative fever."
Quality professionals assist infection control by working to change practices that may put patients at risk for infection, says McNally. "It is also their role to lead performance improvement teams to reduce infections and make recommendations for practices to improve outcomes."
The organization recently formed a multidisciplinary rapid improvement team with infection control, quality, surgery, finance, and senior leaders to implement processes to reduce surgical-site infections.
"We work together to ensure compliance, attend surgery department meetings to feed the data back to the surgeons and surgical staff, and perform education to those groups," she says. "This relationship between us and quality has enhanced support from the medical staff. All disciplines are now much more collaborative than ever before."
When you gather data about surgical wound infections, are many of these infections going unrecognized because theyre not apparent until after the patient is discharged? Here are successful strategies for this data collection challenge.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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