Hospitals sharply reduce infections, related costs
Any effort to reduce surgical infections and their associated costs may run into a formidable hurdle: Operating room teams tend to assume they’re using best practices when they’re actually not.
That’s one conclusion from a major study of 56 hospitals from 50 states and U.S. territories, collaborating to improve surgical care, significantly cut the rate of surgical infections for more than 35,000 patients in a yearlong, nationwide effort sponsored by the Centers for Medicare & Medicare Services (CMS) and led by Qualis Health, the Quality Improvement Organization (QIO) for Washington, Alaska, and Idaho.
Results of the National Surgical Infection Prevention Collaborative were reported recently in an article published in the American Journal of Surgery.
Forty-four hospitals that provided data throughout the collaborative reduced their surgical site infection rate by
27%.1
Conducted in 2002-2003, the National Surgical Infection Prevention Collaborative also involved 43 QIOs working under contract to CMS and laid the groundwork for ongoing QIO assistance to help groups of hospitals in every state prevent surgical infections.
A major cause of preventable morbidity and mortality in hospitals, surgical site infections complicate an estimated 780,000 operations each year, says Mark McClellan, MD, PhD, CMS administrator.
Research has shown that compared to similar risk patients undergoing the same surgery, a patient who gets a surgical site infection is twice as likely to die, five to six times more likely to require readmission, and likely to stay in the hospital twice as long. The costs of these complications may range from $30,000 to $50,000 per major surgery, he notes
Teams assume they use best practices
Jonathan Sugarman, MD, CEO of Qualis Health, says the collaborative focused on helping hospital teams adopt proven techniques for avoiding surgical infections.
A co-author of the article and current president of the American Health Quality Association (AHQA), Sugarman notes that hospital teams generally assume they already are routinely using the best practices.
"The collaborative helps teams measure what they are actually doing, provides guidance on systematically implementing processes known to cut the infection rate, and facilitates tracking of results," he says.
The collaborative emphasized rapid testing of small changes in the work of surgical teams, then incorporating successful modifications into routine care.
Surgical teams from the National Collaborative hospitals joined staff from state-based QIOs at a series of two-day learning sessions with Qualis Health over the course of a year.
Most of the teams came from large, urban hospitals, although some small, rural institutions participated as well. Between sessions, the teams worked with their local QIOs and communicated frequently with each other to share information about implementing improvements, barriers encountered, and lessons learned.
All teams in the collaborative agreed to focus on improving performance on three processes that CMS uses as national quality measures: administration of antibiotics within 60 minutes of surgical incision, use of appropriate antibiotics, and discontinuation of antibiotics within 24 hours of the end of surgery.
Most of the teams also worked on improving performance on one or more of the following: control of glucose levels during surgery, avoiding hypothermia during surgery, use of supplemental oxygen during surgery and recovery, and clipping rather than shaving the surgical site.
Over the course of the collaborative, the median performance of participating hospital teams improved on all process measures.
The overall infection rate fell more than a quarter, from 2.3% in the first three months of the collaborative to 1.7% in the last three months.
Evidence-based guidelines for preventing surgical infections are widely underutilized. Recent research shows, for example, that patients receive antibiotics in the 60 minutes prior to surgical incision — a key technique for avoiding infections — only a little more than half the time.
"Many participating hospitals found there was no one person in the perioperative routine who had an acknowledged responsibility for administration of the prophylactic antibiotic; performance improved when responsibility was made clear," the study authors report.
"Hospitals achieved significant improvement in this measure, which may have had the greatest impact on reported infection rates," they add.
Reference
- Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections.
Am J Surg 2005; 190:9-15.
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