Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients. Bundle elements included use of chlorhexidine gluconate wipes the night before surgery and the day of surgery, use of preoperative nutrition screens, development and use of a prophylactic antibiotic dosing chart, use of methicillin-resistant Staphylococcus aureus screening, maintenance of normal patient temperature, and use of nasal swabs in the operating room. The SSI rate dropped from a baseline figure of 4% in 2013 (n = 154) and 3.2% in 2014 (n = 189) to 0.0% (n = 198) in 2015 after the bundles were implemented. Both compliance with the bundle and SSI rates must be monitored monthly. Staff and providers should be offered monthly feedback on SSI rates and care bundle compliance. If an SSI does occur, a root-cause analysis is performed with the multidisciplinary care team using a standardized review form.
Introduction The pediatric perioperative surgical home (PPSH) is a population health management model designed to provide a seamless experience for children and their families undergoing surgical procedures. The purpose of this quality improvement project is to evaluate the feasibility and utility of implementing a PPSH at an academic medical center. Method A multidisciplinary team was formed, composed of representatives from nursing, surgery, anesthesiology, and perioperative medicine. This group developed a comprehensive preoperative screening tool designed for early identification of patient barriers before elective surgery. The screening tool was developed with input from multiple pediatric subspecialists. At the initial surgical visit, patients and families are encouraged to complete this screening tool. The screening tool was piloted to 74 patients (46 completed) in a pediatric orthopedic clinic for an 8-month period. Existing tools in the electronic medical record system were identified to assist with care coordination perioperatively. Result In comparing our baseline period (2016, n = 174) with the early implementation phase of our PPSH (2017, n = 188), unplanned readmission rates decreased from 4.0% to 2% (p = .011), and surgical site infections decreased from 3.5% to 2.3% (p = .002), whereas unplanned return to operating room and average length of stay remained the same. Conclusion Information obtained within a PPSH informs the entire team of important factors that could influence perioperative care. A PPSH serves to make the health care team more efficient and may also be associated with a reduction in complications, cost, and time spent in the hospital.
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