Description of a multidisciplinary initiative to improve SCIP measures related to pre-operative antibiotic prophylaxis compliance: a single-center success story

Abstract

BackgroundThe Surgical Care Improvement Project (SCIP) was launched in 2005. The core prophylactic perioperative antibiotic guidelines were created due to recognition of the impact of proper perioperative prophylaxis on an estimated annual one million inpatient days and $1.6 billion in excess health care costs secondary to preventable surgical site infections (SSIs). An internal study was conducted to create low cost, standardized processes on an institutional level to improve compliance with prophylactic antibiotic administration.MethodsWe assessed the impact of auditing and notifying providers of SCIP errors on overall compliance with inpatient antibiotic guidelines and on net financial gain or loss to a large tertiary center between March 1st 2010 and September 31st 2013. We hypothesized that direct physician-to-physician feedback would result in significant compliance improvements.ResultsThrough physician notification, our hospital was able to significantly improve SCIP compliance and emphasis on patient safety within a year of intervention implementation. The hospital earned an additional $290,612 in 2011 and $209,096 in 2012 for re-investment in patient care initiatives.ConclusionsProvider education and direct notification of SCIP prophylactic antibiotic dosing errors resulted in improved compliance with national patient improvement guidelines. There were differences between the anesthesiology and surgery department feedback responses, the latter likely attributed to diverse surgical department sub-divisions, frequent changes in resident trainees and supervising attending staff, and the comparative ability. Provider notification of guideline non-compliance should be encouraged as standard practice to improve patient safety. Also, the hospital experienced increased revenue for re-investment in patient care as a secondary result of provider notification.

Using physiological monitoring data for performance feedback: an initiative using thermoregulation metrics

“…Ces données sont partagées tous les six mois sous forme de graphique de séquences pour le groupe complet et sous forme de diagramme des quartiles dépersonnalisé (codé) pour chaque anesthésiologiste. Résultats Ce renvoi des données de retard dans la prise de température a réduit le retard moyen [écart interquartile] de 39,0 [18,5] min à 14,4 [10,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]9] min (réduction médiane, 21,8 min; intervalle de confiance 95 %, 14,9 à 28,2; P \ 0,001). Toutefois, ce renvoi d'information n'a pas permis de réduire davantage le pourcentage de temps durant lequel les patients étaient en hypothermie au-delà des améliorations déjà apportées grâce au préchauffage.…”

“…Feedback of performance data has been shown to improve professional practice and outcomes. [1][2][3] Examples include improved antibiotic administration, 4,5 reduced drug cost, 6 and improved operating room booking efficiency. 7 Vital signs, drug infusion, and therapy device data are not routinely included in quality improvement (QI) research because of their limited availability.…”

Anaesthetists’ knowledge of surgical antibiotic prophylaxis: a prospective descriptive study

“…Local anaesthesia journals and continuing medical educations programmes could focus on the topic of SAP as a means of improving senior anaesthetists' knowledge as well. Other interventions that have proved successful worldwide include auditing SAP received by patients and notifying providers of their errors, 29 distributing newsletters, 30 use of a timeout period in which SAP can be administered 30 and development and implementation of public reporting of compliance with SAP guidelines. 14 The lack of widely available local guidelines at the universityaffiliated hospitals in which the study population works may contribute to the lack of knowledge and poor awareness of guidelines.…”

Correction of Femoral Acetabular Impingement at the Time of Primary THA

“…Wound closure was performed without drains. Intravenous antibiotics were administered preoperatively and continued for 24 hours, adhering to SCIP guidelines [17].…”