TY - JOUR
T1 - Leveraging a Comprehensive Program to Implement a Colorectal Surgical Site Infection Reduction Bundle in a Statewide Quality Improvement Collaborative
AU - Mcgee, Michael F.
AU - Kreutzer, Lindsey
AU - Quinn, Christopher M.
AU - Yang, Anthony
AU - Shan, Ying
AU - Halverson, Amy L.
AU - Love, Remi
AU - Johnson, Julie K.
AU - Prachand, Vivek
AU - Bilimoria, Karl Y.
N1 - Funding Information:
From the *Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago, IL; †Surgical Outcomes and Quality Improvement Center (SOQIC), Depart-ment of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; zCenter for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; and §Department of Surgery, University of Chicago, Chicago, IL. Y mmcgee1@nm.org. This work is supported by the Agency for Healthcare Research and Quality (R01HS024516 [PI: K.Y.B.]), National Institutes of Health (K08HL145139 [PI: A.Y.]), and the Health Care Services Corporation/Blue Cross Blue Shield of Illinois (PI: K.Y.B.). This work was presented at the American Surgical Association Annual Meeting in Dallas, TX on April 13, 2019. The authors report no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/19/27004-0701 DOI: 10.1097/SLA.0000000000003524
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Objectives:Our objective was to examine the implementation and associated clinical outcomes of a comprehensive surgical site infection (SSI) reduction bundle in a large statewide surgical quality improvement collaborative leveraging a multifaceted implementation strategy.Summary Background Data:Bundled perioperative interventions reduce colorectal SSI rates when enacted at individual hospitals, but the ability to implement comprehensive SSI bundles and to examine the resultant clinical effectiveness within a larger, diverse population of hospitals is unknown.Methods:A multifaceted SSI reduction bundle was developed and implemented in a large statewide surgical quality improvement collaborative through a novel implementation program consisting of guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence and ACS NSQIP outcomes were examined preimplementation versus postimplementation.Results:Among 32 hospitals, there was a 2.5-fold relative increase in the proportion of patients completing at least 75% of bundle elements (preimplementation = 19.5% vs. postimplementation = 49.8%, P = 0.001). Largest adherence gains were seen in wound closure re-gowning/re-gloving (24.0% vs. 62.0%, P < 0.001), use of clean closing instruments (32.1% vs. 66.2%, P = 0.003), and preoperative chlorhexidine bathing (46.1% vs. 77.6%, P < 0.001). Multivariable analyses showed a trend toward lower risk of superficial incisional SSI in the postimplementation period compared to baseline (OR 0.70, 95% CI 0.49-10.2, P = 0.06). As the adherence in the number of bundle elements increased, there was a significant decrease in superficial SSI rates (lowest adherence quintile, 4.6% vs. highest, 1.5%, P < 0.001).Conclusions:A comprehensive multifaceted SSI reduction bundle can be successfully implemented throughout a large quality improvement learning collaborative when coordinated quality improvement activities are leveraged, resulting in a 30% decline in SSI rates. Lower superficial SSI rates are associated with the number of adherent bundle elements a patient receives, rendering considerable benefits to institutions capable of implementing more components of the bundle.
AB - Objectives:Our objective was to examine the implementation and associated clinical outcomes of a comprehensive surgical site infection (SSI) reduction bundle in a large statewide surgical quality improvement collaborative leveraging a multifaceted implementation strategy.Summary Background Data:Bundled perioperative interventions reduce colorectal SSI rates when enacted at individual hospitals, but the ability to implement comprehensive SSI bundles and to examine the resultant clinical effectiveness within a larger, diverse population of hospitals is unknown.Methods:A multifaceted SSI reduction bundle was developed and implemented in a large statewide surgical quality improvement collaborative through a novel implementation program consisting of guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence and ACS NSQIP outcomes were examined preimplementation versus postimplementation.Results:Among 32 hospitals, there was a 2.5-fold relative increase in the proportion of patients completing at least 75% of bundle elements (preimplementation = 19.5% vs. postimplementation = 49.8%, P = 0.001). Largest adherence gains were seen in wound closure re-gowning/re-gloving (24.0% vs. 62.0%, P < 0.001), use of clean closing instruments (32.1% vs. 66.2%, P = 0.003), and preoperative chlorhexidine bathing (46.1% vs. 77.6%, P < 0.001). Multivariable analyses showed a trend toward lower risk of superficial incisional SSI in the postimplementation period compared to baseline (OR 0.70, 95% CI 0.49-10.2, P = 0.06). As the adherence in the number of bundle elements increased, there was a significant decrease in superficial SSI rates (lowest adherence quintile, 4.6% vs. highest, 1.5%, P < 0.001).Conclusions:A comprehensive multifaceted SSI reduction bundle can be successfully implemented throughout a large quality improvement learning collaborative when coordinated quality improvement activities are leveraged, resulting in a 30% decline in SSI rates. Lower superficial SSI rates are associated with the number of adherent bundle elements a patient receives, rendering considerable benefits to institutions capable of implementing more components of the bundle.
KW - bundle
KW - colectomy
KW - colorectal
KW - proctectomy
KW - quality improvement
KW - surgical site infection
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U2 - 10.1097/SLA.0000000000003524
DO - 10.1097/SLA.0000000000003524
M3 - Article
C2 - 31503066
AN - SCOPUS:85070765274
VL - 270
SP - 701
EP - 711
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 4
ER -