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Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections
Alexander R Hover1, William W Sistrunk2, Robert M Cavagnol2
1Mercy Medical Research Institute, Springfield, MO Alexander.hover@mercy.net.
Abstract:
Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective.
Insights
Failure Mode and Effects Analysis (FMEA) significantly reduced neurosurgery infections at Mercy Hospital Springfield, lowering rates by 41% and saving costs. This quality improvement initiative demonstrated clinical cost-effectiveness.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Surgical Site Infections
Background:
- Mercy Hospital Springfield, a tertiary care facility, maintained a stable inpatient elective neurosurgery infection rate of 2.15% from June 2009 to January 2011.
- Healthcare-associated infections pose significant morbidity and economic burdens.
Purpose of the Study:
- To implement and evaluate the effectiveness of the Failure Mode and Effects Analysis (FMEA) methodology in reducing inpatient neurosurgery infections.
- To assess the clinical cost-effectiveness of FMEA implementation.
Main Methods:
- The Failure Mode and Effects Analysis (FMEA) methodology was applied to identify and mitigate risks associated with inpatient neurosurgery infections.
- Infection rates were monitored before and after FMEA implementation.
Main Results:
- Following FMEA implementation, the overall elective neurosurgery infection rate decreased to 1.51% and was sustained through May 2012.
- A 41% reduction in deep-space and organ infection rates was observed post-FMEA (P = .052).
- Overall hospital clean surgery infection rates did not show a comparable decrease, suggesting a specific FMEA effect.
Conclusions:
- FMEA implementation resulted in a significant reduction in neurosurgery infections, with an estimated 14 fewer infections, $270,270 in savings, a 168-day reduction in length of stay, and 22 fewer readmissions.
- The study concludes that FMEA implementation is a clinically cost-effective strategy for reducing healthcare-associated infections in surgical settings.
