Using quality improvement methods to change surgical practice: a case example of pediatric soft-tissue abscesses

Area of Science:

• Surgical Innovation
• Quality Improvement in Healthcare
• Pediatric Surgery

Background:

• Traditional surgical treatments for soft-tissue abscesses (STAs) involve packing or ring drain (RD) and straight drain (SD) placement.
• Straight drains (SDs) offer potential benefits like a single incision, reduced scarring, and elimination of follow-up appointments.
• A multidisciplinary quality improvement (QI) process was implemented to encourage surgeon adoption of SDs for STAs.

Purpose of the Study:

• To assess the impact of a QI initiative on the adoption of straight drain (SD) placement for soft-tissue abscesses (STAs).
• To evaluate changes in surgical practice, patient follow-up requirements, and complication rates following the QI intervention.

Main Methods:

• The study measured the proportion of STAs treated with SDs.
• Key outcomes included the number of postoperative clinic visits and the rate of complications, defined as the need for re-operation.
• Data were collected before and after the QI initiative was introduced.

Main Results:

• The use of SDs for STAs increased significantly from 23% to 78% post-QI implementation (P < .00001).
• The proportion of patients requiring surgical follow-up decreased from 71% to 32% (P < .00001).
• Complication rates were comparable between RD (2.4%) and SD (1.7%) groups (P = .57), with no increase observed.

Conclusions:

• The QI initiative effectively promoted the adoption of straight drain (SD) placement for soft-tissue abscesses (STAs).
• This shift in practice led to a significant reduction in postoperative clinic visits without an increase in complications.
• The findings demonstrate a successful QI strategy for improving efficiency and quality of care in STA management.