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Published on: December 4, 2021
Pediatric surgeon-directed wound classification improves accuracy.
Tiffany J Zens1, Deborah A Rusy2, Ankush Gosain3
1Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; American Family Children's Hospital, University of Wisconsin Hospital and Clinics Madison, Madison, Wisconsin.
Surgeon-directed surgical wound classification (SWC) during debriefing significantly improved documentation accuracy. However, further education is needed as incorrect classifications, especially for contaminated wounds, persist.
Area of Science:
- Surgical Safety
- Healthcare Quality Improvement
- Medical Documentation
Background:
- Surgical wound classification (SWC) is crucial for assessing contamination and stratifying surgical site infection risk.
- Current nurse-directed SWC may lack accuracy.
- Improving SWC documentation is essential for reliable outcome comparisons.
Purpose of the Study:
- To evaluate the impact of transitioning from nurse-directed to surgeon-directed SWC during structured operative debriefing.
- To determine if surgeon-directed SWC improves documentation accuracy.
- To identify specific areas needing further improvement in SWC.
Main Methods:
- Retrospective chart review of pediatric general surgery cases before and after implementing surgeon-directed SWC during debriefing.
- Defined two periods: nurse-directed SWC (June 2012-May 2013) and surgeon-directed SWC (January 2014-August 2014).
- Assessed SWC accuracy for four common procedures: inguinal hernia repair, gastrostomy ± Nissen fundoplication, appendectomy without perforation, and appendectomy with perforation.
Main Results:
- SWC accuracy improved from 42% to 58.5% after implementing surgeon-directed SWC (P = 0.003).
- The rate of misclassification by more than one wound class decreased from 26.8% to 3.5% (P < 0.001).
- A significant proportion of contaminated cases were still misclassified as clean-contaminated after the intervention.
Conclusions:
- Structured operative debriefing with surgeon-directed SWC enhances correct wound classification and reduces misclassification severity.
- Despite improvements, a notable rate of incorrect SWC documentation (41.5%) persists, particularly for contaminated wounds.
- Further targeted education and process refinement are necessary to achieve optimal SWC accuracy.
