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Change the habit to change the practice: Do audits really ever change anything?

D Bodansky1, Y Oskrochi1, G Judah2

  • 1Department of Orthopaedic Surgery, Royal Liverpool Hospital, PrescottPrescot Street, L7 8XP, United Kingdom.

Injury
|April 27, 2017
PubMed
Abstract

Insights

Point-of-decision prompts improved antibiotic selection for methicillin-resistant Staphylococcus aureus (MRSA) in emergency hip fracture surgery. However, MRSA eradication adherence and timely swab results remain challenges. Interventions should be sequential and habitual.

Area of Science:

  • Trauma Surgery
  • Infectious Disease Control
  • Healthcare Quality Improvement

Background:

  • Mandatory MRSA eradication and pre-operative antibiotics are crucial for emergency surgery.
  • Adherence to MRSA guidelines in emergency hip fracture surgery requires assessment.
  • Point-of-decision prompts can influence clinical behavior.

Purpose of the Study:

  • To assess adherence to MRSA guidelines in emergency hip fracture surgery.
  • To evaluate the impact of point-of-decision prompts on clinician behavior.
  • To improve patient outcomes through enhanced MRSA management.

Main Methods:

  • Retrospective record review of emergency hip fracture surgery patients.
  • Analysis of demographics, MRSA eradication therapy, and antibiotic use.
  • Intervention with posters and stickers, followed by re-audit.

Main Results:

  • Significant improvement in correct antibiotic choice for MRSA-unknown patients (18% to 94%) post-poster intervention.
  • Minimal increase in MRSA eradication therapy adherence (1% to 8%) post-sticker intervention.
  • MRSA swab results (median 48h) significantly delayed compared to operation time (median 24h).

Conclusions:

  • Point-of-decision reminders are effective for improving antibiotic selection.
  • Audit interventions should be simple and integrated into existing workflows.
  • Sustained improvement requires sequential and habitual integration of new behaviors.
Keywords:
AuditHip fracturesMRSAService improvement

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