Evidence that a Regional Surgical Collaborative Can Transform Care: Surgical Site Infection Prevention Practices for
Joceline V Vu1, Stacey D Collins2, Elizabeth Seese2
1Department of Surgery, University of Michigan, Ann Arbor, MI.
Background:
Surgical site infections (SSI) after colectomy are associated with increased morbidity and health care use. Since 2012, the Michigan Surgical Quality Collaborative (MSQC) has promoted a "bundle" of care processes associated with lower SSI risk, using an audit-and-feedback system for adherence, face-to-face meetings, and support for quality improvement projects at participating hospitals. The purpose of this study was to determine whether practices changed over time.
Study Design:
We previously found 6 processes of care independently associated with SSI in colectomy. From 2012 to 2016, we promoted a bundle of 3 care measures (cefazolin/metronidazole, oral antibiotics after mechanical bowel preparation, and normoglycemia) in 52 hospitals. Primary outcome was change in use of the 3-item SSI bundle. We also used a hierarchical logistic regression model to assess the association between 6-item compliance and SSI rate, morbidity, and health care use.
Results:
The use of cefazolin/metronidazole increased from 18.6% to 32.3% (p < 0.001), oral antibiotic preparation increased from 42.9% to 62.0% (p < 0.001). The increase in normoglycemia was not significant. Concurrently, the SSI rate fell from 6.7% to 3.9% in the 52 hospitals (p = 0.012). Patients receiving more bundle measures had decreased rates of SSI, sepsis, and pneumonia. Morbidity and health care use significantly decreased with increased bundle compliance.
Conclusions:
These data show a significant increase in use of process measures promoted by a regional quality improvement collaborative, and an associated decrease in SSI after elective colectomy. These results highlight the promise of regional collaboratives to accelerate practice change and improve outcomes.
Insights
Regional quality collaboratives can improve surgical site infection (SSI) rates after colectomy. Promoting a bundle of care processes significantly reduced SSI and associated complications, demonstrating the effectiveness of collaborative quality improvement initiatives.
Area of Science:
- Surgical Quality Improvement
- Infectious Disease Prevention
- Colorectal Surgery Outcomes
Background:
- Surgical site infections (SSI) following colectomy increase patient morbidity and healthcare utilization.
- The Michigan Surgical Quality Collaborative (MSQC) implemented a care bundle and audit-feedback system to reduce SSI risk since 2012.
- Assessing practice changes and their impact on SSI rates over time was the study's objective.
Purpose of the Study:
- To evaluate the impact of a regional quality improvement collaborative on surgical practices and outcomes after colectomy.
- To determine if the adoption of a specific care bundle influenced SSI rates.
- To assess the association between adherence to care processes and patient outcomes.
Main Methods:
- A prospective study involving 52 hospitals from 2012 to 2016.
- Promotion of a 3-item care bundle: cefazolin/metronidazole, oral antibiotics post-bowel preparation, and normoglycemia.
- Hierarchical logistic regression analysis to correlate bundle compliance with SSI rates, morbidity, and healthcare use.
Main Results:
- Significant increases in the use of cefazolin/metronidazole (18.6% to 32.3%) and oral antibiotics (42.9% to 62.0%) were observed (p < 0.001).
- The overall SSI rate decreased from 6.7% to 3.9% (p = 0.012) across the participating hospitals.
- Higher compliance with the care bundle correlated with reduced SSI, sepsis, pneumonia, morbidity, and healthcare use.
Conclusions:
- Regional quality collaboratives can effectively drive practice changes to improve surgical outcomes.
- The implemented care bundle demonstrated a significant reduction in SSI after elective colectomy.
- These findings underscore the potential of collaborative efforts in accelerating practice transformation and enhancing patient care.
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