A Performance Improvement Project in Antibiotic Administration for Open Fractures

To evaluate the effects of a trauma performance improvement project involving standardized protocols for the administration of antibiotics in open fractures at a level one trauma center. This study specifically evaluated the protocol's efficacy for improving the timing of delivery and appropriate therapy administration and sought to identify factors that lead to the delay in antibiotic delivery.

Retrospective comparative cohort study comparing patients with open fractures treated at our hospital between January 2013 and September 2015 (group 1) and between April 2016 and June 2017 (group 2). Group 1 was treated before implementation of the performance improvement project and group 2 was treated after implementation.

Group 1 consisted of 79 patients and group 2 consisted of 80 patients with open fractures. Each group was statistically similar in patient and injury factors. Group 1 received antibiotics at an average of 97 minutes after arrival to our hospital while group 2 patients received them at an average of 46 minutes (P < 0.0001). Average time from admission to initial evaluation improved from 10 to 3 minutes (P < 0.0001). Average time from evaluation to antibiotic order placement improved from 77 to 26 minutes (P < 0.0001). Average time from order entry to antibiotic administration showed no significant difference (12 versus 15 minutes, P = 0.25). Thirty-four percent (27/79) of group 1 patients and 84% (67/80) of group 2 patients received antibiotics within 1 hour of admission (P < 0.0001), while 91% and 99% received antibiotics within 3 hours, respectively (P = 0.03).

The described multifaceted performance improvement protocol was highly effective for producing a more coordinated, efficient, and timely process for administration of antibiotics to patients with open fractures at our hospital. This protocol may be adopted and implemented at other facilities.

Therapeutic level III.