Improving Time to Antibiotics for Long-Bone Open Fractures: A Quality Improvement Initiative.

Area of Science:

• Trauma surgery
• Infectious disease prevention
• Healthcare process improvement

Background:

• Open fractures pose a high infection risk due to environmental exposure.
• Timely antibiotic administration (within 60 minutes) in the emergency department (ED) is critical for infection prevention.
• High ED patient volumes often impede timely antibiotic delivery.

Purpose of the Study:

• To enhance the time to antibiotic administration for patients with long-bone open fractures.
• To improve adherence to the 60-minute window for antibiotic delivery in a Level 1 trauma center ED.

Main Methods:

• Utilized the Lean Six Sigma Define, Measure, Analyze, Improve, and Control (DMAIC) framework.
• Implemented interventions including educational initiatives, an electronic medical record (EMR) order set, and workflow restructuring.
• Prioritized long-bone open fractures for immediate evaluation and antibiotic administration in a critical care zone.

Main Results:

• Significantly decreased the mean time to antibiotics from 76 to 40 minutes (p < .001).
• Increased the percentage of patients receiving antibiotics within 60 minutes from 64% to 92% (p < .001).
• No significant changes observed in age, sex, injury mechanism, antibiotic choice, or fracture location.

Conclusions:

• Process improvement methodologies, specifically Lean Six Sigma, effectively reduced antibiotic administration time for open fractures.
• Workflow optimization and targeted interventions are key to improving timely care in high-volume ED settings.
• Successful implementation demonstrates a replicable model for enhancing critical care delivery in trauma centers.