The Joint Commission Center for Transforming Healthcare has done a number of collaborative projects aimed at improving quality and patient safety, including projects on hand hygiene, wrong-site surgery, and handoffs (see our August 2012 What’s New in the Patient Safety World column “New Joint Commission Tools for Improving Handoffs”).
Results of one of their most recent collaboratives have just been released and the outcomes are quite impressive. The collaborative to reduce colorectal surgical site infections was done in conjunction with the American College of Surgeons and 7 hospitals, most of which you’ll readily recognize as having high quality to begin with. They were able to reduce superficial incisional SSIs by 45 percent and all types of colorectal SSIs by 32 percent. In addition, the average length of stay for hospital patients with any type of colorectal SSI was decreased by 2 days. The estimated net savings was $3.7 million.
Their collaborative programs make use of LEAN and Six Sigma and RPI (Robust Process Improvement™). They first identified factors contributing to SSI’s and then developed targeted solutions for these. And, of course, strict use of metrics and feedback are a core part of the process. The solutions implemented are nicely described in the site’s storyboards. The actual interventions should not be any surprise to you but the facilities each identified which interventions were not fully adhered to and developed programs to improve adherence to those recommended interventions. For example, while most were already doing well with choice and timing of prophylactic antibiotics they addressed the issue of weight-based dosing of prophylactic antibiotics and the need to re-dose during prolonged procedures.
Other interventions included:
· Standardized preoperative order sets
· Standardization of skin cleansing for both patients and caregivers
· Protocols for preoperative warming and warming within the OR
· Standardize the closing process
· Separate clean vs. dirty parts of procedure (eg. new gloves, gowns, equipment and instruments after the “dirty” part of procedure completed)
· Standardize wound dressing and wound management
· Focus on hand hygiene (eg. make hand cleansing agent readily available for staff for example by attaching hand sanitizer to bed poles)
· Patient education on wound care at discharge
· Wound ostomy nurse
· Followup phone calls
This is another great example of saying “We know what to do. Why don’t we do it and do it right every time?” Probably the most important lessons from these collaboratives are the change management principles utilized and the rigorous adherence to protocols plus making it easier for everyone to remember to do the right thing. Most importantly it says that even already high performing organizations can apply these principles to make their performance even better.
Joint Commission Center for Transforming Healthcare. Surgical Site Infections Press Kit.
A Look at the Joint Commission. Robust Process Improvement™ at the Joint Commission. Bulletin of the American College of Surgeons. August 2011 p. 75
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