What’s New in the Patient Safety World
December 2012
Joint Commission Collaborative on Colorectal SSI’s
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.
References:
Joint Commission
Center for Transforming Healthcare. Surgical Site Infections Press Kit.
http://www.centerfortransforminghealthcare.org/news/surgical_site_infections.aspx
story boards
http://www.centerfortransforminghealthcare.org/assets/4/6/SSI_storyboard.pdf
A Look at the Joint Commission. Robust Process Improvement™ at the Joint Commission. Bulletin of the American College of Surgeons. August 2011 p. 75
http://www.facs.org/fellows_info/bulletin/2011/jointcomm0811.pdf
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