Clinical Science
Reducing colorectal surgical site infections: a novel, resident-driven, quality initiative

https://doi.org/10.1016/j.amjsurg.2016.04.009Get rights and content

Highlights

  • Question: We aim to show that a resident-driven and implemented quality initiative can measurably improve patient outcomes and care in an academic hospital center.

  • Findings: This was an implementation study that demonstrated a significant decrease in surgical site infections from 13.9% to 4.7% after initiating a colorectal surgery care bundle.

  • Meaning: Patient care initiatives can and should be initiated by all members of the health community and have the potential to measurably improve the care of patients.

Abstract

Background

Surgical site infections (SSIs) cause significant patient morbidity and increase costs. This work prospectively examines our institutional effort to reduce SSIs through a resident-driven quality initiative.

Methods

A general surgery resident-championed, evidenced-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship. National Surgical Quality Improvement Program definitions for SSIs were used. Data were collected prospectively and bundle compliance was monitored using a checklist. The primary outcome compared SSIs before and after implementation.

Results

In the 2 years preceding standardization, 489 colorectal surgery cases were performed. SSIs occurred in 68 patients (13.9% SSI rate). Following implementation of the bundle, 212 cases were performed with 10 SSIs (4.7% SSI rate, P < .01). Multivariate logistic regression analysis found a decrease in superficial and overall SSIs (odds ratio .17, 95% confidence interval .05 to .59; odds ratio .31, 95% confidence interval .14 to .68).

Conclusions

These data demonstrate that resident-driven initiatives to improve quality of care can be a swift and effective way to enact change. We observed significantly decreased SSIs with a renewed focus on evidence-based, standardized patient care.

Section snippets

Study design

Institutional Review Board approval at Thomas Jefferson University Hospital was obtained. Institutional ACS-NSQIP colorectal data on all nonemergent cases from January 1, 2012 to February 28, 2015 were reviewed. Cases included both open and laparoscopic procedures including the following: partial or total colectomy with or without proctectomy, Hartmann-type procedure, total abdominal colectomy with or without proctectomy, proctectomy, or excision of rectal procidentia (including the following

Results

Seven hundred and one (n =701) consecutive patients who underwent nonemergent colorectal operations from January 2012 to February 2015 at the Thomas Jefferson University Hospital were included in the analysis, and divided into 2 cohorts: preintervention and postintervention. There was no significant difference between pre- and postintervention characteristics such as age, sex, body mass index, smoking status, diabetes, steroid use, and American Society of Anesthesiologists class. The only

Comments

It is now an Accreditation Council for Graduate Medical Education requirement that surgical residents “actively participate in interdisciplinary clinical quality improvement and patient safety programs.” In response to this requirement, our general surgical residency program developed QBIRT: Quality Based Improvement Resident Teams, a resident-championed quality improvement program. Residents form teams containing one resident from each postgraduate year of training. Each team chooses a quality

Conclusion

We have demonstrated that a resident-driven quality initiative can provide a swift and effective avenue to enact change and improve the quality of patient care, particularly in an academic setting that empowers all members of the medical community to focus on quality-driven care.

Acknowledgments

We acknowledge Dr Scott Keith for assistance with the statistical analysis. We would also like to acknowledge the countless operating room staff, scrub nurses, and administrators who helped shape this intervention and who have diligently carried out its practice every day.

References (21)

There are more references available in the full text version of this article.

Cited by (18)

  • Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

    2019, American Journal of Surgery
    Citation Excerpt :

    However, despite its introduction and implementation at numerous hospitals across the country, surgical site infections remain a source of morbidity.1 Consequently, due to the large number of elective colorectal operations performed annually, there remains increased scrutiny on various best-practice methods to reduce surgical site infections and their associated morbidity7,8. Individual elements of these efforts vary across institutions, however the overall results are promising in reduction of overall infection rates.

  • Implementation of an abdominal closure bundle to reduce surgical site infection in patients on a gynecologic oncology service undergoing exploratory laparotomy

    2018, Gynecologic Oncology
    Citation Excerpt :

    Multiple intrinsic and extrinsic factors such as patient age, BMI, diabetes, tobacco use, blood transfusion, length of procedure, hospital length of stay, and wound classification, have been identified as SSI risk factors [1,24]. In addition, both the colorectal and the gynecologic oncology literature are conflicted as to whether or not patients with bowel resection benefit from SSI reduction bundles [2,6,10,11,13,14,25,26]. In our study population, significantly fewer bowel resections were performed in the post-bundle period (17% pre-bundle vs. 9% post-bundle).

  • Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

    2017, Gynecologic Oncology
    Citation Excerpt :

    A key component of our initial quality improvement prospectus was the creation of interdepartmental teams to review the literature and collectively decide upon bundled interventions and their implementation. This aspect of reduction bundling is similarly supported and emphasized throughout the literature [1,2,11,15]. Furthermore, the ongoing issues of compliance and monitoring are integral to the creation and success of an SSI reduction bundle program.

View all citing articles on Scopus

The authors declare no conflicts of interest.

View full text