Deidre L Wyrick1, Samuel D Smith2, Melvin S Dassinger2. 1. Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. Electronic address: dlwyrick@uams.edu. 2. Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA.
Abstract
BACKGROUND: Surgical wound classification (SWC) is a component of surgical site infection risk stratification. Studies have demonstrated that SWC is often incorrectly documented. This study examines the accuracy of SWC after implementation of a multifaceted plan targeted at accurate documentation. METHODS: A reviewer examined operative notes of 8 pediatric operations and determined SWC for each case. This SWC was compared with nurse-documented SWC. Percent agreement pre- and postintervention was compared. Analysis was performed using chi-square and a P value less than .05 was significant. RESULTS: Preintervention concordance was 58% (112/191) and postintervention was 83% (163/199, P = .001). Appendectomy accuracy was 28% and increased to 80% (P = .0005). Fundoplication accuracy increased from 44% to 84% (P = .016) and gastrostomy tube from 56% to 100% (P = .0002). The most accurate operation preintervention was pyloromyotomy and postintervention was gastrostomy tube and inguinal hernia. The least accurate pre- and postintervention was cholecystectomy. CONCLUSION: Implementation of a multifaceted approach improved accuracy of documented SWC.
BACKGROUND: Surgical wound classification (SWC) is a component of surgical site infection risk stratification. Studies have demonstrated that SWC is often incorrectly documented. This study examines the accuracy of SWC after implementation of a multifaceted plan targeted at accurate documentation. METHODS: A reviewer examined operative notes of 8 pediatric operations and determined SWC for each case. This SWC was compared with nurse-documented SWC. Percent agreement pre- and postintervention was compared. Analysis was performed using chi-square and a P value less than .05 was significant. RESULTS: Preintervention concordance was 58% (112/191) and postintervention was 83% (163/199, P = .001). Appendectomy accuracy was 28% and increased to 80% (P = .0005). Fundoplication accuracy increased from 44% to 84% (P = .016) and gastrostomy tube from 56% to 100% (P = .0002). The most accurate operation preintervention was pyloromyotomy and postintervention was gastrostomy tube and inguinal hernia. The least accurate pre- and postintervention was cholecystectomy. CONCLUSION: Implementation of a multifaceted approach improved accuracy of documented SWC.
Authors: Janaka Lagoo; Steven R Lopushinsky; Alex B Haynes; Paul Bain; Helene Flageole; Erik D Skarsgard; Mary E Brindle Journal: BMJ Open Date: 2017-10-16 Impact factor: 2.692
Authors: Joseph W Gorvetzian; Katharine E Epler; Samuel Schrader; Joshua M Romero; Ronald Schrader; Alissa Greenbaum; Rohini McKee Journal: Heliyon Date: 2018-08-08