Mark Kashtan1, Michele Dawson1, Seema Anandalwar1, Jonathan Hills-Dunlap1, Dionne A Graham2, Shawn Rangel3. 1. Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2. Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA. 3. Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: shawn.rangel@childrens.harvard.edu.
Abstract
PURPOSE: The goal of this study was to use a Plan-Do-Study-Act (PDSA) framework to reduce utilization of unindicated surgical antibiotic prophylaxis (SAP) for clean cases without foreign body implantation. METHODS: This was a pre-post intervention study conducted at a single children's hospital comparing 6 months of retrospective preintervention data to 10 months of prospectively collected postintervention data. Interventions to reduce unindicated SAP included faculty meetings to review guidelines and establish consensus around inclusion criteria, publicizing guidelines with regular email reminders, and conducting ongoing compliance audits to root cause noncompliance. Early unanticipated noncompliant cases were associated with rotating trainees who prescribed SAP routinely without attending knowledge. A second PDSA cycle then included education-based emails targeting residents with mandatory feedback loop closure. RESULTS: Preintervention, 40.4% (107/265) of patients received unindicated SAP. Postintervention, the rate of unindicated SAP decreased to 15.4% (6/39) after the first month and 6.2% (20/323) after 10 months, reflecting an 85% reduction across periods (p < 0.01). There was no difference in the rate of surgical site infections between the pre and postintervention cohorts (0.36% vs. 0.67%, p = 1.00). CONCLUSIONS: Unindicated surgical antibiotic prophylaxis was significantly reduced by implementing a Plan-Do-Study-Act intervention targeting both faculty and trainees. LEVEL OF EVIDENCE: Prospective comparative treatment study, level II.
PURPOSE: The goal of this study was to use a Plan-Do-Study-Act (PDSA) framework to reduce utilization of unindicated surgical antibiotic prophylaxis (SAP) for clean cases without foreign body implantation. METHODS: This was a pre-post intervention study conducted at a single children's hospital comparing 6 months of retrospective preintervention data to 10 months of prospectively collected postintervention data. Interventions to reduce unindicated SAP included faculty meetings to review guidelines and establish consensus around inclusion criteria, publicizing guidelines with regular email reminders, and conducting ongoing compliance audits to root cause noncompliance. Early unanticipated noncompliant cases were associated with rotating trainees who prescribed SAP routinely without attending knowledge. A second PDSA cycle then included education-based emails targeting residents with mandatory feedback loop closure. RESULTS: Preintervention, 40.4% (107/265) of patients received unindicated SAP. Postintervention, the rate of unindicated SAP decreased to 15.4% (6/39) after the first month and 6.2% (20/323) after 10 months, reflecting an 85% reduction across periods (p < 0.01). There was no difference in the rate of surgical site infections between the pre and postintervention cohorts (0.36% vs. 0.67%, p = 1.00). CONCLUSIONS: Unindicated surgical antibiotic prophylaxis was significantly reduced by implementing a Plan-Do-Study-Act intervention targeting both faculty and trainees. LEVEL OF EVIDENCE: Prospective comparative treatment study, level II.
Authors: Martha-Conley E Ingram; Abbey Studer; Jamie Schechter; Sarah A Martin; Manisha Patel; Emily C Z Roben; Nicholas E Burjek; Patrick K Birmingham; Mehul V Raval Journal: Pediatr Qual Saf Date: 2021-07-28