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Experience With a Cross-disciplinary Quality Improvement Team

Laurence E. McCahill, MD; John W. Ahern, PharmD; Linda A. Gruppi, RN; James Limanek, MD; Gail A. Dion, RN; Jessica A. Sussman, RN; Christina B. McCaffrey, RN; Diane B. Leary; Margaret B. Lesage; Richard M. Single, PhD

Arch Surg. 2007;142:355-361.

Hypothesis  The Center for Medicare and Medicaid Services instituted standardized reporting of measures aimed at surgical infection prevention (SIP). The complexity and number of medical personnel involved in antibiotic administration requires multiple disciplines to successfully improve compliance.

Design  Survey study.

Setting  Tertiary care university hospital.

Patients  All patients undergoing the following operations from July 2004 through December 2005 were monitored for compliance with SIP: (1) coronary artery bypass graft, (2) other cardiac, (3) vascular, (4) hysterectomy, (5) colon resection, (6) hip arthroplasty, and (7) knee arthroplasty.

Intervention  A team including a surgeon, an anesthesiologist, nurses (preoperative, operating room, and floor), a pharmacist, a hospital infection control committee member, and quality improvement and operations specialists was created in July 2004. Hospital guidelines for SIP were defined, personnel roles defined and processes standardized, and communication/education for health care professionals was enhanced.

Main Outcome Measures  Compliance with 3 SIP measures over 3 consecutive periods of 6 months each: (1) percentage of patients receiving antibiotics within 1 hour of incision, (2) percentage of patients with appropriately selected antibiotics, and (3) percentage of patients with antibiotics discontinued within 24 hours of operation end time.

Results  One thousand seventy-two patients were monitored. Measure 1 compliance improved from 72.25% to 83.78% (P<.001, Cochran-Armitage trend test); improvement or high performance (>90% compliance) was demonstrated in 5 of 7 services. Measure 2 compliance remained uniformly high (approximately 98%). Measure 3 compliance improved from 54.5% to 87.16% (P<.001); improvement was seen in 5 of 7 services.

Conclusions  The clearly defined roles of a cross-disciplinary team and the process improvements discussed in this article can easily be implemented in other institutions. These elements were integral to our success in improving the timely delivery and discontinuation of prophylactic surgical antibiotics.

Author Affiliations: Departments of Surgical Oncology (Dr McCahill) and Mathematics and Statistics (Dr Single), University of Vermont, and Fletcher Allen Health Care (Drs Ahern and Limanek and Mss Gruppi, Dion, Sussman, McCaffrey, Leary, and Lesage), Burlington.