I AM Patient Safety 2019: Ambulatory Care/Surgery Award

Rodney Abney, Maureen Aitken, Jean Albany, Debbie Allmond, Dr. Andrew Beaver, Teresa Bolden, Dottie Borton, Dr. Jack Cohen, Dr. Richard Fine, Denise Grobelny, Julie Hensler-Cullen, Lamont Irvin, Tisa Julius, Rob Levin, Dr. Eric Sachinwalla, Karen Schwartz, Mark Talamona, Tom Trout, and Annette Yerkes

Surgical site infections (SSI) in the United States are the leading cause of morbidity and mortality among all hospital-acquired infections, and they also are among the most preventable healthcare associated infections. As such, decreasing SSI has become a priority for orthopedic surgeons around the nation, including those at Einstein Medical Center Elkins Park.

After noting a rise in SSI throughout the Einstein network (2.8% compared to the statewide average of 0.82–0.89%), in 2014 Elkins Park hospital staff established a Surgical Unit Safety Practice (SUSP) committee to address the issue. The multidisciplinary team was tasked with reviewing all processes and procedures around total joint replacement surgery, from patient consultation through rehabilitation. Of particular concern was the timing of administering antibiotics before and after surgery.

The SUSP team used gap analysis and tracers to identify ways to reduce SSI in total hip and knee arthroplasty. In January 2015, they introduced a standardized care bundle to monitor antibiotic compliance and documentation, which includes a checklist that follows the patient from the orthopedic surgeon's office through discharge. The staff was required to sign their initials on this bundle tag beside the tasks for which their department was responsible as they were completed.

The whole staff embraced the new tool, collaborating with the SUSP team to implement it and help refine and improve the process. The impact on patient safety and outcomes was immediate and dramatic. SSI associated with hip and knee arthroplasty fell to 1.2% in 2015, less than 1% in 2016, and 0% in the first quarter of 2017. Following this success, the team has been expanding the tool to other surgical procedures.


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