The Effect of a Quality Improvement Collaborative to Improve Antimicrobial Prophylaxis in Surgical Patients

• DOI: 10.7326/0003-4819-149-7-200810070-00007
• Publication Date: 2013-04-12T18:53:32Z
• Authors: Stephen B. Kritch...; Barbara I. Braun; Andrew J. Bush; Michele R. Bozikis; Linda Kusek; John P. Burke; Edward S. Wong; John Jernigan; Cralen C. Davis; Bryan Simmons
• Keywords: Antibiotic Prophylaxis; 16. Peace & justice; Hospitals; United States; Feedback; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Humans; Surgical Wound Infection; Cooperative Behavior; Quality Indicators, Health Care

Background: Quality improvement collaboratives are used to improve health care quality, but their efficacy remains controversial. Objective: To assess the effects of a quality collaborative on preoperative antimicrobial prophylaxis. Design: Longitudinal cluster randomized trial, with as intervention. Setting: United States. Participants: 44 acute hospitals, each which randomly sampled approximately 100 selected surgical cases (cardiac, hip or knee replacement, and hysterectomy) at both baseline remeasurement phases. Intervention: All hospitals received comparative feedback report. Hospitals assigned intervention group (n = 22) participated in comprising 2 in-person meetings led by experts, monthly teleconferences, receipt supplemental materials over 9 months. Measurements: Change proportion patients receiving least 1 antibiotic dose within 60 minutes surgery (primary outcome) change proportions given any antibiotics, antibiotics for 24 hours less, an appropriate drug, single 5 measures (secondary outcome). Results: The groups did not differ who properly timed prophylaxis (−3.8 percentage points [95% CI, −13.9 6.2 points]) after adjustment region, hospital size, type. Similarly, individual duration; use drug; dose; all-or-none measure combining timing, duration, selection. Limitations: volunteered effort, thereby resulting selection participants were motivated change. Implementation infection prevention reporting requirements Centers Medicare & Medicaid Services Joint Commission may have performance. Conclusion: At time heightened national attention toward performance, trial demonstrate benefit participation performance these measures.