Hewitt Daniel Brock, Tannouri Sami S, Burkhart Richard A, Altmark Randi, Goldstein Scott D, Isenberg Gerald A, Phillips Benjamin R, Yeo Charles J, Cowan Scott W
Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
Am J Surg. 2017 Jan;213(1):36-42. doi: 10.1016/j.amjsurg.2016.04.009. Epub 2016 Jun 14.
Surgical site infections (SSIs) cause significant patient morbidity and increase costs. This work prospectively examines our institutional effort to reduce SSIs through a resident-driven quality initiative.
A general surgery resident-championed, evidenced-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship. National Surgical Quality Improvement Program definitions for SSIs were used. Data were collected prospectively and bundle compliance was monitored using a checklist. The primary outcome compared SSIs before and after implementation.
In the 2 years preceding standardization, 489 colorectal surgery cases were performed. SSIs occurred in 68 patients (13.9% SSI rate). Following implementation of the bundle, 212 cases were performed with 10 SSIs (4.7% SSI rate, P < .01). Multivariate logistic regression analysis found a decrease in superficial and overall SSIs (odds ratio .17, 95% confidence interval .05 to .59; odds ratio .31, 95% confidence interval .14 to .68).
These data demonstrate that resident-driven initiatives to improve quality of care can be a swift and effective way to enact change. We observed significantly decreased SSIs with a renewed focus on evidence-based, standardized patient care.
手术部位感染（SSIs）会导致患者出现严重发病情况并增加费用。本研究前瞻性地考察了我们机构通过住院医师主导的质量改进举措来降低手术部位感染的努力。
在一位主治医师的指导下，为一家学术机构中接受结直肠手术的患者制定了一套由普通外科住院医师倡导的循证护理方案。采用国家外科质量改进计划对手术部位感染的定义。前瞻性收集数据，并使用检查表监测方案的依从性。主要结局指标比较了实施前后的手术部位感染情况。
在标准化实施前的两年中，共进行了489例结直肠手术。68例患者发生手术部位感染（手术部位感染率为13.9%）。实施该护理方案后，进行了212例手术，其中10例发生手术部位感染（手术部位感染率为4.7%，P <.01）。多因素逻辑回归分析发现浅表和总体手术部位感染均有所减少（比值比为0.17，95%置信区间为0.05至0.59；比值比为0.31，95%置信区间为0.14至.)。
这些数据表明，住院医师主导的提高医疗质量的举措可以是实现变革的迅速而有效的方式。我们观察到，通过重新关注循证、标准化的患者护理，手术部位感染显著减少。
