Shapiro Robert, Laignel Rose, Kowcheck Caitlin, White Valerie, Hashmi Mahreen
Department of Obstetrics/Gynecology, West Virginia University , Morgantown, West Virginia, USA.
Department of Obstetrics/Gynecology, Alaska Native Medical Center, Anchorage, Alaska, USA.
Int J Health Care Qual Assur. 2018 Jun 11;31(5):400-405. doi: 10.1108/IJHCQA-04-2017-0066.
Purpose Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to current perioperative antibiotic prophylaxis guidelines in gynecologic surgery at a tertiary care, academic institution. As a secondary outcome, improving guidelines after physician re-education were analyzed. Design/methodology/approach A retrospective chart review (2,463 patients) was completed. The authors determined if patients received perioperative antibiotic prophylaxis in accordance with current guidelines from the America College of Obstetricians and Gynecologists. Data were obtained before and after physician tutorials. Quality control was implemented by making guideline failures transparent. Statistical analysis used Fisher's exact and agreement tests. Findings In total, 23 percent of patients received antibiotics not indicated across all procedures. This decreased to 9 percent after physician re-education and outcome transparency ( p<0.0001). Laparoscopy was the procedure with the lowest guideline compliance prior to education. The compliance improved from 52 to 92 percent ( p<0.0001) after re-education. Practical implications Gynecologic surgeons overuse antibiotics for surgical prophylaxis. Physician re-education and transparency were shown to enhance compliance. Originality/value Educational tutorials are an effective strategy for encouraging physicians to improve outcomes, which, in turn, allows the healthcare system a non-punitive way to monitor quality and mitigate cost.
目的 以往研究表明，术前抗生素预防指南的依从性一直不足。本文旨在确定一家三级医疗学术机构妇科手术中当前围手术期抗生素预防指南的依从率。作为次要结果，分析了医生再教育后指南的改进情况。设计/方法/途径 完成了一项回顾性病历审查（2463例患者）。作者根据美国妇产科医师学会的现行指南确定患者是否接受了围手术期抗生素预防。在医生培训前后获取数据。通过使指南违规情况透明化来实施质量控制。采用Fisher精确检验和一致性检验进行统计分析。结果 总体而言，23%的患者在所有手术中接受了未指明的抗生素治疗。在医生再教育和结果透明化后，这一比例降至9%（p<0.0001）。腹腔镜检查是教育前指南依从性最低的手术。再教育后，依从性从52%提高到92%（p<0.0001）。实际意义妇科外科医生在手术预防中过度使用抗生素。医生再教育和透明化被证明可提高依从性。原创性/价值 教育教程是鼓励医生改善结果的有效策略，这反过来又使医疗系统能够以非惩罚性方式监测质量并降低成本。
