QAPI 22 - Multidisciplinary Implementation of Published Surgical Site Infection Prevention Recommendations Is Associated with Improved Outcomes in Neurosurgical Patients

Background: Surgical site infections (SSIs) are among the most common, most expensive healthcare-associated infections. In 2019, spinal fusions and laminectomies are associated with the most excess SSIs at an urban, 420-bed acute care hospital. Adherence to published SSI prevention recommendations is unknown in this patient population and improving adherence may improve SSI rates, readmission rates, and patient satisfaction.

Methods: In 2020, we established a multidisciplinary workgroup of subject-matter experts and champions responsible for implementing published SSI prevention recommendations through education, coaching, and validation. Validators reviewed medical records of a random sample of procedures to assess adherence to select SSI prevention recommendations. Adherence and SSI rates were reported to the workgroup monthly the first year, then quarterly. In this quasi-experimental study, we compared pre-intervention to post-intervention SSI rates, readmission rates, and patient satisfaction measures. We obtained SSI rates from the National Healthcare Safety Network. We calculated readmission rates via medical record abstraction. SSI and readmission rates pre- and post-intervention were compared using the mid-p value method. A mid-p value < 0.05 was significant. We obtained measures of patient satisfaction from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey responses.

Results: Surgeon-specific standardized infection ratio (SIR) decreased by 87% between 2019 and 2021 (p=0.0017). Facility neurosurgery SIR decreased by 82% between 2019 and 2021 (p=0.0003). From 2019 to 2020, neurosurgery-related 90-day and 30-day readmission rates decreased by 46% (p=0.10) and 74% (p=0.02), respectively. From 2019 to 2021, patient experience HCAHPS top box scores in this population increased in hospital rating (55.9% to 60.2%), hospital recommendation (55.4% to 62.8%), physician communication (73.1% to 74.5%), and care transition domains (47.9% to 54.2%).

Conclusions: Formation of a multidisciplinary SSI prevention workgroup responsible for implementing, coaching, and routinely monitoring adherence to published SSI prevention recommendations is associated with decreased SSI and readmission rates and increased patient satisfaction.