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ECONOMICS, EDUCATION, AND POLICY

A System and Process Redesign to Improve Perioperative Antibiotic Administration

From the Department of Anesthesiology and Division of Healthcare Quality, Baystate Medical Center, Springfield, Massachusetts.

Address correspondence and reprint requests to Neil Roy Connelly, MD, Department of Anesthesiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199. Address e-mail to neil.roy.connelly{at}bhs.org.

Abstract

Surgical infection is a leading cause of patient injury, mortality, and excess health care costs. As part of a collaborative effort, we instituted three main focuses for perioperative antibiotic administration: appropriate selection of antibiotics, administration of antibiotics within 60 min before incision, and discontinuation of prophylactic antibiotics within 24 h of surgery. Anesthesiologists were identified as the practitioners most likely to accomplish the successful administration of antibiotics within 60 min before incision. Changes were made in ordering, documentation, and antibiotic preparation. Education was provided to all operating room staff at meetings and grand round presentations. Results were prominently displayed, and feedback was provided. The baseline appropriate antibiotic selection was 82% and is now 95% The preintervention administration-incision time was 79 (range, 32–380) min, with 11% within the 60 min before incision. The administration-incision time is currently 19 (range, 0–95) min, and the number within 60 min is 95%. Before the institution of the process, the rate of surgical site infections was 3.8%, and is now approximately 1.4%. We describe our process used to improve antibiotic administration. During this time, the surgical site infection rate has been significantly reduced.

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