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ECONOMICS, EDUCATION, AND POLICY

Six Sigma Methodology Can Be Used to Improve Adherence for Antibiotic Prophylaxis In Patients Undergoing Noncardiac Surgery

Brian M. Parker, MD^*, J. Michael Henderson, MD, Sue Vitagliano, RHIA, Bala G. Nair, PhD^*, John Petre, PhD^*, Walter G. Maurer, MD^*, Michael F. Roizen, MD^*, Monica Weber, RN, Lori DeWitt, RN, Jason Beedlow, CRNA^*, Barbara Fahey, RN, Aimee Calvert, RN, Kitty Ribar, RN, and Steven Gordon, MD

From the Division of *Anesthesiology, Critical Care Medicine and Comprehensive Pain Management; Surgery; Nursing; and Department of Infectious Disease, The Cleveland Clinic, Cleveland, Ohio.

Abstract

BACKGROUND: Six Sigma methodology is a data management process that can be used to achieve a goal of near perfection in process performance. An audit of 615 surgeries over 2 mo revealed only 38% of noncardiac patients admitted on the day of surgery at our institution received perioperative antimicrobial prophylaxis within the target interval of 60 min before incision.

METHODS: Six Sigma methodology was used to improve our process of timing of antimicrobial prophylaxis administration. A multidisciplinary team was assembled which identified seven process inputs by which patients receive antimicrobial prophylaxis. Interventions for improvement included reinforcement of use of preoperative antibiotic order forms, eliminating administration of antibiotics in the preoperative admission area, and sending appropriate antibiotics and IV tubing with the patient to the operating room. We concurrently developed a control plan to sustain this improvement using a recently deployed electronic anesthesia record keeping system using real-time measurement and reporting capabilities of antimicrobial prophylaxis administration. After defining the new process and undertaking a system-wide educational effort, implementation was begun with data collection and analysis occurring over the next 7 mo.

RESULTS: For the 8-mo postintervention interval, there was a significant improvement with 86% of 1716 surgical patients receiving their antibiotic prophylaxis within the specified time frame (P < 0.01). The time interval for antibiotic administration before surgical incision also decreased from a preintervention mean of 88 (CI 56–119 min) to 38 min (CI 25–51 min) (P < 0.01).

CONCLUSION: We conclude that Six Sigma methods were used to successfully improve our process for timing of perioperative antibiotic prophylaxis before surgical incision. An electronic anesthesia record keeping system is a useful tool to monitor this process improvement.

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