BETTER TOGETHER: BOOKING THE OR COLLABORATIVELY

Abstract

Five percent above the National Healthcare Safety Network (NHSN) benchmark for surgical site infections, the Zone Clinical Department Head and Chief of Cardiac Surgery initiated a quality improvement project to review the issue. Supported by an Infection Control Professional and an Improvement Advisor, a collaborative team of health care practitioners from across the CV surgery program were brought together to improve the quality and safety of surgical care at the Mazankowski Alberta Heart Institute. METHODS: The surgical site infection data was analyzed to differentiate between infection types; organ space, superficial sternum, and leg. To understand the cause of the deep surgical site infections the multi-disciplined team used Plan-Do-Study-Act methodology to review the patient journey starting in the same day admission or in house ward unit and progressed to the operating room (OR), CV Intensive Care Unit (ICU) and CV Ward. Process mapping and chart reviews were conducted to provide in-depth contextual knowledge of each patient identified with a surgical site infection. The collaborative team observed the CV surgical journey through multiple innovative methods: enabling the identification and removal of multiple vectors of infection. RESULTS: Several opportunities for improvement were identified in the OR, CVICU and CV Ward. Table 1 provides an overview of the changes made to decrease contamination thought to contribute to infection. As a result, infection rates decreased from 5.3% in Q2 2012/2013 to 0.5% in Q2 2014/ 2015. A reduction in hospital stays due to infection tapered from 588 days in 2013 to 242 days in 2014. Significant cost savings were also achieved as the CV ward experienced a 55% cost diversion. CONCLUSION: Through innovative collaborative efforts the CV Surgery Program at the Mazankowski Alberta Heart Institute achieved its target rate of 0.5% deep sternal infections. Engagement from all levels of the CV surgery program, healthcare providers, clinicians and leadership, supported improvement efforts to improve the quality and safety of patient care while reducing hospital length of stay and program costs. A culture of partnership and learning enabled a diverse team to explore multiple factors resulting in improved patient care. 093 BETTER TOGETHER: BOOKING THE OR COLLABORATIVELY