Utilization of National Surgical Quality Improvement Program (NSQIP) data to improve the rate of urinary tract infection in general surgery patients

Abstract

Introduction Urinary tract infection (UTI) is a common cause of increased cost and morbidity in general surgery patients and is most often associated with indwelling urinary catheters. The NSQIP identified our hospital as a high outlier for UTI in general surgery patients. A UTI-Performance Excellence Team (UTI-PET) was instituted in Q4 of 2009 to reduce the incidence of UTI. Methods The UTI-PET used a Define-Research-Analyze-Improve-Control strategy to derive evidence-based guidelines for perioperative urinary care and Surgical Care Improvement Project (SCIP) compliance for urinary catheter removal. This study is a retrospective review of NSQIP data for UTI in general surgery patients pre- and post-introduction of the UTI-PET quality improvement measures. Results Between 7/08 and 9/10, our hospital recorded 5,481 general surgery cases in the NSQIP with 86 UTIs. Prior to the implementation of the UTI-PET, the quarterly rate of UTI peaked at 3.2% (average 2.7%) with a NSQIP expected rate of 1.4% and observed-to-expected ratio of 2.3. Compliance with SCIP guidelines was 65.5%. After implementation of the UTI-PET, the rate of UTI decreased to 1.0% with 95.2% SCIP compliance in Q3 of 2010. This represents a 69% relative and 2.2% absolute reduction in UTI rate (p = 0.007). Conclusions Real-time use of the NSQIP identified a need for improvement in the area of UTI. By implementing a UTI-PET, a significant reduction in UTI rate occurred. NSQIP is a powerful tool to identify areas of increased institutional morbidity and mortality and, therefore, serve to guide patient care protocol improvements.