SSI Total = Superficial, Deep, & Organ/Space Deep Incisional SSI Organ/Space SSI Superficial Incisional SSI Denominator: All Cases Denominator: All Cases Denominator: All Cases Numerator: Infection occurs within 30 days Numerator: Infection occurs within 30 Numerator: Infection occurs within 30 of the procedure and involves only skin and days of the procedure and involves deep days of the procedure and infection subcutaneous tissue of the incision and soft tissues of the incision (e.g., fascial and involves any part of the body, excluding patient has at least 1 of the following: muscle layers) and patient has at least one the skin incision, fascia, or muscle layers, of the following: that is opened or manipulated during the a. purulent drainage from the superficial operative procedure and patient has at incision a. purulent drainage from the deep least 1 of the following: incision b. organisms isolated from an aseptically- a. purulent drainage from a drain that is obtained culture of fluid or tissue from the b. a deep incision that spontaneously placed into the organ/space superficial incision dehisces or is deliberately opened by a surgeon, attending physician or other b. organisms isolated from an aseptically- c. superficial incision that is deliberately designee and is culture-positive or not obtained culture of fluid or tissue in the opened by a surgeon and is culture-positive cultured and patient has at least one of organ/space or not cultured and patient has at least one the following signs or symptoms: fever of the following signs or symptoms of (>38°C); localized pain or tenderness. A c. an abscess or other evidence of infection: pain or tenderness; localized culture-negative finding does not meet infection involving the organ/space that is swelling; redness; or heat. A culture this criterion. found on direct examination, during negative finding does not meet this criterion invasive procedure, or by histopathologic c. an abscess or other evidence of d. diagnosis of superficial incisional SSI by examination or imaging test infection involving the deep incision is the surgeon or attending physician or other found on direct examination, during designee d. diagnosis of an organ/space SSI by a invasive procedure, or by histopathologic surgeon or attending physician or other examination or imaging test. designee and meets at least one criterion for a specific organ/space infection site d. diagnosis of a deep incisional SSI by a listed in Table 1 - See MSQC surgeon or attending physician or other Operational Manual designee
Diagram of SSI s CDC & Prevention’s NHSN classification for SSI Source: Anderson, et al
SSI Statistics MSQC QI NEWS THE WORLD’S FAVORITE NEWSPAPER - Since 2005 Surgical Site Infections • Between 2% - 5% surgical patients acquire SSI (between $160,000 and $300,000/year) • 60% of SSIs have been estimated to be preventable • Account for 20% of the HAIs in hospitalized patients • Each SSI is associated with an additional 7-11 post-operative hospital days • Patients with SSIs have a 2-11 times higher risk of death • Accounts for $3.5 Billion to $10 billion annually in healthcare expenditures • Most estimates do not account for re-hospitalization, outpatient treatment, post-discharge expenses, quality of life for the patient, or any long term disability costs Anderson, et al http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/
Who Knows Your Data? Hospital Compare (medicare.gov) CDC/NHSN (National Healthcare Safety Network Patients Accountable Care Organizations (ACO) SOURCE: http://www.cdc.gov/hai/pdfs/stateplans/factsheets/mi.pdf
Accountable Care Organization On average, a single ACO costs *, making this the Hospital Value-Based Purchasing VBP Hospital Compare LOS and Cost HCAHPS Cost Reimbursement www.medi Timely and Effective Care care.gov Readmissions, Complications, and Deaths SSI Hospital –Acquired Condition Reduction Program Readmissions Complications HAC *Zimlichman et al (2013)
Your Hospital’s SSI Rates (Insert Here)
Actions to Achieve Successful Improvements Commitment from Leadership Action Plan Formation of Steering Committee with clear expectations Continuous Effective Protocol, Mechanisms Education of evaluation of communication integrated to hold staff staff efforts and of plan into order sets accountable outcomes
Assess Culture Safety Culture is the way safety is perceived, valued and prioritized in an organization. It reflects the real commitment to safety at all levels in the organization. It has also been described as "how an organization behaves when no one is watching". Source: http://www.skybrary.aero/index.php/Safety_Culture
Engage Physicians Make physicians partners not customers Surgeon Champion/Project Lead Identify what is important to them: Improved patient outcomes (evidence based: Respected as a physician data-driven) Excellent Communication skills Reduced difficulties & wasted time Strong social & leadership skills Understand the existing culture (beliefs, norms, Committed to the project (shows values) courage) Understand legal barriers & opportunities Use “Engaging” Improvement Methods Standardize what is “standardizable” - no more Generate light, not heat with data (use data sensibly) Make the right thing easy to do Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)
Form an SSI Team Core Membership Integral Members ( Leadership) (Managers & Staff) Anesthesiology Surgeon Physician Pharmacy Champion Champion Infection Prevention Quality MSQC - SCQR Leadership Pre/Periop Nursing Others as Hospital identified Inpatient Nursing Administration Nursing Leadership Leadership
Establish SSI Team Goals Assign Team Develop Roles the Action Define the Plan Goal * Champion(s) Define the Statement Scope of * Facilitator * Establish State the the Project priorities- what Problem/ * Recorder are you going to Must be: Purpose do & how are you * Specific * Timekeeper going to do it? * Measurable * Define inclusions (a * Realistic * Identify the steps * Provide data to specific procedure in the process support the i.e. colectomy, or ALL surgical cases) problem or * Identify process purpose. * Set time frame owners /key team members * Why is a team necessary? * Develop Timeline Adapted from NQF (2006) VTE Consensus Standards
Enhanced Recovery Program Optimal Preparation for Surgery: Patient Education • Smoking cessation • Incentive spirometry • Progressive ambulation • Nutrition • Glycemic Control Advances in Anesthesia Management Specific Quality Improvement protocols Prevention of post operative complications * • Pneumonia ($40,184) • Wound infection ($20,785) • Sepsis ($38,900) http://www.ncbi.nlm.nih.gov/pubmed/23999949 Taheri et al. (2000) Zimlichman et al. (2013)
Delivering Excellence at a Value SURGICAL Initiatives ANESTHESIA Initiatives HOSPITAL Initiatives SSI SI
Evaluate Progress Cycling Steering Quality Committee Improvement (SSI Team) Clinical Practice Outcomes Pathway Plan Do Morbidity Act Study Mortality • Presurgical Preparation SSI rates & Intervention LOS • Intraoperative Readmissions Efficiency • Targeted Post-op Postop ED visits Intervention QI Initiatives Adapted from IHI Process Improvement Model
Change is a process, not an event
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