AkkeNeel Talsma, PhD, RN, Clinical Information and Decision Support Services,Office of Clinical Affairs
Michael O’Reilly, MD, MS, Anesthesiology
Richard E. Burney, MD, General Surgery
Vanessa Griswold, BA, Anesthesiology QA Department
Sharon Van Riper, MS, RN, CCRN, Corporate QI Department

Accomplish a 90 percent compliance rate of prophylactic antibiotics initiated within 60 minutes of surgical incision time, to adhere to national guidelines aimed at reducing surgical site infections. 

• Rate of prophylactic antibiotic started within 60 minutes of incision time (all procedures)
• Prophylactic Antibiotic Rate by OR Room
• 100 percent Anesthesiology Compliance Rate
• 100 percent CRNA / House Officer / Resident Compliance Rate
• SIP 1 Prophylactic antibiotic timing rate (SIP procedures)

The main change evaluated was the rate of prophylactic antibiotics given within 60 mins before surgery.  The multidisciplinary workgroup used data extensively to communicate with Anesthesiology and OR staff. 

• Improved appropriate timing of prophylactic antibiotics from 70 percent (August 2003) to 92 percent (August 2004)
• Developed bi-weekly HTML feedback report for Anesthesiologists, House Officers/CRNA’s, and by OR Rooms
• Feedback specified whether prophylactic antibiotics were provided too early (greater than 60 minutes) or after incision
• Posted reminders on anesthesiology machines and OR room doors
• Shared information regularly at weekly Anesthesia staff meetings and monthly QA meetings

Following a year of providing regular focused feedback, the goal of providing prophylactic antibiotics 90 percent within 60 minutes of incision time was reached.  The ability to utilize electronic anesthesia data has been paramount to the success of the project.  The weekly feedback reports were well received due to the active participation of the anesthesiologist and a general surgeon. Efforts were made to communicate project efforts with the surgeons, OR staff, and all anesthesiology staff and residents.  Future improvement efforts, such as intra-operative blood glucose management, will be implemented using a similar approach.

• Involvement of knowledgeable and active people.  Leadership and anesthesia support were important for the project to progress and make changes.
• The availability of electronic anesthesia data allowed us to provide feedback within 7-10 days after the closing week.  Frequent and regular feedback proved important, after a brief break in reporting rates would decrease.
• HTML email reports avoided opening excel files and greatly improved the response to the emails.  Posting of the results throughout the OR suite, scrub areas, and break rooms was part of the broad dissemination of current results.
• Providing confidential letter codes to all staff involved allowed comparisons and posting of results.  Details about whether the antibiotics were initiated too early (greater than 60 minutes) or after surgical incision were helpful to staff. 
• A “100 Percent Compliance” list was compiled on a weekly basis and disseminated to all staff who provided all prophylactic antibiotics within the recommended timeframe.  The “100 Percent Club” changed weekly and the included staff were only known by the staff who were 100 percent compliant.
• Specific feedback about missed timing was quickly communicated to the Anesthesiology lead who personally approached staff to clarify the purpose of the project.  The personal approach proved very effective.
• Senior leadership support from the Office of Clinical Affairs and Anesthesia were an important factor in the success of this project.  Active involvement of the anesthesiologist and general surgeon included many conversations with colleagues in break rooms, hallways, and the OR and proved an effective way to communicate practice changes.

AkkeNeel Talsma, PhD RN
Clinical Information Decision Support Services (CIDSS)
Office of Clinical Affairs University of Michigan Hospital
antalsma@med.umich.edu

[Storyboard presentation at IHI's National Forum, December 2004]