Program to decrease SSIs wins quality award

Also awarded: revamped patient survey

A program to decrease surgical infections in knee, hip, and back procedures is a winner of the 2012 Bernard A. Kershner Innovations in Quality Improvement Awards. The award for surgical/procedural care is given annually by the AAAHC Institute for Quality Improvement (AAAHC Institute). An initiative to increase patient satisfaction garnered honorable mention.

The staff at the Siouxland Surgery Center (SSC), Dakota Dunes, SD, noticed an increase in surgical site infections (SSIs) in knee and hip arthroplasty and lumbar spinal fusion patients. The philosophy at SSC is that one surgical site infection is one too many. They immediately created an improvement plan. The plan identified areas for improvement, such as surgical instrument cleaning and decontamination processes, as well as some of their infection prevention processes. The improvement plan included a new workflow pattern in the decontamination room to minimize cross-contamination.

"Everyone on the leadership team and staff collaborated on the redesign and implementation of new processes and received detailed training on the new processes," said Jennifer Hadley, RN, BSN, CIC, the director of quality and infection prevention at SSC. "It worked. Everyone took ownership, and infections have been reduced to zero in the last quarter. It feels good knowing every employee, every day is doing their best for every patient."

After the program, hip arthroplasty and knee arthroplasty infection rates have decreased to zero in last quarter. Lumbar spinal fusion infection rates have decreased by 61.5%.

Patient satisfaction survey improved

A study to improve patient satisfaction questionnaires received an honorable mention in surgical/procedural care for the Madison Surgery Center (MSC), Madison, WI.

The questionnaire they were using allowed patients to check-box one of three options: "Yes, exceeded my expectations," "Yes, met my expectations," or "No, did not meet my expectations." It didn't weigh positive and negative perceptions, and it didn't offer a "neutral" or "not applicable" response.

The former questionnaire assessed patient perception by admission, prior to your procedure, during the procedure, and recovery and discharge. These categories fostered finger-pointing and an attitude of "it's not my problem," according to the center. Eliminating these categories encouraged a team-based improvement attitude where patient satisfaction became everyone's responsibility.

"Instead of looking at a few separate areas, we went to a questionnaire that encompassed the patient's entire experience as a whole," said Pam Smestad, RN, quality and risk manager at MSC. "This will allow us to improve our quality of care for every patient."

To better understand patient needs, the center updated the questionnaire process to include:

updates to the range of information collected from patients; a more detailed rating scale to better measure patient satisfaction; additional questions to score the center as a whole; improved communication of results to staff members.

The updates to the questionnaire were completed recently, and data will continue to be analyzed and compared quarterly. [A copy of the questionnaire is included.]

Once completed, tabulated and interpreted, survey results historically have been presented and discussed at management meetings and a couple of committee meetings. Now outcomes are communicated to staff and performing physicians through a daily report, a patient satisfaction bulletin board in the staff lounge, various committee meetings, in-services, and monthly staff meetings.

"By revising our patient questionnaire and our processes — questions asked, use of an equally weighted scale, engaging staff, communicating data, and influencing change — MSC hopes to bring to life our philosophy of 'Every patient, every time,'" the center said in its application.