Using Quality Improvement Methods to Change Surgical Practice. Issue 2 (April 2015)

• Record Type: Journal Article
• Authors: Mahida, Justin B.; Sulkowski, Jason P.; Kurtovic, Kelli J.; Cooper, Jennifer N.; Kenney, Brian D.; Brilli, Richard J.; Deans, Katherine J.; Minneci, Peter C.
• Is Part Of: Quality management in health care. Volume 24:Issue 2(2015)
• Publication Date: 2015-04
• Subjects: Medical care -- Quality control -- Periodicals; Total quality management -- Periodicals; Health services administration -- Periodicals; 362.1068
• DOI: 10.1097/QMH.0000000000000054
• Languages: English
• ISSNs: 1063-8628

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Surgical treatments of soft-tissue abscesses (STAs) include packing and ring drain (RD) and straight drain (SD) placement. Potential benefits of SDs include a single incision, less scarring, and no need for a follow-up appointment. We used a multidisciplinary quality improvement (QI) process to promote surgeon adoption of an STA drainage technique to improve efficiency and quality of care.</p> </sec> <sec> <title>Subjects and Methods:</title> <p>Outcome measures included the proportion of STAs drained using SDs, the number of postoperative clinic visits, the proportion of patients requiring follow-up with a pediatric surgeon and other providers, and the postoperative complication rate, defined as need for an additional drainage procedure.</p> </sec> <sec> <title>Results:</title> <p>After beginning the QI initiative, the proportion of STAs drained by SDs increased from 23% to 78% (<italic>P</italic> < .00001) and the proportion of patients requiring a surgical follow-up clinic appointment decreased from 71% to 32% (<italic>P</italic> < .00001). The mean number of surgical clinic visits per patient decreased from 0.79 to 0.39 visits per patient (<italic>P</italic> < .00001). Complication rates were similar between drain types (RD: 2.4%; SD: 1.7%; <italic>P</italic> = .57). This QI initiative produced a rapid sustained shift in surgeon practice with increased use of SDs, decreased number of follow-up visits, and no increase in complications.</p> </sec> </abstract>