Committed to Better: Reducing Infection after Surgery across the Ontario Surgical Quality Improvement Network.

Abstract

BACKGROUND\nIn 2015, the Ontario Surgical Quality Improvement Network (ON-SQIN) was established to create a community of practice for Ontario hospitals to improve surgical quality. A provincial campaign to decrease post surgical infections was launched in 2017.\n\n\nSTUDY DESIGN\nThirty hospitals implemented activities related to the campaign from April 2018 to March 2019. The Community of Practice was utilized to disseminate suggested change ideas in each area. Self-reported data from participating hospitals and collaborative-wide aggregate risk-adjusted data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were reviewed to determine the impact of the campaign on the rates of postoperative surgical site infections (SSI), urinary tract infections (UTI), and pneumonia.\n\n\nRESULTS\nA total of 24, 8, and 2 hospitals respectively selected SSI, UTI, and pneumonia as their targets for improvement. Three hospitals selected both SSI and UTI, one hospital selected SSI and pneumonia, and 1 hospital selected all 3 indicators as targets. Self-reported data demonstrated that the rates of SSI and UTI decreased significantly post-campaign from 4.87% to 3.99% (p<0.0001) and from 3.65% to 1.25% (p=0.007), respectively. Pneumonia rates also decreased from 1.27% to 1.05%. The overall rates of SSI, UTI, and pneumonia across all ON-SQIN hospitals were reduced from 3.4%, 1.29%, and 0.88% to 3.37%, 1.14%, and 0.84%, respectively.\n\n\nCONCLUSION\nThe 1-year campaign resulted in a clinically significant reduction in the rates of SSI and UTI, as well as a trend for decrease for pneumonia incidence among participating hospitals. Utilizing a flexible approach with priority setting, and leveraging the Community of Practice for dissemination of change ideas is an effective way of sustaining quality improvement activities.