Surgical Safety Collaborative
The Surgical Patient Safety Collaborative was launched at the end of 2007 and involves 10 teams working in hospitals across Fraser Health. The Collaborative aims to spread the improvements gained from the Safer Healthcare Now! Surgical Site Infection (SSI) intervention targeted at preventing and reducing surgical site infections. Through the creation of the Collaborative, teams established a learning community to share ongoing changes and improvements to care. Teams completed an improvement charter and selected an initial surgical population which focused on implementing an “improvement bundle” – a set of evidence-based interventions that, if implemented, will reduce the likelihood of infection following surgery. These included:
- Providing antibiotics 60 minutes prior to surgical incision;
- Discontinuing those antibiotics within 24 hours after surgery ends;
- Clipping hair versus razor shaving;
- Keeping patients “warm” – as close to 36 degrees Celcius as possible;
- Marking the site where surgery will occur; and
- Ensuring that the surgical team takes a “surgical pause” before the start of surgery.
Monthly conference calls, presentations from Safer Healthcare Now! and internal experts were used to share knowledge and resources across participating teams. Five learning sessions were held to engage teams in quality improvement methodology through presentations, team planning sessions and interactive learning sessions. After the learning sessions, teams actively pursued some or all of the interventions listed above.
Over the course of 16 months, improvement was seen in all elements of the “improvement bundle.” Since October 2007, patients receiving antibiotics within 60 minutes of surgery has improved from 44 to 78 per cent, discontinuing antibiotics has improved from 35 to 92 per cent, and work to keep patients warm has improved from 53 to 83 per cent.
Work was also completed to implement these changes in other surgical areas by the end of the collaborative. This work was supported by engaged leadership and by making some key changes in the hospital environment. For example, having refrigeration available in the pre-surgery waiting area helped to provide antibiotics on time, removing razors from the surgical areas increased the frequency of clipping hair, and use of new thermometers (temporal artery) and warming devices helped to maintain the patient’s temperature. Work to maintain these results and to support the community of practice continues through ongoing conference calls, as well as linking with existing conferences and seminars.
For more information, please contact Lori Hughes (Quality Improvement / Patient Safety Consultant, Fraser Health) at firstname.lastname@example.org.