Utilization of National Surgical Quality Improvement Data and Surgical Care Improvement Protocols to Improve the Rate of Catheter Association Urinary Tract Infection Robert E. Glasgow, MD Department of Surgery University of Utah Salt Lake City, UT - PowerPoint PPT Presentation

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Utilization of National Surgical Quality Improvement Data and Surgical Care Improvement Protocols to Improve the Rate of Catheter Association Urinary Tract Infection Robert E. Glasgow, MD Department of Surgery University of Utah Salt Lake City, UT

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Title: Utilization of National Surgical Quality Improvement Data and Surgical Care Improvement Protocols to Improve the Rate of Catheter Association Urinary Tract Infection Robert E. Glasgow, MD Department of Surgery University of Utah Salt Lake City, UT


1
Utilization of National Surgical Quality
Improvement Data and Surgical Care Improvement
Protocols to Improve the Rate of Catheter
Association Urinary Tract InfectionRobert E.
Glasgow, MDDepartment of SurgeryUniversity of
UtahSalt Lake City, UT
1
2
Background
  • Catheter-Associated Urinary Tract Infection
    (CA-UTI) is a major cause of healthcare
    associated morbidity in the United States
  • Over 80 of patients undergoing major operations
    have periprocedural urinary catheterization
  • Prolonged urinary catheterization is
    significantly associated with increased risk of
    UTI and 30 day operative mortality
  • CA-UTI costs the healthcare system approximately
    758 per infection and over 330 million annually

Anderson DJ. Infect Control Hosp Epidemiol.
2007 Jul28(7)767-73 Scott RD. The direct
medical costs of healthcare-associated infections
in US hospitals and the benefits of prevention.
Centers for Disease Control and Prevention.
March, 2009
3
NSQIP and the University of Utah
  • ACS NSQIP is a data-driven, risk-adjusted,
    outcomes-based surgical quality improvement
    program.
  • 258 participating hospitals in 2010
  • Benefits of participation
  • Identifying QI targets
  • Improving patient care
  • Decreasing institutional costs
  • University of Utah joined in 2001

4
June 2009 NSQIP Report Urinary Tract Infection
Goal
5
June 2009 NSQIP Report Our Hospital O/E Thru
June 2009
6
SCIP Core Measure Catheter Associated-UTI
(CA-UTI)
SCIP Core Measures SCIP Compliance November 2009
Urinary catheter removed on POD 1 or POD 2 49.2 N 61
7
Timeline
University of Utah High Outlier
June 09
8
Timeline
UTI Performance Excellence Team Created
University of Utah High Outlier
Aug 09
June 09
9
Nursing
Urology
Performance Excellence Team
10
Timeline
Define-Research-Analyze-Improve-Control
UTI-Performance Excellence Team Created
University of Utah High Outlier
Sept 09
Aug 09
June 09
11
Define The Problem
  • Strict definition of UTI (NSQIP definition)
  • Patient had indwelling urinary catheter at
    diagnosis or within 48 hours before onset of the
    event
  • Positive urine culture of 100,000 CFU/ml with no
    polymicrobia
  • Identify patient-related variables
  • Gender, age, type of surgery, history of urinary
    retention (males) and/or UTIs (females),
    bacteriuria
  • Identify healthcare provider-related variables

12
Define Ask the right questions
1. Are the right patients getting UC? 2. Are UC
in place for right duration? 3. Are we inserting
UC properly? 4. Are we performing proper
peri-care?
4 Key Questions
13
Define The Goals
  • Lower the rate of UTI to 1.4 or better and O/E
    status to non-outlier
  • SCIP Core Measure compliance
  • Urinary catheter removed on POD 1 or POD 2
  • Greater than 90 compliance in non-excluded
    patients
  • Sustained quality improvement

14
Research The Standard
  • Define evidence-based practices in patient and
    urinary catheter management
  • Management of urinary retention, catheters in
    setting of regional anesthesia
  • Study of nursing training and current practice in
    catheter care

15
Research - Current practice (2009)
  • Review of 48 general surgery patients who
    developed UTI lt30 days following surgery
  • Foley catheter left in place gt48h in 85 of
    patients
  • Average duration of foley catheter placement at 6
    days

16
Timeline
Action and Results
Define - Research - Analyze - Remedy - Implement
Strategy
Performance Excellence Team Created
Oct 09
University of Utah High Outlier
Sept 09
Aug 09
June 09
17
Remedy - The Bladder Bundle
18
Remedy - The Bladder Bundle
  • NEED
  • Use indwelling catheters only when necessary
  • PLACEMENT
  • Foley placement only by trained personnel
  • DURATION
  • Remove in the O.R. when possible
  • Document reasoning if use gt 24 hours
  • CARE
  • Contained-single unit catheter systems now in
    place
  • Catheter is well-secured and insertion site is
    clean at all times
  • Keep the drainage bag lower than the bladder to
    prevent backflow

19
Bladder Bundle
  • Prompting Care Givers Physicians, Nurses,
    Midlevels
  • Education and media blitz targeting physicians
    nurses
  • Mid-level, nursing, physician champions
  • Visual cue on patient board
  • EMR DC or Justify
  • Foley a daily part of patient rounding RN and
    MD.
  • Epidural order sets modified
  • Data tracked and reported
  • Foley insertion/removal compliance (NSQIP, SCIP),
    UTI rates

20
December 2010 NSQIP Report Urinary Tract
Infection
Includes General and Vascular Surgery Cases
21
June 2009 NSQIP Report Our Hospital O/E Ratio
over Time
Bladder Bundle Initiative
22
Results SCIP Compliance
  • SCIP Compliance
  • Goal
  • Urinary catheter removal on POD 1 or POD 2
  • Result
  • Greater than 90 compliance in General and
    Vascular Surgery since implementation of Bladder
    Bundle protocol

21
11
23
With reference to healthcare cost?
  • Annual savings
  • Reduced our UTI incidence by 86 occurrences per
    year
  • Approximate annual cost savings
  • 65,188 per year

24
Conclusion
  • NSQIP is a powerful tool for identifying
    institutional morbidity and setting quality
    targets to improve healthcare delivery while
    reducing cost.
  • An evidence based approach to management of
    peri-operative urinary tract infections can
    reduce the incidence of UTIs
  • Physician led quality improvement projects can
    result in sustained improvement in patient care
    and reduced cost
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