Patient Safety and Quality

Quality improvement collaborative fails to improve infection prevention in surgical patients

Hospitals randomly assigned to participate in a collaborative program for quality improvement (QI) in preventing health care-associated infections among surgical patients did not have significantly more patients who received a properly timed dose of antibiotics before their surgery than nonparticipating hospitals, according to a recent study. QI collaboratives draw on active training interventions to increase the use of best practices to improve patient safety and the outcome of treatments. The hospitals that received interventions had meetings with QI experts, participated in monthly teleconferences, and received supplementary materials on how to implement changes in presurgical antibiotic practices. The control group of hospitals received feedback only.

The researchers found that implementation of four measures of proper use of antibiotics to prevent infection in surgical patients (timing of antibiotic administration, receipt of preventive antibiotics, use of proper antibiotics, and use of a single preoperative dose) was high at the beginning of the study, ranging from 75 percent to 97 percent. Their use remained high or increased modestly by the end of data collection (ranging from 80 percent to 99 percent). Only the proper duration of preventive treatment increased substantially from baseline to the end of data collection (from 51 percent to 70 percent for the QI collaborative hospitals, and from 55 percent to 67 percent for the feedback-only hospitals).

The researchers note that the QI program may not have shown an effect because hospitals volunteered to participate in the study. Therefore, before joining the study both groups may have already been motivated by recent reporting requirements instituted by governmental and nonprofit regulatory organizations to give more attention to infection prevention. The researchers caution that the results do not mean that QI collaboratives are ineffective. Instead, they suggest that a larger study with a more diverse set of hospitals may be able to determine which collaborative model is most likely to lead to improvement in preventing health care-associated infections among surgical patients in a particular type of hospital.

The study was funded in part by the Agency for Healthcare Research and Quality (HS11331). More details are in "The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients. A randomized trial," by Stephen B. Kritchevsky, Ph.D., Barbara I. Braun, Ph.D., Andrew J. Bush, Ph.D., and others, in the October 2008 Annals of Internal Medicine 149(7), pp. 472–480.

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