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Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.
Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).
To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.
Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,
“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.
In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”
“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”
During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.
“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”
Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.
This study demonstrates dramatically different surgical site infection (SSI) rates for the same patient cohort as detected by three different surveillance methods: hospital billing (derived from the electronic health records), a surgical database, and a tracking system developed by the Centers for Disease Control and Prevention.
On the low end, 79 SSIs were reported by one system, 156 by another, and 433 by the third method – a more than fivefold discrepancy. The authors developed a technique to reconcile the three systems and then evaluated a variety of interventions designed to reduce the SSI rate. As a result of this initiative, the quality of event reporting was improved (with greater agreement between reporting methods) and the rate of SSIs was reduced.
The implications of this report are sobering and should be of great interest to all surgeons and hospital administrators for several reasons. First and fundamentally, the report suggests that widely used reporting systems may be inaccurate and produce conflicting results. Since the results of these reports are used to assess and modify clinical practice, this is very disturbing. Additionally, the results may be used by payers as a basis for financial reward (or penalty) and therefore must be accurate. Finally, exposure of the use of erroneous information as the source data for billing may render an institution vulnerable to civil and criminal penalties. For all of these reasons, the present report should prompt self-assessment by all institutions, if it has not already been undertaken.
Dr. Robert Jaquiss is associate medical editor for congenital heart disease for Thoracic Surgery News.
This study demonstrates dramatically different surgical site infection (SSI) rates for the same patient cohort as detected by three different surveillance methods: hospital billing (derived from the electronic health records), a surgical database, and a tracking system developed by the Centers for Disease Control and Prevention.
On the low end, 79 SSIs were reported by one system, 156 by another, and 433 by the third method – a more than fivefold discrepancy. The authors developed a technique to reconcile the three systems and then evaluated a variety of interventions designed to reduce the SSI rate. As a result of this initiative, the quality of event reporting was improved (with greater agreement between reporting methods) and the rate of SSIs was reduced.
The implications of this report are sobering and should be of great interest to all surgeons and hospital administrators for several reasons. First and fundamentally, the report suggests that widely used reporting systems may be inaccurate and produce conflicting results. Since the results of these reports are used to assess and modify clinical practice, this is very disturbing. Additionally, the results may be used by payers as a basis for financial reward (or penalty) and therefore must be accurate. Finally, exposure of the use of erroneous information as the source data for billing may render an institution vulnerable to civil and criminal penalties. For all of these reasons, the present report should prompt self-assessment by all institutions, if it has not already been undertaken.
Dr. Robert Jaquiss is associate medical editor for congenital heart disease for Thoracic Surgery News.
This study demonstrates dramatically different surgical site infection (SSI) rates for the same patient cohort as detected by three different surveillance methods: hospital billing (derived from the electronic health records), a surgical database, and a tracking system developed by the Centers for Disease Control and Prevention.
On the low end, 79 SSIs were reported by one system, 156 by another, and 433 by the third method – a more than fivefold discrepancy. The authors developed a technique to reconcile the three systems and then evaluated a variety of interventions designed to reduce the SSI rate. As a result of this initiative, the quality of event reporting was improved (with greater agreement between reporting methods) and the rate of SSIs was reduced.
The implications of this report are sobering and should be of great interest to all surgeons and hospital administrators for several reasons. First and fundamentally, the report suggests that widely used reporting systems may be inaccurate and produce conflicting results. Since the results of these reports are used to assess and modify clinical practice, this is very disturbing. Additionally, the results may be used by payers as a basis for financial reward (or penalty) and therefore must be accurate. Finally, exposure of the use of erroneous information as the source data for billing may render an institution vulnerable to civil and criminal penalties. For all of these reasons, the present report should prompt self-assessment by all institutions, if it has not already been undertaken.
Dr. Robert Jaquiss is associate medical editor for congenital heart disease for Thoracic Surgery News.
Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.
Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).
To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.
Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,
“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.
In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”
“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”
During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.
“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”
Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.
Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.
Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).
To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.
Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,
“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.
In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”
“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”
During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.
“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”
Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.
Key clinical point: Linking registry and infection control data with a hospital’s electronic health records can significantly improve surveillance of SSIs, as the linkage allows for improved visualization abilities, communication within and between departments, facilitated adjudication of SSIs, and improved assessment of quality improvement initiatives to prevent further SSIs.
Major finding: Over the 47-month study period, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. The rolling 12-month SSI rate based on the STS-CHSD decreased from 2.48% (21/848) to 0.76% (11/1,442).
Data source: A retrospective analysis of 668 cases in the STS-CHSD database over the course of 47 months.
Disclosures: Ms. Nayar reported that she had no relevant financial conflicts.
