An effort to improve the accuracy of documented surgical wound classifications - 24/04/18
Abstract |
Background |
Discordance between circulating nurse- and surgeon diagnosis-based wound classifications may lead to erroneous risk-adjusted rates of surgical site infections with effects on inter-hospital rating, reimbursement, and public perceptions regarding quality of care.
Methods |
After an initial two-month audit, we placed a wound class reference algorithm in each operating room and educated staff. An audit was repeated for a two-month period after this intervention. Statistical analysis of the whole and subgroup was performed.
Results |
Pre-intervention, the wound classifications for 70 of 300 cases were discordant. In the post-intervention group, 79 of 483 cases were discordant (p = 0.016). Subgroup analysis of colectomy and appendectomy cases demonstrated dramatically improved concordance. For colectomies, discordance dropped from 84.6% to 15% post-intervention (p = <0.001). Appendectomy discordance went from 80% of cases to 30.4% post-intervention (p = 0.001). Wound class discordance increased for the cholecystectomy subgroup (20.4%–37%) but this was not statistically significant (p = 0.066).
Conclusions |
As we trend towards a pay-for-performance model, health care systems should review their internal controls on documenting surgical wound classes.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Considerable discrepancy exists between surgeon diagnosis-based and nurse-documented surgical wound classifications. |
• | Cases involving colectomies and appendectomies are frequently misclassified. |
• | Our algorithm improved concordance between nurses and surgeons documenting the surgical wound class. |
Keywords : Surgical wound classification, Surgical site infection, Quality improvement, Documentation, Wound classification
Plan
Vol 215 - N° 3
P. 515-517 - mars 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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