Sustainability in quality improvement project to reduce SSI;Redefining value!

ABSTRACT

Objective: Sustainability in a QIP is a pivotal domain of quality in healthcare. It induces the need of implementing changes in a QIP which add value to the results. In a secondary level hospital of Qatar, a quality improvement project was proposed to reduce the SSIs from 8.3% in 2013. SSI rates were reduced to 1.47% in 2016. However, it was noted that in women with high risk for wound infection, the SSIs rate increased to 10.71% in the last quarter of 2016. To make the project sustainable, in the second quarter of the year 2017, changes were implemented, and antibiotic prophylaxis was given to high-risk cases and the results were evaluated. Design: Quality Improvement Project (QIP) Methods: PDSA cycle was implemented. All women operated at our hospital by either elective or emergency Cesarean from third quarter of 2017 to 2020 were included. Women who were operated in other facilities with SSIs were excluded. A total of 8372 women were delivered by Cesarean section during the study period. Extended use of antibiotics was implemented for 48 h in patients with high risk of SSI. SSIs rate was considered as the key performance indicator and statistical evaluation (odds' ratio) was carried out using online statistical software. Results: The overall SSIs rate observed after implementation of changes was 1.51%. Significant decrease was noted (3.26% vs. 1.51%) (p < 0.001). In the first quarter of 2017, the SSIs rate was 2.73%. After the completion of 14 quarters of the project in 2020, results were analyzed. In the last two quarters of 2019, a significant decrease in SSIs was noted and the SSIs rate reduced to less than one percent. Due to the COVID-19 pandemic, post-operative wound evaluation was done by telephonic consultation by midwives. During this period the rate of SSIs increased to 2.60% in the last quarter of 2020. However, there was insignificant increase in the annual rate of SSIs (1.8% vs. 1.51%). Face to face appointments were re-started as the cases of COVID-19 decreased in the country in 2021. Conclusion: The project led to a great impact on quality. It reduced the rates of SSRIs significantly. Reduced the duration of hospital stay and the cost of care. It also reduced the re-admissions due to SSIs. This project clearly proves that sustainability improves quality by immediate benefits and motivates changes that redefine value.