The effect of electronic feedback on anesthesia providers' timely preoperative antibiotic adminstration

The growing presence of electronic anesthesia record keeping and perioperative informatics systems is contributing to a database of valuable information that can significantly improve patient care and patient outcomes. Efforts such as the National Surgical Quality Improvement Project and the Surgical Care Improvement Project have analyzed quality measures that directly correlate to patient outcomes. Several of these quality indicators are influenced by the performance of anesthesia providers’ activities in the perioperative period. These programs promote timely administration of preoperative antibiotics. One of their guidelines states that preoperative antibiotic should be given within an hour prior to surgical incision. Surgical site infections are the most common postoperative complication. Reducing postoperative complications can reduce health care costs, and postoperative morbidity and mortality rates. The purpose of this project was to utilize an electronic feedback mechanism to improve anesthesia providers’ documentation of timely preoperative antibiotic administration. Electronic feedback reminders in the form of screensaver dashboards displaying updated departmental timely antibiotic percentage metrics for the day, the past week, and the past month were displayed for 16 weeks. Text messages were delivered once a week for 6 weeks showing an anesthesia providers’ prior average one week on time antibiotic along with an equivalent department on time average. The measures were effective in improving the documentation of timely antibiotic administration. CHAPTER ONE: INTRODUCTION The goal of improving patient care in the hospital should be pursued constantly by those in the health care field. Interventions aimed at improving the type of treatments delivered, the patient’s safety while staying in the hospital, and better selection and timing of pharmacologic therapies, have been implemented in many hospitals with this goal in mind. Over the past decade, a national surgical quality initiative called the National Surgical Quality Improvement Project (NSQIP) was tasked to measure and improve the quality of patient care on a national level. New discoveries were made concerning the correlation of data collected such as timely preoperative antibiotic delivery, normothermia maintenance, and euglycemia. When performance of these measures improved, postoperative morbidity and mortality decreased (Doenst et al., 2005; “History”, 2006; Kurz, Sessler, & Lendhardt, 1996). With the growing presence of electronic anesthesia information systems (AIS), it is now possible to harness the readily available data and provide feedback to providers and organizations. Today’s AIS’ harvest anesthetic data including: patient physiologic data, medication administration doses and timing, surgery duration, and staff utilization. These data can be easily compiled and reviewed for analysis. The final step in closing the loop is to make this process more rapid and provide feedback to the provider who generated the data in a meaningful way. The provision of meaningful feedback may have the potential to motivate improvement or continued excellent performance (Franklin, Rosenbaum, Carey, & Roizen, 2006).