Systematic Quality Improvement With Realtime Event Support

Study Overview
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Brief Summary
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The goal of this study is to improve perioperative quality metric performance in patients receiving anesthesia care provided by Washington University Department of Anesthesiology. In this protocol, we describe (1) the use of telemedicine-augmented quality improvement interventions to enhance on-time dosage of surgical prophylactic antibiotics, while (2) carrying out large scale monitoring of surgical site infection incidence in the target population. If this quality improvement framework is found to be feasible and successful, we plan subsequently to study its application to additional perioperative quality metrics, including many pertinent to surgical site infection incidence such as perioperative glucose monitoring and management, and intraoperative temperature management.

Official Title
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Systematic Quality Improvement With Realtime Event Support

Conditions
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Telemedicine

Intervention / Treatment
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* Other: Telemedicine intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having procedures at Barnes-Jewish Hospital in suites not part of the TECTONICS trial will be included. Exclusion Criteria: Patients enrolled in the ongoing TECTONICS intraoperative Anesthesiology Control Tower telemedicine trial at Barnes-Jewish Hospital will be excluded from this study
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Improvement in administration of surgical antibiotic prophylaxis.<br>The eight-month module will include a baseline phase, educational interventions, real-time guidance from a remote telemedicine center, regular feedback regarding adherence to protocols related to that module, and continued silent monitoring. | Other: Telemedicine intervention<br>* Following education, the telemedicine center will subsequently monitor operating rooms included in this trial for protocol adherence for three-months. The telemedicine center is staffed by attending anesthesiologists, resident anesthesiologists, certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) and is currently providing evidence-based support to clinicians in a subset of operating rooms and post-anesthesia care unit (PACU) beds at Barnes-Jewish Hospital.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in administration of surgical antibiotic prophylaxis- intervention period | 1a. Increase the rate of on-time surgical antibiotic prophylaxis administration prior to incision during the intervention period. | 3 months | 
| Improvement in administration of surgical antibiotic prophylaxis-after quality improvement intervention | 1b. Increase the rate of on-time surgical antibiotic prophylaxis administration prior to incision six weeks after the quality improvement intervention is completed. | 2 months | 
| Improvement in administration of surgical antibiotic prophylaxis | 1c. Increase the rate of on-time re-dosing of antibiotic prophylaxis throughout the duration of the trial. | 8 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surgical site infection rate | Decrease the proportion of patients which develop surgical site infections throughout the duration of the trial. | 8 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, Quality-Improvement, surgical antibiotics