Obtaining Institutional Support: Surgical Site Infections (SSIs)

BY SABITHA RAJAN, MD

To build your team, you need support from your medical center leadership. Getting institutional buy-in and administrative support is essential. Although you may not yet have robust data, the rationale for directing resources toward surgical site infection (SSI) efforts can be spelled out. A direct line to administrative support for your effort, by either a direct reporting structure or the involvement of a senior administrator in the team, should be in place before you go any farther. One example of an approach is to have an "executive sponsor" (e.g., CEO, CMO, CNO), or administrative champion of the project. This sponsor should receive regular updates on the project (and ideally attend at least some committee meetings) and be an advocate of the project to the remainder of hospital leadership.

Task

Meet with members of your administration and have prepared talking points and, ideally, some preliminary information you've collected demonstrating the need for the administration's attention. Talking points may include the following:

• Surgical site infections are the second most common hospital-acquired infections in the United States (Bratzler DW, Houck PM, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706—1715).
• Of 40 million operations performed in the United States annually, 0.8—2 million are associated with surgical site infections.
• Surgical site infections prolong hospital stays by an average of 7.5 days.
• Surgical site infections cost the nation between $130 million and $845 million each year.
• It is estimated that 40%—60% of surgical site infections can be prevented.
• In about 25%—50% of operations, overuse, underuse, improper timing, and inappropriate use of antibiotics occur.
• Both JCAHO and CMS encourage hospitals to focus on prevention of surgical site infections.
• CMS is considering 2 financial incentives related to surgical site infection prevention:
• Including all SSIs as a "never event" and not reimbursing hospitals for the increased cost associated with caring for patients with SSIs if it was acquired during their hospital stay
• Expansion of the hospital quality measure reporting program, which reduces the amount a hospital is paid if it does not participate in the voluntary reporting of standardized quality measures. These are measures that are publicly reported on Hospital Compare.
• One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Reduce Surgical Complications . . . by reliably implementing all the changes in care recommended by the Surgical Care Improvement Project (SCIP)."
• All of the above can be referenced from Bratzler DW. The Surgical Care Improvement Project; An Overview. Presentation at Performance Measurement System Briefing, sponsored by the Joint Commission, 2006 (see SCIP overview; available at: www.cms.gov/qualityimprovementorgs; accessed July 4, 2009).

Case vignettes can illustrate specific issues related to the care of patients who have developed a surgical site infection and can often be a powerful supplement to data regarding the institution's current practice and outcomes that support the need for resources. In addition, these vignettes can highlight the areas that your initiatives are directed at improving and add the "patient's voice" to your communications.