Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol
Abstract Background Surgical site infections are common. Risk can be reduced substantially with appropriate preoperative antimicrobial administration. In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) in the setting of high rates of non-compliance with antimicrobial prophylaxi...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-04-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-022-00288-0 |
| _version_ | 1818264318133665792 |
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| author | Westyn Branch-Elliman A. Rani Elwy Rebecca L. Lamkin Marlena Shin Ryann L. Engle Kathryn Colborn Jessica Rove Jacquelyn Pendergast Kierstin Hederstedt Mary Hawn Hillary J. Mull |
| author_facet | Westyn Branch-Elliman A. Rani Elwy Rebecca L. Lamkin Marlena Shin Ryann L. Engle Kathryn Colborn Jessica Rove Jacquelyn Pendergast Kierstin Hederstedt Mary Hawn Hillary J. Mull |
| author_sort | Westyn Branch-Elliman |
| collection | DOAJ |
| description | Abstract Background Surgical site infections are common. Risk can be reduced substantially with appropriate preoperative antimicrobial administration. In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) in the setting of high rates of non-compliance with antimicrobial prophylaxis guidelines. SCIP included public reporting of evidenced-based antimicrobial guideline compliance metrics in high-risk surgeries. SCIP was highly successful and led to high rates of adoption of preoperative antimicrobials and early discontinuation of postoperative antimicrobials (>95%). The program was retired in 2015, as the manual measurement and reporting process was costly with limited expected additional benefit. To our knowledge, no studies have assessed whether the gains achieved by SCIP were sustained since active support for the program was discontinued. Furthermore, there has been no investigation of the spread of antimicrobial prophylaxis guideline adoption beyond the limited set of procedures that were included in the program. Methods Using a mixed methods sequential exploratory approach, this study will (1) quantitatively measure compliance with SCIP metrics over time and across all procedures in the five major surgical specialties targeted by SCIP and (2) collect qualitative data from stakeholders to identify strategies that were effective for sustaining compliance. Diffusion of Innovation Theory will guide assessment of whether improvements achieved spread to procedures not included under the umbrella of the program. Electronic algorithms to measure SCIP antimicrobial use will be adapted from previously developed methodology. These highly novel data mining algorithms leverage the rich VA electronic health record and capture structured and text data and represent a substantial technological advancement over resource-intensive manual chart review or incomplete electronic surveillance based on pharmacy data. An interrupted time series analysis will be used to assess whether SCIP compliance was sustained following program discontinuation. Generalized linear models will be used to assess whether compliance with appropriate prophylaxis increased in all SCIP targeted and non-targeted procedures by specialty over the duration the program’s active reporting. The Dynamic Sustainability Framework will guide the qualitative methods to assess intervention, provider, facility, specialty, and contextual factors associated with sustainability over time. Barriers and facilitators to sustainability will be mapped to implementation strategies and the study will yield an implementation playbook to guide future sustainment efforts. Relevance Sustainability of practice change has been described as one of the most important, but least studied areas of clinical medicine. Learning how practices spread is also a critically important area of investigation. This study will use novel informatics strategies to evaluate factors associated with sustainability following removal of active policy surveillance and advance our understanding about these important, yet understudied, areas. |
| first_indexed | 2024-12-12T19:33:00Z |
| format | Article |
| id | doaj.art-8875b78f6e964a0789545dbe5a047e67 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-12T19:33:00Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-8875b78f6e964a0789545dbe5a047e672022-12-22T00:14:23ZengBMCImplementation Science Communications2662-22112022-04-013111110.1186/s43058-022-00288-0Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocolWestyn Branch-Elliman0A. Rani Elwy1Rebecca L. Lamkin2Marlena Shin3Ryann L. Engle4Kathryn Colborn5Jessica Rove6Jacquelyn Pendergast7Kierstin Hederstedt8Mary Hawn9Hillary J. Mull10Center for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Bedford Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemEastern Colorado VA Healthcare SystemEastern Colorado VA Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemDepartment of Surgery, Stanford University School of MedicineCenter for Healthcare Organization and Implementation Research, VA Boston Healthcare SystemAbstract Background Surgical site infections are common. Risk can be reduced substantially with appropriate preoperative antimicrobial administration. In 2005, the VA implemented the Surgical Care Improvement Project (SCIP) in the setting of high rates of non-compliance with antimicrobial prophylaxis guidelines. SCIP included public reporting of evidenced-based antimicrobial guideline compliance metrics in high-risk surgeries. SCIP was highly successful and led to high rates of adoption of preoperative antimicrobials and early discontinuation of postoperative antimicrobials (>95%). The program was retired in 2015, as the manual measurement and reporting process was costly with limited expected additional benefit. To our knowledge, no studies have assessed whether the gains achieved by SCIP were sustained since active support for the program was discontinued. Furthermore, there has been no investigation of the spread of antimicrobial prophylaxis guideline adoption beyond the limited set of procedures that were included in the program. Methods Using a mixed methods sequential exploratory approach, this study will (1) quantitatively measure compliance with SCIP metrics over time and across all procedures in the five major surgical specialties targeted by SCIP and (2) collect qualitative data from stakeholders to identify strategies that were effective for sustaining compliance. Diffusion of Innovation Theory will guide assessment of whether improvements achieved spread to procedures not included under the umbrella of the program. Electronic algorithms to measure SCIP antimicrobial use will be adapted from previously developed methodology. These highly novel data mining algorithms leverage the rich VA electronic health record and capture structured and text data and represent a substantial technological advancement over resource-intensive manual chart review or incomplete electronic surveillance based on pharmacy data. An interrupted time series analysis will be used to assess whether SCIP compliance was sustained following program discontinuation. Generalized linear models will be used to assess whether compliance with appropriate prophylaxis increased in all SCIP targeted and non-targeted procedures by specialty over the duration the program’s active reporting. The Dynamic Sustainability Framework will guide the qualitative methods to assess intervention, provider, facility, specialty, and contextual factors associated with sustainability over time. Barriers and facilitators to sustainability will be mapped to implementation strategies and the study will yield an implementation playbook to guide future sustainment efforts. Relevance Sustainability of practice change has been described as one of the most important, but least studied areas of clinical medicine. Learning how practices spread is also a critically important area of investigation. This study will use novel informatics strategies to evaluate factors associated with sustainability following removal of active policy surveillance and advance our understanding about these important, yet understudied, areas.https://doi.org/10.1186/s43058-022-00288-0Dynamic sustainability frameworkSustainabilityInformaticsAntimicrobial prophylaxisSurgical care improvement projectPolicy discontinuation |
| spellingShingle | Westyn Branch-Elliman A. Rani Elwy Rebecca L. Lamkin Marlena Shin Ryann L. Engle Kathryn Colborn Jessica Rove Jacquelyn Pendergast Kierstin Hederstedt Mary Hawn Hillary J. Mull Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol Implementation Science Communications Dynamic sustainability framework Sustainability Informatics Antimicrobial prophylaxis Surgical care improvement project Policy discontinuation |
| title | Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol |
| title_full | Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol |
| title_fullStr | Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol |
| title_full_unstemmed | Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol |
| title_short | Assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting: study protocol |
| title_sort | assessing the sustainability of compliance with surgical site infection prophylaxis after discontinuation of mandatory active reporting study protocol |
| topic | Dynamic sustainability framework Sustainability Informatics Antimicrobial prophylaxis Surgical care improvement project Policy discontinuation |
| url | https://doi.org/10.1186/s43058-022-00288-0 |
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