Colorectal Bundle: A Multidisciplinary Teamwork Approach to Reduce Surgical Site Infections

During FY2014, the surgical site infections rate at this academic medical center increased to 21.8 percent among colorectal patients. An internal audit revealed inconsistent practice among providers during preoperative clinic visits and perioperatively. The 2014 Surgical Care Improvement Project, led by the hospital's interdisciplinary surgical quality committee, set a goal to reduce SSI rates by 20 percent. This goal was arrived upon through benchmarking to external agencies and institutional rates during the previous year. Combining expertise in general surgery, infection control and nursing education, the committee designed a 'colorectal bundle intended to standardize preoperative and perioperative phases of care. The bundle--requiring documented preoperative prescriptive care, self-reported adherence prior to surgery and appropriate perioperative skin preparation--was implemented in November 2013, led by frontline staff, with continual feedback between providers and the committee used to inform process redesign. Adherence to the colorectal bundle was measured by infection control audits. The colon SSI rate decreased from 21.8 to 6.2 percent between July 2013 and March 2014.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)