Louisiana success stories

LA Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

Lafayette Surgical Specialty Hospital Targets Surgical Infections

Doctors, nurses and administrators at Lafayette Surgical Specialty Hospital (LSSH) can claim equal pride in a one-year initiative that has dramatically decreased the likelihood of surgical infections. More than 500,000 Americans are diagnosed with surgical site infections annually, which can cause complications, prolong recovery and increase the costs of care.
“The accomplishment stemmed from our participation in a national surgical care improvement project (SCIP) sponsored by the Centers for Medicare & Medicaid Services,” said CEO Buffy Domingue. LSSH has participated in the SCIP project since opening in 2004 in collaboration with eQHealth Solutions, the Medicare Quality Improvement Organization for Louisiana. Work began when infection preventionist Charlotte Dupuis, VP of Quality Management & Compliance for LSSH, reviewed the hospital’s surgical wound infection and SCIP compliance rates with Domingue, and Patient Care Unit Clinical Manager, Ruth Sonnier. From this review, Sonnier took the lead on the project which focused on reducing infection though appropriate antibiotic selection. Results were gathered through collection and analysis of the SCIP data monthly.

The project occurred over a one-year period (January 2011-December 2011). LSSH’s goal was to achieve a 99% compliance rate with appropriate antibiotic selection for orthopedic and neurosurgery cases. Using a baseline of 87%, calculated in January, LSSH reached the stated goal within only five months.

The project team started by performing one-on-one reviews of appropriate antibiotics selections by physician for each specialty. Once that information was obtained, Sonnier collaborated with physicians to review their specific data and revise all physician order sets to include only the specific antibiotics recommended for each procedure. “Improvement was instant once we implemented the new order sets, it was a great feeling of accomplishment to see success immediately through such a small change,” said project manager Ruth Sonnier.

After this was implemented, a few obstacles presented themselves and the LSSH team tackled each one. The first was the selection of appropriate antibiotic when the patient presented an allergy. In these situations, each case was reviewed with the physician along with evidence-based literature regarding antibiotic recommendations. Data was shared with physicians and staff by posting compliance results on bulletin boards in all departments and reporting through physician and staff newsletters. Another recurring issue was the result of one physician consistently prescribing Vancomycin to patients. To resolve this occurrence, the project manager presented literature on best practices and supporting studies in a one-on-one meeting with the physician and an expert physician educated physicians at an annual medical staff meeting. The last major barrier was in documentation requirements for physicians when using antibiotics other than those recommended by best practices. The team worked diligently to stress the importance of the documentation requirements to the physicians and gradually saw adoption of the process by the physicians. Throughout the project, barriers were overcome through concurrent review of physician orders, literature research followed by physician education, and the use of one contact person (the project manager) for all communication about the process.

The success of our program is demonstrated through the short time period in which our goal was obtained and the maintenance of that high standard within 1% variance throughout the year. We will continue to monitor this quality indicator, share data with physicians and staff along with review cases with variances with specific physicians. We also report individual physician compliance through ongoing periodic performance evaluations.