Clinical ScienceReducing colorectal surgical site infections: a novel, resident-driven, quality initiative

- Question: We aim to show that a resident-driven and implemented quality initiative can measurably improve patient outcomes and care in an academic hospital center.
- Findings: This was an implementation study that demonstrated a significant decrease in surgical site infections from 13.9% to 4.7% after initiating a colorectal surgery care bundle.
- Meaning: Patient care initiatives can and should be initiated by all members of the health community and have the potential to measurably improve the care of patients.

BackgroundSurgical site infections (SSIs) cause significant patient morbidity and increase costs. This work prospectively examines our institutional effort to reduce SSIs through a resident-driven quality initiative.MethodsA general surgery resident-championed, evidenced-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship. National Surgical Quality Improvement Program definitions for SSIs were used. Data were collected prospectively and bundle compliance was monitored using a checklist. The primary outcome compared SSIs before and after implementation.ResultsIn the 2 years preceding standardization, 489 colorectal surgery cases were performed. SSIs occurred in 68 patients (13.9% SSI rate). Following implementation of the bundle, 212 cases were performed with 10 SSIs (4.7% SSI rate, P < .01). Multivariate logistic regression analysis found a decrease in superficial and overall SSIs (odds ratio .17, 95% confidence interval .05 to .59; odds ratio .31, 95% confidence interval .14 to .68).ConclusionsThese data demonstrate that resident-driven initiatives to improve quality of care can be a swift and effective way to enact change. We observed significantly decreased SSIs with a renewed focus on evidence-based, standardized patient care.