FROM: Theodore O. Will, Chief Executive Officer
DATE: Feb 12, 1999
SUBJECT: Prolonged Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery
IPRO CONTACTS:
Alan Silver, MD, MPH, Clinical Coordinator, ext 509
Harriet Starr, Vice President, Project Development & Evaluation, ext 527
Enclosed please find the report on "Prolonged Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery". This Medicare project grew out of an earlier Health Care Quality Improvement Project (HCQIP) on surgical antibiotic prophylaxis which suggested that post-operative prophylactic antibiotic usage was common despite guidelines stating that post-operative prophylaxis was typically unneeded.
Thirty-one New York State hospitals collaborated in this project. They sought to ascertain their own antibiotic prescribing patterns. The results of this study demonstrate that prolonged usage of antibiotics was prevalent. The collaborating hospitals have received their individual data. They are currently engaged in quality improvement projects.
IPRO will remeasure prophylactic antibiotic usage in late 1999, in order to assess improvement. We urge other hospitals to consider quality improvement projects examining antibiotic prophylaxis.
Please note that a hard copy slide show presentation has been appended to the report. The slide show itself may be downloaded from IPRO's website (www.ipro.org) using the Professional Connection button.
IPRO's project on Prolonged Use on Prophylactic Antibiotics in Medicare Elective Colorectal Surgery is intended to maximize the proportion of eligible patients who do not receive post-operative antibiotic prophylaxis for elective colorectal surgery. This goal is based on recent medical literature which shows that single dose prophylaxis is as effective as multiple doses in preventing surgical wound infection, and is also associated with less toxicity, fewer adverse events and lower costs.
In abstraction of a sample of 531 Medicare claims with elective colorectal procedures discharged from 31 collaborating hospitals between January and June 1997, IPRO found that only 18 percent had no post-surgical prophylaxis; 42 percent had antibiotics continued for up to 24 hours post-surgery; 14 percent had antibiotic usage for up to 48 hours post-surgery; and 26 percent had antibiotic usage exceeding 48 hours after surgery. Collaborating hospitals have received their own data.
Successful improvement strategies include professional education as well as hospital system changes, including combined pharmacist/surgeon rounds.
IPRO plans to remeasure this project in late 1999, in order to assess improvements.