FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 30, 1999
SUBJECT: Trends in Post-operative Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery
IPRO CONTACTS:
Barbarba Shields RN, Director Quality Improvement, Upstate, 518-426-3300
Margaret Shaffer, RN, Director Quality Improvement, Downstate, 516-326-7767 x 356
Enclosed please find the report on "Trends in Post-operative Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery: January-June, 1997 & September, 1998-March, 1999". 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.
Twenty-nine New York State hospitals collaborated in this project. They sought to ascertain their own antibiotic prescribing patterns. The results of the baseline assessment demonstrated that prolonged usage of antibiotics was prevalent. The collaborating hospitals received their individual data. Impact assessment revealed no major changes in antibiotic prescribing patterns. Perceived organizational barriers appeared to be the major reason for similar prescribing patterns among the baseline and impact years.
Should you have any questions, please feel free to contact any of the IPRO contacts listed above.
IPRO's project on Trends in Post-operative Use of Prophylactic Antibiotics in Medicare Elective Colorectal Surgery was intended to reduce the proportion of eligible patients who receive post-operative antibiotic prophylaxis. This goal was based upon recent medical literature which shows that single-dose prophylaxis, given just before the start of surgery, is as effective as multiple doses in preventing surgical wound infection, and is also associated with less toxicity, fewer adverse events and lower costs.
IPRO performed a baseline analysis of 414 eligible Medicare patients who had an elective colorectal procedure and were discharged from 30 collaborating hospitals between January and June 1997. IPRO found that 18% of patients had no post-surgical prophylaxis; 42% had antibiotics continued for up to 24 hours post-surgery; 14% had antibiotic usage for up to 48 hours post-surgery; and 26% had prophylactic antibiotic usage exceeding 48 hours after surgery.
Collaborating hospitals received their own data. A summary report was distributed to all New York State acute-care hospitals. The IPRO feedback staff worked with the collaborating hospitals in developing quality improvement programs. This occurred through one-to-one meetings with each of the 30 collaborators and small group telephone conference calls.
IPRO conducted a follow-up data abstraction for elective colorectal procedures which were performed between September, 1998 and March, 1999. Twenty-nine hospitals participated in the impact assessment. There was essentially no change. IPRO found that in 372 eligible patients, 16% of patients had no post-surgical prophylaxis; 40% had antibiotics continued for up to 24 hours post-surgery; 15% had antibiotic usage for up to 48 hours post-surgery; and 29% had prophylactic antibiotic usage exceeding 48 hours after surgery. Possible barriers to change include a lack of effective antibiotic prescribing reminders/prompts and a reticence by individual hospitals to implement more stringent antibiotic prescribing rules if they are applied to only a few surgical procedures.