Surgical Infection Prevention: Success Stories NEBRASKA Statewide Collaborative improves care in Nebraska The Nebraska Surgical Infection Prevention (NE-SIP) Collaborative concluded its nine-month project with an Outcomes Congress in Lincoln on July 27, 2004 . The goal of the collaborative was improving care for patients undergoing surgical procedures, with focus in the following areas: Appropriate prophylactic antibiotic selection Administration of prophylactic antibiotics within 1 hour of incision time Discontinuation of prophylactic antibiotics within 24 hours of surgery end time. All Nebraska hospitals were invited to participate in the project, which kicked off with the first learning session in November 2003. Twenty-one teams representing 24 Nebraska hospitals agreed to join the collaborative, representing approximately 95% of the surgical cases done in Nebraska hospitals. Utilizing the Institute for Healthcare Improvement’s (IHI) Break Through Series model, the collaborative teams focused on making rapid-cycle improvements to processes of care in their facilities. Teams attended three learning sessions and an outcomes congress. Each session included local and national speakers, who presented the latest evidence-based recommendations for care of surgical patients. Quality improvement strategies were also included in each learning session. Teams received materials from national organizations, such as the American Association of Orthopedic Surgeons, to support the changes they were asking physicians to make in the care of their patients. The collaborative teams have made significant improvements in each of the antibiotic measures, particularly in the area of discontinuing antibiotics within 24 hours post-operatively. The following tables illustrate improvements achieved by the NE-SIP collaborative teams: Antibiotics Administered within 1 Hour Prior to Incision Baseline* Remeasurement** Area Rate Rank Area Rate Rank NE 58.4% 4 th NE 69.9% 12th US 47.6% - US 64.1% - Antibiotics Discontinued within 24 Hours Post-operatively Baseline* Remeasurement** Area Rate Rank Area Rate Rank NE 43.4% 20 th NE 64.6% 2 nd US 40.7% - US 44.3% - *Baseline period = 6/1/2001 – 11/30/2001 ** Remeasurement Period = 01/01/2004 – 3/31/2004 The Collaborative was led by CIMRO of Nebraska, the Medicare Quality Improvement Organization for Nebraska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. CIMRO is continuing to work with hospitals statewide to improve quality of care and to continue to decrease their rates of surgical infection. Nebraska Surgical Infection Prevention Collaborative Success: As a member of the Nebraska Surgical Infection Prevention Collaborative, BryanLGH Medical Center in Lincoln , Nebraska , increased the percentage of cardiac surgical patients who receive prophylactic antibiotics 60 minutes prior to surgery from 50 to 100 percent. BryanLGH also increased the use of recommended antibiotics from 60 to 100 percent for patients undergoing cardiac surgery. The Nebraska Surgical Infection Prevention Collaborative was sponsored by the Nebraska Quality Improvement Organization, CIMRO of Nebraska. The hospital’s team promoted a “Go For the Green” campaign, encouraging surgery staff and physicians to reach the 100 percent threshold, created with green text, displayed on posters in the surgery department. For more information, contact: Keri McDermott, Communications Director at CIMRO-NE, (402) 476-1399, or kmcdermott@neqio.sdps.org. This material was prepared by CIMRO of Nebraska, the Medicare Quality Improvement Organization for the state of Nebraska, under a contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

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