Contact: Dianne M. Cutillo
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Surgery Team Achieves Top 10% Improvement

Thanks to a team effort among surgeons, nurses, and the Patient Safety Department, nearly all Southwestern Vermont Medical Center surgery patients get two critical safety treatments.


BENNINGTON - During the seven months that ended in June, 98 percent of surgery patients who needed a preventive antibiotic got it within 1 hour before their incision was made. According to the Medicare website Hospital Compare, only the top 10 percent of hospitals nationwide had 95 percent or better in 2006.

And, at SVMC, 98 percent of elective surgery patients got the right antibiotic. Before the quality improvement project, only 84 percent of patients were getting the right antibiotic.

SVMC’s performance improved when an improvement team started a protocol to ensure that the antibiotics are given. The protocol is called, “Adult Preoperative Antibiotic for Surgical Prophylaxis (prevention).”

Getting the right antibiotic at the right time to the right patient is a critical safety practice for surgery patients. That’s because the practices have been proven to reduce infections of surgical sites.

Surgical infections cause complications and expense for patients. For example, patients with this complication are five times more likely to be readmitted to the hospital. Surgical site infections can even cause death. Preventing infections is so important that 10 national organizations work together on the nationwide Surgical Care Improvement Project. 

“The improvement in these measures is a real tribute to our surgeons and anesthesiologists, who had to make a big change in the way they practice as a result of this project,” said Avis Hayden. Hayden is the quality improvement specialist from Patient Safety who co-led the team.

Tanya Martin, RN, MS, of Perioperative Services, co-led the project. She said the improvement requires “nursing finesse and really enhanced nursing/physician relations with both surgeons and anesthesiologists.” That’s because the providers must carefully track timing, knowing, for example, how long it takes for a patient to be positioned for a given procedure. And, if a procedure runs late, everyone has to adjust the time for giving the antibiotic to the next patient.

Developing the protocol took a lot of work, too, Hayden said. Surgeons researched best practices for every type of elective procedure. They had to identify two antibiotics and doses for each type of procedure. They named both a preferred drug and the alternative for patients allergic to that one. Now, surgeons order the protocol for their patients when they set up a surgery.

The team making the project successful extends beyond the operating room. Wilma Salkin, RN, BSN, CIC, and Marcia Podolec, RN, in infection control provide ongoing oversight. They track the measures for reports to Medicare.

And the Pre-Operative Clinic team has a role in the project’s success. Susan Erickson, RN, of the clinic said the team approach at the pre-op visit includes the patient, anesthesiologist, and pre-op nurse. An important step there is to identify early any patient allergies and make sure the right antibiotic is ordered.

“The right antibiotic” does not just mean the right drug. The antibiotics must be given according to a patient’s body weight, so getting it right also means getting the right dose.

“The only way we made this work was a team approach,” Erickson said.
 Southwestern Vermont Medical Center is a 99-bed community hospital and one of only about 250 hospitals recognized by the American Nurses Association as a Magnet Hospital for Nursing Excellence. SVMC is part of Southwestern Vermont Health Care, a community-based, not-for-profit health system that exists solely for the benefit of the communities it serves. SVHC has a quest to make the communities it serves the healthiest in the nation.