SWC Iterative Review
Fidelity of Surgical Wound Classification as a Risk Stratification Measure of Hospital Quality: An Iterative Review and Analysis of Quality Improvement Processes
Currently, we are doing an additional investigation focusing on hospital surgical wound class (SWC) practices and knowledge deficits in hopes of elucidating methods that may or may not be effective at improving SWC accuracy. In 2011, we completed a surgical wound classification quality improvement project that assessed the accuracy of SWC documented in the electronic medical records (EMR) in common pediatric surgical procedures in multiple institutions to understand the scope of the problem with SWC inaccuracy. The SWC-operative note (SWC –ON) was used as the gold standard of comparison to evaluate the accuracy of the SWC in the EMR. It was concluded that there is a large discordance between the SWC –ON and SWC-EMR.
Our iterative review aim is to perform a quality improvement project to assess the accuracy of SWC documented in the EMR at the participating centers during 2013. We will also determine what institutions have done with regards to their SWC processes since the last iteration of SWC data collection in 2011 and compare SWC concordance between 2011 and 2013. Determining these data will help us identify if SWC is a reliable and valid measure for SSI risk stratification as well as what SWC intervention(s) may or may not effectively improve SWC concordance. We hypothesize that amongst the 11 centers that previously participated in the SWC study, those centers in which new SWC measures or processes were put in place will have significantly improved SWC accuracy.
Results from 2011
Figure 2. The Degree of Misclassification of Circulating Nurse Versus Diagnosis Based SWC
Figure .1 Diagnosis and Circulating Nurse SWC Case Distribution