A comparison of 2 surgical site infection monitoring systems

Mila H. Ju, Clifford Y. Ko, Bruce L. Hall, Charles L. Bosk, Karl Y. Bilimoria, Elizabeth C. Wick

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data. OBJECTIVE: To identify discrepancies in the implementation of the NHSN and the ACS NSQIP at hospitals that may be affecting the respective SSI rates. DESIGN, SETTING, AND PARTICIPANTS: A pilot sample of hospitals that participate in both the NHSN and the ACS NSQIP. INTERVENTIONS: For each hospital, observed rates and risk-adjusted observed to expected ratios for year 2012 colon SSIs were collected from both programs. The implementation methods of both programs were identified, including telephone interviews with infection preventionists who collect data for the NHSN at each hospital. MAIN OUTCOMES AND MEASURES: Collection methods and colon SSI rates for the NHSN at each hospital were compared with those of the ACS NSQIP. RESULTS: Of 16 hospitals, 11 were teaching hospitals with at least 500 beds. The mean observed colon SSI rates were dissimilar between the 2 programs, 5.7%(range, 2.0%-14.5%) for the NHSN vs 13.5%(range, 4.6%-26.7%) for the ACS NSQIP. The mean difference between the NHSN and the ACS NSQIP was 8.3%(range, 1.6%-18.8%), with the ACS NSQIP rate always higher. The correlation between the observed to expected ratios for the 2 programs was nonsignificant (Pearson product moment correlation, ρ = 0.4465; P = .08). The NHSN collection methods were dissimilar among interviewed hospitals. An SSI managed as an outpatient case would usually be missed under the current NHSN practices. CONCLUSIONS AND RELEVANCE: Colon SSI rates from the NHSN and the ACS NSQIP cannot be used interchangeably to evaluate hospital performance and determine reimbursement. Hospitals should not use the ACS NSQIP colon SSI rates for the NHSN reports because that would likely result in the hospital being an outlier for performance. It is imperative to reconcile SSI monitoring, develop consistent definitions, and establish one reliable method. The current state hinders hospital improvement efforts by adding unnecessary confusion to the already complex arena of perioperative improvement.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalJAMA Surgery
Volume150
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Surgical Wound Infection
Quality Improvement
Delivery of Health Care
Safety
Colon
State Hospitals
Surgeons
Centers for Disease Control and Prevention (U.S.)
Teaching Hospitals
Outpatients

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Ju, M. H., Ko, C. Y., Hall, B. L., Bosk, C. L., Bilimoria, K. Y., & Wick, E. C. (2015). A comparison of 2 surgical site infection monitoring systems. JAMA Surgery, 150(1), 51-57. https://doi.org/10.1001/jamasurg.2014.2891

A comparison of 2 surgical site infection monitoring systems. / Ju, Mila H.; Ko, Clifford Y.; Hall, Bruce L.; Bosk, Charles L.; Bilimoria, Karl Y.; Wick, Elizabeth C.

In: JAMA Surgery, Vol. 150, No. 1, 01.01.2015, p. 51-57.

Research output: Contribution to journalArticle

Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilimoria, KY & Wick, EC 2015, 'A comparison of 2 surgical site infection monitoring systems', JAMA Surgery, vol. 150, no. 1, pp. 51-57. https://doi.org/10.1001/jamasurg.2014.2891
Ju MH, Ko CY, Hall BL, Bosk CL, Bilimoria KY, Wick EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surgery. 2015 Jan 1;150(1):51-57. https://doi.org/10.1001/jamasurg.2014.2891
Ju, Mila H. ; Ko, Clifford Y. ; Hall, Bruce L. ; Bosk, Charles L. ; Bilimoria, Karl Y. ; Wick, Elizabeth C. / A comparison of 2 surgical site infection monitoring systems. In: JAMA Surgery. 2015 ; Vol. 150, No. 1. pp. 51-57.
@article{49c766866cd04956b6d0d641b2291897,
title = "A comparison of 2 surgical site infection monitoring systems",
abstract = "IMPORTANCE: Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data. OBJECTIVE: To identify discrepancies in the implementation of the NHSN and the ACS NSQIP at hospitals that may be affecting the respective SSI rates. DESIGN, SETTING, AND PARTICIPANTS: A pilot sample of hospitals that participate in both the NHSN and the ACS NSQIP. INTERVENTIONS: For each hospital, observed rates and risk-adjusted observed to expected ratios for year 2012 colon SSIs were collected from both programs. The implementation methods of both programs were identified, including telephone interviews with infection preventionists who collect data for the NHSN at each hospital. MAIN OUTCOMES AND MEASURES: Collection methods and colon SSI rates for the NHSN at each hospital were compared with those of the ACS NSQIP. RESULTS: Of 16 hospitals, 11 were teaching hospitals with at least 500 beds. The mean observed colon SSI rates were dissimilar between the 2 programs, 5.7{\%}(range, 2.0{\%}-14.5{\%}) for the NHSN vs 13.5{\%}(range, 4.6{\%}-26.7{\%}) for the ACS NSQIP. The mean difference between the NHSN and the ACS NSQIP was 8.3{\%}(range, 1.6{\%}-18.8{\%}), with the ACS NSQIP rate always higher. The correlation between the observed to expected ratios for the 2 programs was nonsignificant (Pearson product moment correlation, ρ = 0.4465; P = .08). The NHSN collection methods were dissimilar among interviewed hospitals. An SSI managed as an outpatient case would usually be missed under the current NHSN practices. CONCLUSIONS AND RELEVANCE: Colon SSI rates from the NHSN and the ACS NSQIP cannot be used interchangeably to evaluate hospital performance and determine reimbursement. Hospitals should not use the ACS NSQIP colon SSI rates for the NHSN reports because that would likely result in the hospital being an outlier for performance. It is imperative to reconcile SSI monitoring, develop consistent definitions, and establish one reliable method. The current state hinders hospital improvement efforts by adding unnecessary confusion to the already complex arena of perioperative improvement.",
author = "Ju, {Mila H.} and Ko, {Clifford Y.} and Hall, {Bruce L.} and Bosk, {Charles L.} and Bilimoria, {Karl Y.} and Wick, {Elizabeth C.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1001/jamasurg.2014.2891",
language = "English (US)",
volume = "150",
pages = "51--57",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - A comparison of 2 surgical site infection monitoring systems

AU - Ju, Mila H.

AU - Ko, Clifford Y.

AU - Hall, Bruce L.

AU - Bosk, Charles L.

AU - Bilimoria, Karl Y.

AU - Wick, Elizabeth C.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - IMPORTANCE: Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data. OBJECTIVE: To identify discrepancies in the implementation of the NHSN and the ACS NSQIP at hospitals that may be affecting the respective SSI rates. DESIGN, SETTING, AND PARTICIPANTS: A pilot sample of hospitals that participate in both the NHSN and the ACS NSQIP. INTERVENTIONS: For each hospital, observed rates and risk-adjusted observed to expected ratios for year 2012 colon SSIs were collected from both programs. The implementation methods of both programs were identified, including telephone interviews with infection preventionists who collect data for the NHSN at each hospital. MAIN OUTCOMES AND MEASURES: Collection methods and colon SSI rates for the NHSN at each hospital were compared with those of the ACS NSQIP. RESULTS: Of 16 hospitals, 11 were teaching hospitals with at least 500 beds. The mean observed colon SSI rates were dissimilar between the 2 programs, 5.7%(range, 2.0%-14.5%) for the NHSN vs 13.5%(range, 4.6%-26.7%) for the ACS NSQIP. The mean difference between the NHSN and the ACS NSQIP was 8.3%(range, 1.6%-18.8%), with the ACS NSQIP rate always higher. The correlation between the observed to expected ratios for the 2 programs was nonsignificant (Pearson product moment correlation, ρ = 0.4465; P = .08). The NHSN collection methods were dissimilar among interviewed hospitals. An SSI managed as an outpatient case would usually be missed under the current NHSN practices. CONCLUSIONS AND RELEVANCE: Colon SSI rates from the NHSN and the ACS NSQIP cannot be used interchangeably to evaluate hospital performance and determine reimbursement. Hospitals should not use the ACS NSQIP colon SSI rates for the NHSN reports because that would likely result in the hospital being an outlier for performance. It is imperative to reconcile SSI monitoring, develop consistent definitions, and establish one reliable method. The current state hinders hospital improvement efforts by adding unnecessary confusion to the already complex arena of perioperative improvement.

AB - IMPORTANCE: Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data. OBJECTIVE: To identify discrepancies in the implementation of the NHSN and the ACS NSQIP at hospitals that may be affecting the respective SSI rates. DESIGN, SETTING, AND PARTICIPANTS: A pilot sample of hospitals that participate in both the NHSN and the ACS NSQIP. INTERVENTIONS: For each hospital, observed rates and risk-adjusted observed to expected ratios for year 2012 colon SSIs were collected from both programs. The implementation methods of both programs were identified, including telephone interviews with infection preventionists who collect data for the NHSN at each hospital. MAIN OUTCOMES AND MEASURES: Collection methods and colon SSI rates for the NHSN at each hospital were compared with those of the ACS NSQIP. RESULTS: Of 16 hospitals, 11 were teaching hospitals with at least 500 beds. The mean observed colon SSI rates were dissimilar between the 2 programs, 5.7%(range, 2.0%-14.5%) for the NHSN vs 13.5%(range, 4.6%-26.7%) for the ACS NSQIP. The mean difference between the NHSN and the ACS NSQIP was 8.3%(range, 1.6%-18.8%), with the ACS NSQIP rate always higher. The correlation between the observed to expected ratios for the 2 programs was nonsignificant (Pearson product moment correlation, ρ = 0.4465; P = .08). The NHSN collection methods were dissimilar among interviewed hospitals. An SSI managed as an outpatient case would usually be missed under the current NHSN practices. CONCLUSIONS AND RELEVANCE: Colon SSI rates from the NHSN and the ACS NSQIP cannot be used interchangeably to evaluate hospital performance and determine reimbursement. Hospitals should not use the ACS NSQIP colon SSI rates for the NHSN reports because that would likely result in the hospital being an outlier for performance. It is imperative to reconcile SSI monitoring, develop consistent definitions, and establish one reliable method. The current state hinders hospital improvement efforts by adding unnecessary confusion to the already complex arena of perioperative improvement.

UR - http://www.scopus.com/inward/record.url?scp=84921639263&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921639263&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2014.2891

DO - 10.1001/jamasurg.2014.2891

M3 - Article

C2 - 25426765

AN - SCOPUS:84921639263

VL - 150

SP - 51

EP - 57

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 1

ER -