Best Practice in all of
Surgery
from left to right Robin McLeod &
Emily Pearsall
Robin McLeod has
taken on the responsibility
of Vice Chair
of the Department of
Surgery, Quality and
Performance. Robin
currently leads the Best
Practice in General
Surgery (BPIGS) program
and Jim Rutka has
asked her to expand this
quality initiative across
all the divisions in the
department. The Best
Practice in General Surgery program was initiated in
2006 with the goal of standardizing care based on best
evidence across all of the adult teaching hospitals. The
Steering Group has representatives from all of the fully
and partially affiliated adult hospitals. With the support
of all of the general surgeons, they have developed and
implemented guidelines on Surgical Site Infections,
Thromboprophylaxis, Mechanical Bowel Preparation
and Management of Intra-abdominal Infection. Their
current focus is on developing, in conjunction with
anaesthesia, nursing and allied healthcare representatives,
an “Enhanced Recovery after Surgery” Guideline.
An important aspect of the program is the involvement
of both residents and medical students. Prior to developing
the guidelines, audits had been performed to assess
whether a gap in care exists. A second audit was then
conducted after guideline implementation to determine
if there had been an improvement in care. Not surprisingly,
the group has been able to identify significant gaps
in care. For example, in an audit of 350 patients who
had intra-abdominal sepsis, 34 different antibiotic combinations
were prescribed and 40% of the patients had
prolonged courses of antibiotics of more than 7 days.
A unique feature of BPIGS is the collaborations that have
been developed across hospitals as well as specialties. For
instance, the Intra-abdominal Infection guideline has
been developed in collaboration with the Toronto
Antimicrobial Stewardship Corridor, and a multidisciplinary
listserv is planned to familiarize surgeons, physicians
and residents with the recommendations.
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The BPIGS group has been able to show that they have
been able to improve care. For instance, as shown in
Figure 1, the appropriate administration of pre-operative
antibiotics increased following the implementation of
the Surgical Site Infections Guideline. As a result, there
has been good buy - in from the CEOs of all the hospitals.
The work of BPIGS helps CEO’s fulfill the institutional
requirements of the provincial “Excellent Care for
All” mandate.
Jim Rutka hopes to see the Best Practice in General
Surgery program expanded across the department to
develop protocols, guidelines, and centers of excellence.
Already there are examples where services have been consolidated
to improve care such as the Vascular Surgery
Program. The Trauma Program, which until recently
had been comprised of two fairly independent sites,
is also in the midst of developing common protocols
and sharing fellows. The Bariatric Program is a coordinated
university program situated at 4 sites. Developing
a department quality improvement initiative will be
one of the priorities of the Strategic Planning process.
According to Robin “there is a great opportunity for our
department but it will take surgeon buy -in as well as
champions in each division. Audit will be an important
component to show success, which in turn will help to
attain government and other external funding to support
the initiative.”
Emily Pearsall, a PhD candidate in Knowledge
Translation, is the coordinator for the Department’s
Quality and Performance program. The members of the
Steering Committee include Mary- Anne Aarts, Darlene
Fenech, David Lindsay, Avery Nathens, Allan Okrainec,
Lorne Rotstein, Peter Stotland, and Alice Wei. More
information about Best Practice in General Surgery can
be found at www.bpigs.ca.
M.M.
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