Infection Control & Hospital Epidemiology (2019), 40, 125–132 doi:10.1017/ice.2018.294
Original Article
The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital
Sasha van Katwyk MSc1,2, Kednapa Thavorn PhD1,2,3, Doug Coyle PhD2, Husein Moloo MD1,4,
Alan J. Forster MD1,3,5, Timothy Jackson MD6,7 and David Schramm MD1,8 1Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, 2School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, 3Institute for Clinical and Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada, 4Department of Surgery, Division of General Surgery, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, 5Department of Medicine, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, 6Department of Surgery, University of Toronto, Toronto, Ontario, Canada, 7Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada and 8Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
Abstract
Objective: We performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases. Design: A retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses. Setting: Data were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution. Patients: We used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015. Intervention: We estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP). Results: From 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program. Conclusions: The NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.
(Received 25 June 2018; accepted 19 October 2018; electronically published 23 November 2018)
Surgical site infection (SSI), the second most common cause of nosocomial infection, accounts for ~16% of all hospital-acquired infections.1 At the Ottawa Hospital (TOH), patients with an SSI stayed in hospital on average 7 days longer than those without an SSI in 2010.2 Prolonged hospitalization not only imposes negative consequences to patients but also incurs high opportunity costs by limiting a hospital’s capacity to care for other patients. Various quality improvement programs have been imple- mented in attempts to reduce postsurgical complications.3–9
Author for correspondence: Kednapa Thavorn, PhD, Ottawa Hospital Research
Institute, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, Canada K1H 8L6. E-mail:
kthavorn@ohri.ca
Cite this article: van Katwyk S, et al. (2019). The return of investment of hospital-
based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital. Infection Control & Hospital Epidemiology 2019, 40, 125–132. doi: 10.1017/ice.2018.294
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
Among these programs, the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is considered the preeminent surgical quality improvement pro- gram.5 The NSQIP provides detailed data necessary to measure and monitor SSI rates monthly; these data can be used to estimate the direct and indirect costs incurred by surgical patients. The NSQIP was implemented at TOH in May 2010 as the first phase of the hospital’s surgical quality improvement program (SQIP). Outcome data have been collected on ~20% of all surgical pro- cedures performed at TOH through the NSQIP Essentials Pro- gram. The Comprehensive Unit-based Safety Program (CUSP) was initiated in March 2013 as the second phase of the TOH SQIP. The NSQIP is not an intervention, but its data provide insight for CUSP in designing quality improvement initiatives, and it enables the outcomes to be monitored and evaluated effectively. The Ottawa Hospital has formed 17 multidisciplinary
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144 |
Page 145 |
Page 146 |
Page 147 |
Page 148 |
Page 149 |
Page 150 |
Page 151 |
Page 152 |
Page 153 |
Page 154 |
Page 155 |
Page 156
