Baptist Health Aims to Change Culture in Surgical Suite, Improve ClinicalCare

Baptist Health Medical Center, a 650-bed facility in Little Rock, Ark., continually works to be at the forefront of clinical improvement to maintain its high-quality patient care. In 2003, the organization partnered with VHA Inc., a national alliance of not-for-profit healthcare organizations, to participate in a Surgical Infection Prevention Project (SIP) task force. The hospital applied this work to its ongoing surgical site infection (SSI) reduction program efforts.

Since 2003, the hospital has worked closely with VHA on a variety of clinical programs. Linking to national collaboratives really works and is a powerful tool for us, says John May, MT (ASCP), MS, CIC, an epidemiologist at Baptist Health.

Changing Practices

Understanding that improving patient safety and outcomes within the operating room (OR) requires more than changing clinical and operational factors, VHA developed a new program to transform the OR called Transformation of the Operating Room (TOR). The program is driven by a task force of 19 hospitals, which includes Baptist Health Medical Center Little Rock.

TOR focuses on three domains: culture/safety, clinical, and financial performance/operational improvement. The clinical component of the program aims to require hospitals to implement an enhanced version of the Surgical Care Improvement Project (SCIP) process and outcome measures. SCIP target areas are surgical site infections, adverse cardiac events, venous thromboembolism, and postoperative pneumonia. In addition, TOR will target clinical improvement efforts that include:

• Monitor and control glucose levels in coronary artery bypass surgical patients

• Establish firmer guidelines about the timing and dosages of antibiotic and anticoagulant administration

• Surgical normothermia in colon surgery patients

• Weight-based prophylactic antibiotic dosing

• Re-dosing of prophylactic antibiotics for longer cases

• Eliminate the practice of shaving body hair around surgical sites.

In turn, improving infection rates, reducing surgical complications, and addressing clinical practice changes will reduce the money hospitals lose every year due to inefficiency in the surgical area.

We hope the culture domain will be a catalyst that will increase the results seen from present performance improvement initiatives, says Rocky Hodges, RN, CNOR, director of perioperative services at Baptist Health Medical Center Little Rock. Despite control efforts, operating room staff know that there is always a risk of infection. However, the actual effect that culture has on typical infection control efforts has not been fully evaluated. The TOR program has the potential to reveal new ways to improve infection rates.

Hodges explains that the pressure between people and processes influences all aspects of the surgical suite, including throughput, cost, efficiency and even infection control.

The Heart of the Matter

Staff at Baptist Health believes that the TOR program will help to improve the culture in its operating rooms, leading to:

• Increased retention rates > Reduced surgical staff turnover rates

• Higher employee morale and satisfaction

• Improved relationships between surgeons and staff

• Lower costs

• Improved patient outcomes

Hodges adds, The culture issue is especially important since research has shown that the No. 1 reason nurses leave the OR is due to their working relationship with surgeons.

In 2003, to maintain control of SSI rates, Baptist Health implemented a modified approach to antibiotic delivery to reduce rates. With this approach, patients are administered an antibiotic within one hour of incision. In 2005, Baptist Health executed an assessment survey to gauge its current culture, as well as discover staff and physician perspectives. Other efforts that the hospital has adopted to control SSI rates include:

• Staffing an infection control nurse in the OR to heighten awareness of the organizations commitment to infection control

• Securing physician champions to spread and foster infection control efforts

• Securing support from hospital administration, because change comes from the top down

• Continually monitor infection reports and data, and conduct investigations of trends and patterns

• Vigorously monitor OR department construction activities; if risk exists or is threatened, infection control has the power to stop construction activities

• Infection control staff monitor sterilizer and disinfection functions, routinely intervening in and reviewing the process to ensure proper work

At Baptist Health, the infection control department is empowered and has the authority to do its job, and to do it right. Our hospital understands that infection control doesnt just happen. It takes a lot of people working on it all of the time, Hodges adds.