Over at SixSigmaZone.com, I got the story of how The Cleveland Clinic met the target interval of giving perioperative antimicrobial prophylaxis of equal and/or less than 60 minutes to non-cardiac patients who will undergo surgery.
Featured on Anesthesia & Analgesia, the Clinic found out that only 38% of their patients receive the procedure at the appointed time before going surgery. To improve this process, Cleveland Clinic adopted Six Sigma.
Methods: Six Sigma methodology was used to improve our process of timing of antimicrobial prophylaxis administration. A multidisciplinary team was assembled which identified seven process inputs by which patients receive antimicrobial prophylaxis. Interventions for improvement included reinforcement of use of preoperative antibiotic order forms, eliminating administration of antibiotics in the preoperative admission area, and sending appropriate antibiotics and IV tubing with the patient to the operating room. We concurrently developed a control plan to sustain this improvement using a recently deployed electronic anesthesia record keeping system using real-time measurement and reporting capabilities of antimicrobial prophylaxis administration. After defining the new process and undertaking a system-wide educational effort, implementation was begun with data collection and analysis occurring over the next 7 mo.
Results: For the 8-mo postintervention interval, there was a significant improvement with 86% of 1716 surgical patients receiving their antibiotic prophylaxis within the specified time frame (P < 0.01). The time interval for antibiotic administration before surgical incision also decreased from a preintervention mean of 88 (CI 56–119 min) to 38 min (CI 25–51 min) (P < 0.01).
Incidentally, Cleveland Clinic was ranked one of the top three hospitals in the U.S. by the U.S. News & World Report 2006. It demonstrates exceptional breadth of excellence, and score at or the near top of at least six specialties, among which are gynecology, cancer, eye, pediatrics, psychiatry, and rehabilitation.
