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Saving lives one pop-up at a time

Post-it notes might have done the job, but Vanderbilt's perioperative informatics specialists took it one step further. They programmed computers in the operating rooms to remind doctors with a pop-up screen prompt about dosing patients with prophylactic antibiotics before and during surgery.

The result, says Paul St. Jacques, M.D., was an increase in compliance of administering antibiotics in the suggested time period of an hour or less before surgery, and re-dosing during long procedures based on the half-life of the specific antibiotic.

After a staff education campaign and the addition of the pop-up prompt, compliance with initial antibiotic dosing recommendations more than doubled. After adding a pop-up screen reminder for re-dosing during long procedures, compliance with that step nearly tripled.

And while what happened after these changes can't be called a cause-and-effect since some other factors might have intervened, St. Jacques still is sharing the results with colleagues from across the country. After all, it is really good news: after six months, the Medical Center's surgical site infection rate was cut in half.

"With infection rates below the national average, we were doing well beforehand," observes St. Jacques, director of Perioperative Informatics and an associate professor of Anesthesiology. "We felt we could, nevertheless, do better."

Surgical site infections, estimated to account for about a quarter of the hospital-acquired infections that occur, are serious business.

"There's a very high cost financially, and a very high morbidity to the patient," says St. Jacques.

Administering prophylactic antibiotics before and during surgery for selected patients has been shown to protect against surgical site infections. In addition to the proper administration of these infection-fighting drugs, the Institute for Healthcare Improvement lists these actions as key for preventing surgical site infections: using a clipper or depilatory – not a razor – to remove hair; monitoring and maintaining the patient's glucose levels after surgery; and keeping the body temperature at normal levels, both during and after an operation.

St. Jacques sees computer tracking, already common and budgeted for in much of corporate America, as a next step in medicine. He recalls how, at a professional meeting, a speaker compared the ability of the global shipper Federal Express to locate any package 24 hours a day to the ability of the doctors in the audience to locate all of a patient's medical records – quite a challenging process.

"We realize that medical information management is going to be a key to making medicine more efficient, and more cost effective," he said.
- Elizabeth Older


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