Pediatric surgeon-directed wound classification improves accuracy

Tiffany J. Zens, Deborah A. Rusy, Ankush Gosain

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes among centers. We hypothesized that by changing from nurse-directed to surgeon-directed SWC during a structured operative debrief, we will improve accuracy of documentation. Methods An institutional review board-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (before debrief, June 2012-May 2013) and allowing 6 mo for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (after debrief, January 2014-August 2014). Accuracy of SWC was determined for four commonly performed pediatric general surgery operations: inguinal hernia repair (clean), gastrostomy ± Nissen fundoplication (clean contaminated), appendectomy without perforation (contaminated), and appendectomy with perforation (dirty). Results One hundred eighty-three cases before debrief and 142 cases after debrief met inclusion criteria. No differences between time periods were noted in regard to patient demographics, ASA class, or case mix. Accuracy of wound classification improved before debrief (42% versus 58.5%, P = 0.003). Before debrief, 26.8% of cases were overestimated or underestimated by more than one wound class, versus 3.5% of cases after debrief (P < 0.001). Interestingly, most after debrief contaminated cases were incorrectly classified as clean contaminated. Conclusions Implementation of a structured operative debrief including surgeon-directed SWC improves the percentage of correctly classified wounds and decreases the degree of inaccuracy in incorrectly classified cases. However, after implementation of the debriefing, we still observed a 41.5% rate of incorrect documentation, most notably in contaminated cases, indicating further education and process improvement is needed.

Original languageEnglish (US)
Pages (from-to)432-439
Number of pages8
JournalJournal of Surgical Research
Volume201
Issue number2
DOIs
StatePublished - Apr 1 2016

Fingerprint

Pediatrics
Wounds and Injuries
Appendectomy
Documentation
Nurses
Education
Surgical Wound Infection
Fundoplication
Gastrostomy
Inguinal Hernia
Diagnosis-Related Groups
Herniorrhaphy
Research Ethics Committees
Surgeons
Surgical Wound
Demography

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Pediatric surgeon-directed wound classification improves accuracy. / Zens, Tiffany J.; Rusy, Deborah A.; Gosain, Ankush.

In: Journal of Surgical Research, Vol. 201, No. 2, 01.04.2016, p. 432-439.

Research output: Contribution to journalArticle

Zens, Tiffany J. ; Rusy, Deborah A. ; Gosain, Ankush. / Pediatric surgeon-directed wound classification improves accuracy. In: Journal of Surgical Research. 2016 ; Vol. 201, No. 2. pp. 432-439.
@article{a6da96dd4e684c58aadb290d1f81913e,
title = "Pediatric surgeon-directed wound classification improves accuracy",
abstract = "Background Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes among centers. We hypothesized that by changing from nurse-directed to surgeon-directed SWC during a structured operative debrief, we will improve accuracy of documentation. Methods An institutional review board-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (before debrief, June 2012-May 2013) and allowing 6 mo for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (after debrief, January 2014-August 2014). Accuracy of SWC was determined for four commonly performed pediatric general surgery operations: inguinal hernia repair (clean), gastrostomy ± Nissen fundoplication (clean contaminated), appendectomy without perforation (contaminated), and appendectomy with perforation (dirty). Results One hundred eighty-three cases before debrief and 142 cases after debrief met inclusion criteria. No differences between time periods were noted in regard to patient demographics, ASA class, or case mix. Accuracy of wound classification improved before debrief (42{\%} versus 58.5{\%}, P = 0.003). Before debrief, 26.8{\%} of cases were overestimated or underestimated by more than one wound class, versus 3.5{\%} of cases after debrief (P < 0.001). Interestingly, most after debrief contaminated cases were incorrectly classified as clean contaminated. Conclusions Implementation of a structured operative debrief including surgeon-directed SWC improves the percentage of correctly classified wounds and decreases the degree of inaccuracy in incorrectly classified cases. However, after implementation of the debriefing, we still observed a 41.5{\%} rate of incorrect documentation, most notably in contaminated cases, indicating further education and process improvement is needed.",
author = "Zens, {Tiffany J.} and Rusy, {Deborah A.} and Ankush Gosain",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.jss.2015.11.051",
language = "English (US)",
volume = "201",
pages = "432--439",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Pediatric surgeon-directed wound classification improves accuracy

AU - Zens, Tiffany J.

AU - Rusy, Deborah A.

AU - Gosain, Ankush

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes among centers. We hypothesized that by changing from nurse-directed to surgeon-directed SWC during a structured operative debrief, we will improve accuracy of documentation. Methods An institutional review board-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (before debrief, June 2012-May 2013) and allowing 6 mo for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (after debrief, January 2014-August 2014). Accuracy of SWC was determined for four commonly performed pediatric general surgery operations: inguinal hernia repair (clean), gastrostomy ± Nissen fundoplication (clean contaminated), appendectomy without perforation (contaminated), and appendectomy with perforation (dirty). Results One hundred eighty-three cases before debrief and 142 cases after debrief met inclusion criteria. No differences between time periods were noted in regard to patient demographics, ASA class, or case mix. Accuracy of wound classification improved before debrief (42% versus 58.5%, P = 0.003). Before debrief, 26.8% of cases were overestimated or underestimated by more than one wound class, versus 3.5% of cases after debrief (P < 0.001). Interestingly, most after debrief contaminated cases were incorrectly classified as clean contaminated. Conclusions Implementation of a structured operative debrief including surgeon-directed SWC improves the percentage of correctly classified wounds and decreases the degree of inaccuracy in incorrectly classified cases. However, after implementation of the debriefing, we still observed a 41.5% rate of incorrect documentation, most notably in contaminated cases, indicating further education and process improvement is needed.

AB - Background Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes among centers. We hypothesized that by changing from nurse-directed to surgeon-directed SWC during a structured operative debrief, we will improve accuracy of documentation. Methods An institutional review board-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (before debrief, June 2012-May 2013) and allowing 6 mo for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (after debrief, January 2014-August 2014). Accuracy of SWC was determined for four commonly performed pediatric general surgery operations: inguinal hernia repair (clean), gastrostomy ± Nissen fundoplication (clean contaminated), appendectomy without perforation (contaminated), and appendectomy with perforation (dirty). Results One hundred eighty-three cases before debrief and 142 cases after debrief met inclusion criteria. No differences between time periods were noted in regard to patient demographics, ASA class, or case mix. Accuracy of wound classification improved before debrief (42% versus 58.5%, P = 0.003). Before debrief, 26.8% of cases were overestimated or underestimated by more than one wound class, versus 3.5% of cases after debrief (P < 0.001). Interestingly, most after debrief contaminated cases were incorrectly classified as clean contaminated. Conclusions Implementation of a structured operative debrief including surgeon-directed SWC improves the percentage of correctly classified wounds and decreases the degree of inaccuracy in incorrectly classified cases. However, after implementation of the debriefing, we still observed a 41.5% rate of incorrect documentation, most notably in contaminated cases, indicating further education and process improvement is needed.

UR - http://www.scopus.com/inward/record.url?scp=84960959630&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960959630&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2015.11.051

DO - 10.1016/j.jss.2015.11.051

M3 - Article

VL - 201

SP - 432

EP - 439

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -