2021 General Surgery Presentations

MSS03: RE-EDUCATION AND COMMUNICATION THROUGH SIMPLE SIGNAGE CAN IMPROVE HOSPITAL EFFICIENCY AND QUALITY OF CARE FOR PATIENTS WITH ACUTE APPENDICITIS.
Patrick J Benoit, DO; Rex Atwood, MD; Laura Kraemer; Kal Gunasingha, MD; Matthew Bradley, MD; Walter Reed National Military Medical Center

Introduction: Our institution has had a standardized outpatient appendectomy protocol since 2016.  As part of continued process improvement, we reviewed our institutional changes to improve patient outcomes.

Methods: Our outpatient appendectomy protocol includes antibiotic choices based on society guidelines as well as specific imaging (Computed Tomography of the abdomen and pelvis with intravenous contrast only) if indicated to streamline the workup. After an internal peer review in 2017 of our protocol identifying poor antibiotic stewardship, the surgical house staff, who ordered majority of the antibiotics, was re-educated to the appropriate antibiotic choices. Additional peer review identified inconsistencies in the Emergency Department prescription of antibiotics and imaging techniques. Starting in January of 2020, signs were placed in the radiology suites and in the Emergency Department highlighting the correct imaging modalities for patients with suspected appendicitis and the correct antibiotic choices for those with proven appendicitis. 

Results: Surgical resident re-education led to increased antibiotic stewardship within the surgical department from 30% protocol adherence in 2016 to 95% protocol adherence in 2017.  After placement of the signs within particular departments in the hospital, 90% of patients with appendicitis received antibiotics in the ED prior to being brought to the operating room, an increase of 67% from the previous year (p<0.005).  The average over the previous three years was 47% of patients receiving appropriate antibiotics in the emergency department. Investigation in the changes in imaging modalities obtained after the placement of signs showed protocol compliance on 75% of cases where the patient had uncomplicated appendicitis. This is also a significant improvement over the prior three years, which averaged 35% protocol compliance (p<0.005). 

Conclusion: We demonstrated how simple educational reinforcement was able to significantly increase adherence to the institutional protocol and improve quality of patient care in patients with appendicitis.   This type of initiative, placing easy to understand signs, can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.