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Service improvement study to improve care for patients who developed a surgical site infection after discharge

08 August 2019
17 min read
Volume 28 · Issue 15

Abstract

Background:

many patients develop surgical site infection (SSI) after they have been discharged from hospital. SSI rate is a quality measure intended to support healthcare providers with useful information to improve service and patient outcomes.

Aim:

the purpose of the study was to gain some local insight into current practice and to inform and improve clinical practice for patients who develop SSIs after they have been discharged.

Method:

a quantitative approach was taken, using retrospective data collection and analysis of patient records, of patients reviewed by the tissue viability service after discharge over a 1-year period.

Findings:

a total of 112 patients were included in the study. Of these, 59 were assessed as having developed an SSI, of whom 39 patients presented after discharge. Most of these patients had shorter inpatient stays and many were under the care of community nurses, but referral to the specialist tissue viability service to seek expert advice was often delayed.

Conclusion:

the study has highlighted the potential value of post-discharge surveillance in contributing to more accurate SSI rates, and the importance of patients and community nurses being provided with clear, understandable information to ensure patients receive timely and effective management, which could reduce the severity of, and duration of treatment for, SSIs.

This service improvement study emerged from the experiences of the tissue viability nurses (TVNs) working in the acute care environment, who are referred patients following their discharge from hospital, many of whom presented with a surgical site infection (SSI) and some of whom had inappropriate or delayed assessment or treatment. The study aimed to gain some local insight into current practices and to inform and improve clinical practice for patients who develop SSIs after discharge. Relatively little attention has been given to the amount of SSIs that present following discharge (Woelber, 2016).

An SSI is a wound infection that can develop after a surgical procedure (National Institute for Health and Care Excellence (NICE), 2019). Between 2013 and 2018 the incidence of SSIs following surgery (including readmissions) ranged between 0.5% for knee replacements and 8.7% for large bowel surgery, with coronary artery bypass graft (CABG) having an incidence of 3.5% (Public Health England (PHE), 2018), caused by bacteria multiplying in the wound.

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