Reduction in Post-Operative Pneumonia

From the 2019 HVPAA National Conference

Dr. Kristen Glasgow (YNHH Bridgeport Hospital), Dr. Nabil Atweh (YNHH Bridgeport Hospital), Mx. Nancy Athanasiou (YNHH Bridgeport Hospital), Dr. Kenneth Stone (YNHH Bridgeport Hospital), Mrs. Bonnie Malloy (YNHH Bridgeport Hospital), Mrs. Debora Dunlop (YNHH Bridgeport Hospital), Mrs. Mary Toohey-Repko (YNHH Bridgeport Hospital), Mr. Jose Jimenez (YNHH Bridgeport Hospital), Mrs. Maribeth Oleynick (YNHH Bridgeport Hospital), Mrs. Nicole Rogucki (YNHH Bridgeport Hospital), Dr. Mihaela Costin (YNHH Bridgeport Hospital), Dr. Shea Gregg (YNHH Bridgeport Hospital), Dr. Roselle Crombie (YNHH Bridgeport Hospital), Dr. Walter Cholewczynski (YNHH Bridgeport Hospital), Dr. Alisa Savetamal (YNHH Bridgeport Hospital), Dr. John Tyson (YNHH Bridgeport Hospital)

Background

Post-op PNA reduces quality of care, increases length of stay and increases healthcare costs.  Bridgeport Hospital is a participant in the NSQIP database collection for post-operative occurrences.  From Oct 1st 2015 to Sept 30th 2016 we were found to be a high outlier for post-op PNA in General Surgery cases with an Odds Ratio of 1.84 from an expected ratio of 0.89.

Objectives

Reduce the number of general surgery post-operative PNA cases for abdominal surgery by 33%

Methods

From May 2017 to May 2018 we implemented measures in the pre-operative, peri-operative, PACU, and post-operative periods for all elective general surgery abdominal cases.  These included preoperative chlorhexidine mouthwash and incentive spirometry (IS) teaching.  Pre- and peri-operative non-narcotic pain control, iv acetaminophen use and combination with new ERAS protocols as well as asking about NGT placement.  In the PACU we used the POSS score to reduce post-operative delirium and utilized HOB elevation.  Finally, in the post- operative period, patients were encouraged to walk from stretcher to bed/chair, were OOB to chair on arrival to unit, and were encouraged to walk on POD 0.  The floor nurses also documented IS teaching and average IS use with ongoing reeducation for poor performers

Results

We had an overall reduction in the Odds ratio from 1.84 to 1.69, roughly 10%.

Conclusions

While we did not meet our goal of a 33% reduction in all post-operative pneumonia cases, we did achieve a near 10% reduction.  Taking into account that our initiative only focused on elective abdominal general surgery cases we hope that expansion of these guidelines to all emergent and non-emergent general surgery cases would result in further reduction to meet our goals.

Clinical Implications

Reducing post-operative pneumonia will help to reduce length of stay, healthcare costs, and increase the quality of care for our patients.

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