Postoperative Pneumonia Prevention Checklist Improves Provider Compliance and Patient Awareness of Previously Established Reduction Protocol
Keywords:checklist, postoperative pneumonia, quality improvement, compliance
Background: Postoperative pneumonia (PoPNA) is a highly prevalent complication in patients. Despite a previously successful protocol, this institution has become a high outlier on national metrics for PoPNA in the last four years.
Methods: Between October 2020 and May 2021, patients were surveyed to measure 10 initiatives which have shown previous success. A provider-driven 10-item checklist was implemented and patients were resurveyed.
Results: 135 patients were included: 96 pre-checklist and 39 post-checklist. Improvement was seen in all 10 categories. This included provider-driven initiatives, such as patient oral care, ambulation, frequency of patient being in chair, having incentive spirometer (IS) within reach, having information booklet within reach, and the patient’s ability to perform IS correctly, as well as patient awareness initiatives, including importance of oral care, cough and deep breathing, ambulation, and IS use.
Conclusions: Implementation of a simple checklist can improve awareness and compliance with previously successful established protocols.
Dimick JB, et al. Hospital Costs Associated With Surgical Complications: A Report From the Private-Sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531-7.
Khan NA, et al. Association of Postoperative Complications With Hospital Costs and Length of Stay in a Tertiary Care Center. J Gen Intern Med. 2006;21(2):177-180.
Cassidy MR, et al. I COUGH: Reducing Postoperative Pulmonary Complications With a Multidisciplinary Patient Care Program. JAMA Surg. 2013;148(8):740-745.
Khuri SF, Daley J, Henderson WG. The Comparative Assessment and Improvement of Quality of Surgical Care in the Department of Veterans Affairs. Arch Surg. 2002;137(1):20-27.
Conley, DM, et al. Effective Surgical Safety Checklist Implementation. J Am Coll Surg. 2011;212(5):873-879.
Galvin, G, et al. Availability of Safe Childbirth Supplies in 284 Facilities in Uttar Pradesh, India. Matern Child Health J, 2019;23(2):240-249.
Ramsay G, et al. Reducing Surgical Mortality in Scotland by Use of the WHO Surgical Safety Checklist. Br J Surg. 2019;106(8)1005-1011.
Urbach DR, et al. Is WHO’s Surgical Safety Checklist Being Hyped? BMJ. 2019;366:l4700.
Berry WR, et al. Scaling Safety: The South Carolina Surgical Safety Checklist Experience. Health Aff (Millwood). 2018;37(11):1779-1786.
Alexander JA, Hearld LR. What Can We Learn From Quality Improvement Research? A Critical Review of Research Methods. Med Care Res Rev. 2009;66(3):235-271.
Investigators, W.G.f.t.C.-I. and B.R.i.I.C. Network, Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial. JAMA. 2016;315(14):1480-1490.
Snyder C, Anderson G. Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries? JAMA. 2005;293(23):2900-2907.
Bowman CC, et al. Measuring Persistence of Implementation: QUERI Series. Implement Sci. 2008;3(1):1-13.
Dückers ML, et al. Exploring the Black Box of Quality Improvement Collaboratives: Modelling Relations Between Conditions, Applied Changes and Outcomes. Implement Sci. 2009;4(1):1-12.