K. E. Epler1, S. Schrader1, J. Gorvetzian1, J. Romero1, R. Schrader3, A. Greenbaum2, R. McKee2 1University Of New Mexico,School Of Medicine,Albuquerque, NEW MEXICO, USA 2University Of New Mexico,Department Of Surgery,Albuquerque, NEW MEXICO, USA 3RMS Biostatistics Services,Albuquerque, NEW MEXICO, USA
Introduction:
Misclassification of wounds in the operating room can have adverse effects on surgical site infection (SSI) reporting and reimbursement. The aim of this study was to measure the effects of a curriculum on documentation of surgical wound classification (SWC) for operating room staff and surgeons.
Methods:
Accuracy of SWC was determined by comparing SWC documented by operating room (OR) staff during the original operation to SWC determined by in-depth clinical chart review. Patients 18 years or older undergoing inpatient surgical procedures met inclusion criteria; dental and endoscopic procedures were excluded. A SWC curriculum was implemented during OR staff meetings and surgeon conferences over 4 months. SWC posters were placed in all adult ORs. The accuracy of SWC documentation was retrospectively assessed in 248 randomly selected surgeries during a 5-week period prior to curriculum implementation and compared to 5 weeks of prospective data for 242 cases after the intervention. Changes in SWC accuracy were assessed pre- and post-intervention using the kappa coefficient. A p-value for change in agreement was computed by comparing pre- and post-intervention kappas. A power analysis was done.
Results:
Inaccurate documentation of surgical wound class decreased from 33% to 21% after curriculum implementation (Kappa improved from 0.54 to 0.70; p = 0.001). Classification accuracy improved across all wound classes; however, class III and IV wounds were more frequently misclassified and to a higher degree than class I and II wounds, both before and after the intervention (see figure).
Conclusion:
Implementation of a multidisciplinary documentation curriculum resulted in a significant decrease in SWC documentation error. Improved accuracy of SWC reporting will facilitate a better assessment of SSI risk in a complex patient population.
