Pilot Implementation of a Health Equity Checklist to Improve the Identification of Equity-Related Adverse Events.

OBJECTIVE: To establish a sustainable and trackable process to delineate the role of social determinants of health, bias, and racism in adverse gynecologic events. METHODS: The existing process entails monthly reviews of adverse events. Each case is assessed for preventability, harm, and standards of care. The equity-focused process consists of: 1) creation of a standardized health equity checklist; 2) application of the checklist to each gynecologic adverse event beginning on September 1, 2020; 3) collection of event review data in a secure central digital repository; 4) review of the cases to understand apparent causes of the event; 5) exploration of areas for improvement by using standard fields; and 6) identification of specific ideas for change. RESULTS: Within 15 months, 46 safety events were identified by standard criteria. Twenty-four of the cases were deemed preventable. Of the 24, there were 12 cases in which social determinants of health or bias or both social determinants of health and bias were identified playing a role. Diagnostic delays and care delays were attributed to social determinants of health and implicit bias. Our process has mapped areas of infrastructure as well as the need for culture improvement and has also highlighted the need for restorative work on addressing implicit bias and improving approaches to shared decision making. CONCLUSION: Through the use of a health equity checklist, we have illustrated the feasibility of creating a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events.

Decreased Surgical Site Infection Rate in Hysterectomy: Effect of a Gynecology-Specific Bundle.

OBJECTIVE: We implemented a hysterectomy-specific surgical site infection prevention bundle after a higher-than-expected surgical site infection rate was identified at our institution. We evaluate how this bundle affected the surgical site infection rate, length of hospital stay, and 30-day postoperative readmission rate. METHODS: This is a quality improvement study featuring retrospective analysis of a prospectively implemented, multidisciplinary team-designed surgical site infection prevention bundle that consisted of chlorhexidine-impregnated preoperative wipes, standardized aseptic surgical preparation, standardized antibiotic dosing, perioperative normothermia, surgical dressing maintenance, and direct feedback to clinicians when the protocol was breached. RESULTS: There were 2,099 hysterectomies completed during the 33-month study period. There were 61 surgical site infections (4.51%) in the pre-full bundle implementation period and 14 (1.87%) in the post-full bundle implementation period; we found a sustained reduction in the proportion of patients experiencing surgical site infection during the last 8 months of the study period. After adjusting for clinical characteristics, patients who underwent surgery after full implementation were less likely to develop a surgical site infection (adjusted odds ratio [OR] 0.46, P=.01) than those undergoing surgery before full implementation. Multivariable regression analysis showed no statistically significant difference in postoperative days of hospital stay (adjusted mean ratio 0.95, P=.09) or rate of readmission for surgical site infection-specific indication (adjusted OR 2.65, P=.08) between the before and after full-bundle implementation periods. CONCLUSION: The multidisciplinary implementation of a gynecologic perioperative surgical site infection prevention bundle was associated with a significant reduction in surgical site infection rate in patients undergoing hysterectomy.