Toyota production system quality improvement initiative improves perioperative antibiotic therapy.
Am J Manag Care
; 15(9): 633-42, 2009 Sep.
Article
em En
| MEDLINE
| ID: mdl-19747028
ABSTRACT
OBJECTIVE:
To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. STUDYDESIGN:
Pre-post quasi-experimental study using local and national retrospective cohorts.METHODS:
We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time.RESULTS:
Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time.CONCLUSION:
The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
/
Infecções Estafilocócicas
/
Infecção Hospitalar
/
Gestão da Qualidade Total
/
Eficiência Organizacional
/
Staphylococcus aureus Resistente à Meticilina
/
Antibacterianos
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Estados Unidos