Ideas That Work: Move Beyond Paper-based SSI Tracking… Even Without an EMR

Practical pearls from your colleagues

When it came to surveilling SSIs, Baptist Health South Florida’s Outpatient Services unit was, in the words of its nurse leaders, “tracking everything, but tracking nothing.”

Its existing SSI surveillance system cast an extremely wide net by manually documenting and tracking every single procedure performed at three multispecialty ASCs. The paper-based system was laboriously slow, time-consuming and difficult to monitor.

A massive team — Julie Garcia, RN, BSN; Janisse Marin, RN; Viviane Monteiro, BSN, RN; Christian Fuentes, LPN; Vanessa Carillo; Brian Graham, RN; Ana Pita, RN; Moises Vasquez-Cerna, MS; Gloria Arteaga, MBA; and Catalina Campbell, BHSA — assembled to tackle the problem, which boiled down to tracking too much data using an inefficient paper-based system.

“Our process relied on human capital to provide worklists via paper reporting to physicians via fax or on-site,” says Ms. Garcia, a clinical manager at Baptist Health South Florida.

The team refocused its SSI surveillance practice from tracking all procedures to tracking a targeted subset aligned with the National Healthcare Safety Network’s Outpatient Procedure Component (NHSN OPC) SSI Surveillance program’s Operative Procedure Categories. The team discovered that 84% of the cases it was tracking were not listed under the NHSN OPC.

After whittling down tracked procedures to a much more manageable list focused particularly on breast and general surgery cases and GYN procedures, the team added site-specific ophthalmology procedure codes not listed under the NHSN OPC to its new SSI Surveillance program, including cataracts and retina procedures and eye plastics.

The system ensures that procedure types not actively tracked are still addressed. “If an infection is reported outside of the procedures outlined by NHSN and the physician’s worklist, we submit an incident report which allows our consultant teams and sites to track and trend,” says Ms. Garcia. Because the team didn’t have an electronic medical record, it used REDcap, a web-based platform, to build a database that enabled physicians to more easily report SSIs, and leaders to more easily track the resulting data. The team built, tested and validated a REDcap survey utilizing the NHSN post-discharge worksheet for suspected SSIs that enabled its physicians to submit SSI attestations electronically. It also created a worklist in the database to allow each ASC to track individual surgeons’ compliance with SSI attestations.

Once the REDcap tool was created, the team met with the leaders and some physicians at the ASCs who would pilot the program to talk through the process. Each site’s designated SSI surveillance leaders collect, analyze and monitor the worklists and attestations. They check the worklist every day, and prep for the following day based on which physicians are scheduled to be on-site with pending attestations. The flow coordinator captures those physicians in real time or sends out electronic communication to collect attestations.

“This electronic tool allows for verbal attestations,” says Ms. Garcia. “If you have a physician who does not come to the site often, they can review their worklist electronically and the flow coordinator and/or SSI champion can attest for them and submit it as a verbal attestation.”

The results so far have been transformational. In addition to reducing the costs and time associated with SSI surveillance and better tracking trends, surgeons now have a more convenient and timely way to report SSIs — and they’re using it. In 2022, the physician response rate for SSI attestations was well below the benchmark of 90% across the three Baptist ASCs, at 83%, 72% and 45%. After the new workstream implementation, it increased to 90% in 2023 at all three.

Nursing leaders, meanwhile, have gained a better understanding of why SSIs occur and how to prevent them. Perioperative nurses use the information the system generates to adjust their patient education and care to enhance SSI prevention efforts.

“The new process has allowed for more timely responses to any reported infections,” says Ms. Garcia.

“For example, if a patient has a breast procedure and the physician reports an infection post-op through their worklist, we can now track this patient and take a deep dive in our investigation. It also allows us to re-educate the team if needed, as well as the patient and/or family on post-op care.”

Ultimately, the Baptist Outpatient team says all this work has paid off in terms of better patient outcomes with lower risk of SSIs. OSM