title: Toyota production system quality improvement initiative improves perioperative antibiotic therapy.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Dr (151C-H), Pittsburgh, PA 15206, USA. kelly.burkitt@va.gov
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Burkitt
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jain
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Kruszewski
authors.forename: Ellesha E
authors.initials: EE
authors.lastname: McCray
authors.forename: Michael E
authors.initials: ME
authors.lastname: Moreland
authors.forename: Robert R
authors.initials: RR
authors.lastname: Muder
authors.forename: David Scott
authors.initials: DS
authors.lastname: Obrosky
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wilson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000191:economics; D004526:Efficiency; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics; D013997:Time Factors; D017749:Total Quality Management; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents