title: The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis.
abstract: BACKGROUND
  Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration of antibiotic prophylaxis before induction of anaesthesia. The aim of this study was to determine the effect of SURPASS implementation on timing of antibiotic prophylaxis.
  
  
  METHODS
  A retrospective analysis was performed on two cohorts of patients: one cohort of surgical patients that underwent surgery before implementation of the checklist and a comparable cohort after implementation. The interval between administration of antibiotic prophylaxis and incision was compared between the two cohorts.
  
  
  RESULTS
  A total of 772 surgical procedures were included. More than half of procedures were gastro-intestinal; others were vascular, trauma and hernia repair procedures. After implementation, the checklist was used in 81.4% of procedures. The interval between administration of antibiotic prophylaxis and incision increased from 23.9 minutes before implementation of SURPASS to 29.9 minutes after implementation (p = 0.047). In procedures where the checklist was used, the interval increased to 32.9 minutes (p = 0.004). The proportion of patients that did not receive antibiotics until after the incision decreased significantly.
  
  
  CONCLUSIONS
  The use of the SURPASS checklist leads to better compliance with regard to the timing of antibiotic prophylaxis administration.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands. m.a.boermeester@amc.uva.nl.
authors.forename: Eefje N
authors.initials: EN
authors.lastname: de Vries
authors.forename: Lucia
authors.initials: L
authors.lastname: Dijkstra
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Smorenburg
authors.forename: R Peter
authors.initials: RP
authors.lastname: Meijer
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
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