title: A tale of 2 hospitals: a staggered cohort study of targeted interventions to improve compliance with antibiotic prophylaxis guidelines.
abstract: BACKGROUND
  The purpose of this prospective study was to determine the effectiveness of targeted interventions to improve compliance with antibiotic prophylaxis guidelines (timing, spectrum, and discontinuation) at 2 university-affiliated hospitals.
  
  
  METHODS
  Based on barriers identified previously, hospital-specific interventions were developed such as educational conferences, standardized forms, an extended time-out, and feedback. Guideline compliance and surgical site infection (SSI) data were recorded on all patients who underwent elective laparotomies for colorectal procedures, vascular operations, and hysterectomies during four 6-month study periods. Prestudy data from July to December 2006 served as a baseline. One year later, a prospective cohort study was performed. The interventions were introduced to the 2 hospitals in a staggered fashion with 2-month implementation periods before reassessing compliance during the 6-month study periods. General linear modeling was performed (P < .05 significant).
  
  
  RESULTS
  Compliance with all 3 guidelines combined improved during the year preceding the study, after attention only, at both hospitals. Hospital-specific differences were found in the effectiveness of the intervention package on individual guidelines. Hospital 2 but not 1 improved in timing after the interventions; both hospitals improved in spectrum, and neither hospital improved in discontinuation. Overall compliance with all 3 antibiotic prophylactic measures was greater at hospital 1, but hospital 2 had lower SSI rates.
  
  
  CONCLUSIONS
  Simply increasing attention to a quality problem can result in a significant and sustained improvement. Quality improvement interventions should be evaluated rigorously for effectiveness given hospital-specific differences in effectiveness and for correlation of guideline compliance with outcome.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX 77026, USA. Lillian.S.Kao@uth.tmc.edu
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Debbie F
authors.initials: DF
authors.lastname: Lew
authors.forename: Peter D
authors.initials: PD
authors.lastname: Doyle
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Carrick
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Jordan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006766:Hospitals, County / Q000592:standards*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013781:Texas; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents