Performance of Dutch hospitals in the management of splenectomized patients.
BACKGROUND
After splenectomy, patients are at increased risk of sepsis with considerable mortality. This risk can be reduced by taking preventive measures, such as prescribing immunizations and antibiotic prophylaxis. Studies from various countries show that a substantial percentage of patients are not managed adequately. The aim of the present study was to investigate the quality of care in the prevention of infections after splenectomy in Dutch hospitals. The research questions were two-fold: (1) Is there an association between hospital teaching status and guideline adherent preventive measures? (2) Which factors contribute to hospital performance?


METHODS
A total of 28 Dutch hospitals (30%) participated in the study. A retrospective review of medical records of 536 splenectomy patients was performed. Adherence to prevention guidelines was assessed for all patients, and analyzed according to teaching status and the presence or absence of a post-splenectomy protocol.


RESULTS
(1) University hospitals in the Netherlands offered higher quality of care than other teaching and nonteaching hospitals. There were only small differences between nonuniversity teaching and nonteaching hospitals. (2) The presence of a hospital post-splenectomy protocol did not improve vaccination rates. Other aspects of practice organization, such as surgical staff size and keeping a complication registry were only weakly related to performance.


CONCLUSIONS
In the Netherlands, university hospitals deliver state-of-the-art care in the prevention of infections in asplenic patients more often than nonuniversity teaching and nonteaching hospitals. The availability of a hospital protocol does not seem to contribute to guideline adherence.
Lammers
Jolanda
J
Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Zuid-Oost, The Netherlands. a.j.lammers@amc.uva.nl
Veninga
Daphne
D
Speelman
Peter
P
Hoekstra
Joost
J
Lombarts
Kiki
K
D006761:Hospitals; D006801:Humans; D007114:Immunization / Q000592:standards; D008485:Medical Audit; D009426:Netherlands; D005791:Patient Care / Q000592:standards*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000517:prevention & control; D013156:Splenectomy / Q000534:rehabilitation*