title: Using quality improvement methods to change surgical practice: a case example of pediatric soft-tissue abscesses.
abstract: BACKGROUND
  Surgical treatments of soft-tissue abscesses (STAs) include packing and ring drain (RD) and straight drain (SD) placement. Potential benefits of SDs include a single incision, less scarring, and no need for a follow-up appointment. We used a multidisciplinary quality improvement (QI) process to promote surgeon adoption of an STA drainage technique to improve efficiency and quality of care.
  
  
  METHODS
  Outcome measures included the proportion of STAs drained using SDs, the number of postoperative clinic visits, the proportion of patients requiring follow-up with a pediatric surgeon and other providers, and the postoperative complication rate, defined as need for an additional drainage procedure.
  
  
  RESULTS
  After beginning the QI initiative, the proportion of STAs drained by SDs increased from 23% to 78% (P < .00001) and the proportion of patients requiring a surgical follow-up clinic appointment decreased from 71% to 32% (P < .00001). The mean number of surgical clinic visits per patient decreased from 0.79 to 0.39 visits per patient (P < .00001). Complication rates were similar between drain types (RD: 2.4%; SD: 1.7%; P = .57). This QI initiative produced a rapid sustained shift in surgeon practice with increased use of SDs, decreased number of follow-up visits, and no increase in complications.
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital (Drs Mahida, Sulkowski, Cooper, Deans, and Minneci), Department of Surgery, Nationwide Children's Hospital (Drs Mahida, Sulkowski, Kenney, Deans, and Minneci and Kurtovic), and Department of Pediatrics, Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital (Dr Brilli), Columbus, Ohio.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sulkowski
authors.forename: Kelli J
authors.initials: KJ
authors.lastname: Kurtovic
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009820:Ohio; D010372:Pediatrics / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000601:surgery*; D062606:Tertiary Care Centers; D016896:Treatment Outcome