title: Improving Cardiac Surgical Site Infection Reporting and Prevention By Using Registry Data for Case Ascertainment.
abstract: BACKGROUND
  The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2].
  
  
  METHODS
  At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives, including wound alert reports, bedside reviews, prevention bundles, and billing coder education.
  
  
  RESULTS
  Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32 SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73% (21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3 SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI rate reductions.
  
  
  CONCLUSIONS
  Linkage of registry and infection control surveillance data with the EHR improves SSI surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates.
authors.affiliation: Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: nayarv@email.chop.edu.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Nayar
authors.affiliation: Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Janine
authors.initials: J
authors.lastname: Pappas
authors.affiliation: Cardiac Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Krista D
authors.initials: KD
authors.lastname: Atchley
authors.affiliation: Cardiac Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Field
authors.affiliation: Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Smathers
authors.affiliation: Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Eva E
authors.initials: EE
authors.lastname: Teszner
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Sammons
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Division of Pediatric Cardiac Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James M
authors.initials: JM
authors.lastname: Steven
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Joan
authors.initials: J
authors.lastname: Forrer
authors.affiliation: Information Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gonzalez
authors.affiliation: Office of Clinical Quality Improvement, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Albert
authors.initials: A
authors.lastname: Chi
authors.affiliation: Information Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: William J
authors.initials: WJ
authors.lastname: Nieczpiel
authors.affiliation: Information Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: John N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D018563:Disease Notification / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control