title: Implementation of the World Health Organization checklist and debriefing improves accuracy of surgical wound class documentation.
abstract: BACKGROUND
  Surgical wound classification (SWC) is a component of surgical site infection risk stratification. Studies have demonstrated that SWC is often incorrectly documented. This study examines the accuracy of SWC after implementation of a multifaceted plan targeted at accurate documentation.
  
  
  METHODS
  A reviewer examined operative notes of 8 pediatric operations and determined SWC for each case. This SWC was compared with nurse-documented SWC. Percent agreement pre- and postintervention was compared. Analysis was performed using chi-square and a P value less than .05 was significant.
  
  
  RESULTS
  Preintervention concordance was 58% (112/191) and postintervention was 83% (163/199, P = .001). Appendectomy accuracy was 28% and increased to 80% (P = .0005). Fundoplication accuracy increased from 44% to 84% (P = .016) and gastrostomy tube from 56% to 100% (P = .0002). The most accurate operation preintervention was pyloromyotomy and postintervention was gastrostomy tube and inguinal hernia. The least accurate pre- and postintervention was cholecystectomy.
  
  
  CONCLUSIONS
  Implementation of a multifaceted approach improved accuracy of documented SWC.
authors.affiliation: Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. Electronic address: dlwyrick@uams.edu.
authors.forename: Deidre L
authors.initials: DL
authors.lastname: Wyrick
authors.affiliation: Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Smith
authors.affiliation: Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA.
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
mesh_terms: D057189:Checklist; D002648:Child; D004282:Documentation / Q000592:standards*; D006801:Humans; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000145:classification*; D014944:World Health Organization
keywords: Surgical debrief; Surgical site infection; WHO checklist; Wound classification