title: A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.
abstract: OBJECTIVE
  Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events.
  
  
  METHODS
  Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review.
  
  
  RESULTS
  Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected.
  
  
  CONCLUSIONS
  Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies.
authors.affiliation: Division of Pediatric Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY. Electronic address: jason.fisher@nyumc.org.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Fisher
authors.affiliation: Division of Pediatric Orthopedic Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Godfried
authors.affiliation: Division of Pediatric Hospital Epidemiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lighter-Fisher
authors.affiliation: Medical Center Information Technology - Clinical Systems, NYU Langone Medical Center, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pratko
authors.affiliation: Department of Nursing, NYU Langone Medical Center, New York, NY.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Sheldon
authors.affiliation: Department of Nursing, NYU Langone Medical Center, New York, NY.
authors.forename: Thelma
authors.initials: T
authors.lastname: Diago
authors.affiliation: Division of Pediatric Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Kuenzler
authors.affiliation: Division of Pediatric Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Tomita
authors.affiliation: Division of Pediatric Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Ginsburg
mesh_terms: D002648:Child; D057286:Electronic Health Records / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D064872:Patient Care Bundles / Q000592:standards*; D019990:Perioperative Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
keywords: Surgical wound infection; bundle; electronic health record; pediatric; process; quality improvement