In FY15, the orthopaedics care team developed and implemented a comprehensive clinical protocol for patients undergoing elective spine surgery that includes pre-, intra-, and post-operative components that screen for and mitigate surgical site infection (SSI) risk. Following the successful implementation, spine SSI decreased from an average rate of 5.5 per 100 procedures to 0.5 per 100 procedures. In FY16, this algorithm, or “bundle,” was expanded to both general surgical and orthopaedic surgical specialties; most notably, hip surgery.

The clinical care algorithm includes close to 50 steps (12 pre-operative, 12 intra-operative, and 25 post-operative) designed to standardize care and reduce each patient’s length of stay, and with it, clinical risk and medical costs. A dozen of those steps impact SSI, and are labeled separately as the SSI reduction bundle. Following implementation of the algorithm, the FY16 rate of SSI with hip surgeries was 0.

The newly implemented algorithm also benefits patients undergoing surgery for supracondylar fractures. Since this procedure is handled by every surgeon on staff, it is possible that every clinician can employ a slightly different method, leading to inconsistencies in care delivery. This standardized model has the potential to reduce errors as well as control costs. The protocol dictates that the same set of instruments, the same setup and the same set of follow-up orders be used in every procedure. Cincinnati Children’s clinical staff has actually changed instrument trays to reflect this streamlined approach.

This work led to the organization being awarded a $60,000 grant to fund the spread of the length of stay and SSI reduction bundles throughout the hospital.