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OSF St. Francis Hospital & Medical Group was recently named one of the top hospitals in the United States for providing perfect surgical care. The hospital was ranked ahead of the top 25% of hospitals in the country, and well above the Michigan average, according to WhyNotTheBest.org, a national website for health care quality.

U.S. hospitals – including OSF – regularly report quality data to the Centers for Medicare and Medicaid Services (CMS), according to Pat Savitski, vice president of patient care services at OSF St. Francis. Data is reported quarterly on WhyNotTheBest.org and annually as part of the CMS hospital compare website. In August 2008, to more readily track its progress, Savitski said OSF St. Francis started a “real-time” measuring process that has been key to the hospital’s success in achieving recognition for perfect surgical care.

“Staff knows and has working knowledge of the criteria, what it means, why it’s so important and their individual roles in making it happen. They own the data and they know their efforts are driving it. Looking at data on a daily basis has helped us improve our scores and provide our patients with a higher level of care.” Savitski said the real-time measuring process was introduced at OSF St. Francis Hospital as a pilot for OSF Healthcare System.

“Now we have other hospitals calling to find out what we’re doing and how.”

The perfect surgical care measurement process includes a number of indicators for which hospitals are scored, according to Becky Sliva, RN and manager of Surgical Services at OSF St. Francis. Indicators include:

Antibiotic administered within one hour of the start of incision
Where appropriate, patients may require an antibiotic to prevent infection during a surgical procedure, said Sliva. The antibiotic must be given within one hour of the start of the surgery. Staff must be aware of numerous considerations, including when the procedure is scheduled and any delays in starting the procedure.

Discontinuing anti-infection antibiotics within 24 hours of the surgery
For surgical patients admitted to the hospital, Sliva said anti-infection antibiotics must be discontinued within 24 hours of the surgery, and new antibiotics started where appropriate, which requires good communication and coordination among staff, between departments and among physicians.

Patient temperature at 96.8 or above
Maintaining a patient’s temperature within a certain guideline is important in preventing infection, said Sliva, noting that cooler temperatures may cause vessels to constrict and prevent antibiotics from flowing as they should. She added that infection rates at OSF St. Francis are typically well below national averages.

Proper use of beta blockers
For many surgical procedures, patients are instructed that they cannot have anything to eat or drink – including medications – for a certain period of time prior to their surgery, said Sliva. Exceptions are made when patients are taking critical medications like a beta blocker – a medication used to treat certain heart conditions. It is important patients receive proper counseling on when to take these and other critical medications.

Initiation of DVT protocol
Depending on health history and/or the nature of the procedure, some patients are at greater risk than others for deep vein thrombosis (DVT), a blood clot that can form in a vein deep in the body and lead to serious complications, most notably pulmonary embolism, said Sliva. For these patients it is important a DVT protocol be established and the proper coagulants ordered.

According to CMS guidelines, all criteria must be met in order for a particular surgery to be deemed “perfect,” said Sliva. “If a patient’s temperature is 96.7, or if an anti-infection antibiotic is given 61 minutes prior to the start of an incision instead of 60 minutes, the entire case is considered unsuccessful according to CMS and we have failed to provide that patient with perfect care.”

These very rigid guidelines make Sliva and others even more proud of the hospital’s recognition. “To provide this type of quality care in a rural area is tremendous,” said David Hamacher, MD, OB/GYN and chair of surgical services at OSF St. Francis. “Our equipment is state-of-the art and the staff is outstanding. Our surgical outcomes are reflective of that.”

Though recognized for perfect surgical care, it’s not just the hospital’s Surgical Services and Anesthesia departments that get all the credit, but rather all staff, in all departments, pointed out Savitski. “It’s the Ambulatory Care Unit instructing patients properly on the use of food or drink and taking of medications prior to surgery. It’s the Medical/Surgical and Special Care units and Pharmacy making sure antibiotics are discontinued and started as appropriate. This recognition is a very good indicator of what exceptional communication and teamwork can do.”

WhyNotTheBest.org is a website that allows health care organizations to compare their performance against that of peer organizations, against a range of benchmarks, and over time. The site includes data publicly reported on the CMS web site, www.hospitalcompare.hhs.gov. Data is updated quarterly and includes information from over 4,500 U.S. hospitals.

For more information about surgical services at OSF St. Francis Hospital & Medical Group, visit the hospital’s website at www.osfstfrancis.org. For information on perfect surgical care and other CMS core measures, visit WhyNotTheBest.org.