Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Describe the long-term results of a pneumonia prevention quality improvement program for surgical ward-acquired pneumonia.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwOct2. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
Pneumonia is a common nosocomial infection that accounts for approximately 2.7% to 3.4% of complications among surgical patients. Nosocomial pneumonia has been linked to high morbidity, mortality, and costs, and is among the complications used to assess readmission rates for hospital profiling and reimbursement. “In recent years, greater attention has been given to improving the quality of patient care, with an emphasis on infection control,” says Sherry M. Wren MD, FACS. “This has spurred the development of several guidelines for nosocomial pneumonia prevention.”
Throughout the United States, some hospitals have developed multidisciplinary quality improvement (QI) programs that aim to reduce postoperative risk for pneumonia. Most of these programs have been initiated in critical care and ICU settings, but few have explored their effect in surgical wards. To address this research gap, Dr. Wren and colleagues at the VA Palo Alto Health Care System developed a pneumonia prevention QI program for surgical ward-acquired pneumonia prevention strategies that consist of several important steps (Table 1). The study group published long-term results of the program in JAMA Surgery.
“We focused our research entirely on patients hospitalized on the surgical ward to evaluate the long-term effectiveness of our program,” Dr. Wren says. “It’s important to see if we can achieve sustained reductions in postoperative pneumonia in the surgical ward and to assess how effective it has been to adopt of our pneumonia prevention program.” The study revealed results of the program over a 5-year period since the intervention was implemented.
According to findings, between 2008 and 2012, there were just 18 cases of postoperative pneumonia among the more than 4,000 at-risk patients who were hospitalized on the surgical ward and included in prospectively tracked data from the VA Surgical Quality Improvement Program (VA-SQIP) sample, which captures approximately 50% of inpatients after surgical procedures. This yielded a case rate of 0.44%, which represented a 43.6% decrease from our pre-intervention rate, according to Dr. Wren. The pneumonia rates in all years assessed in the study were lower than pre-intervention rates between 2008 and 2012 (Table 2).
The researchers also compared overall pneumonia rates of their pneumonia prevention program with that of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP). The overall pneumonia rate in ACS-NSQIP was 2.56%, which was 582% higher than the post-intervention rate seen at the surgical ward in the study by Dr. Wren and colleagues. If a 43.6% decrease in pneumonia rates occurred at ACS-NSQIP hospitals during the same 5-year period—as was the case for the QI program used by the VA Palo Alto Health Care System—there would be approximately 6,118 prevented pneumonia cases and a cost savings of more than $280 million.
“By introducing our program and making concerted efforts to maintain compliance with it, we have achieved substantial and sustained decreases in pneumonia rates,” Dr. Wren says. There was only one case of pneumonia in 2012 among more than 750 postoperative patients in the VA-SQIP sample hospitalized in the VA Palo Alto surgical ward, indicating that the goal of zero cases of pneumonia may be achievable. “Other hospitals throughout the U.S. are implementing similar QI initiatives to reduce postoperative pneumonia rates,” adds Dr. Wren. “Our results demonstrate that pneumonia among surgical patients can be prevented by adhering to bundles of infection prevention measures.”
Commitment Is Key
In recent years, there has been a renewed focus on patient safety, and recent healthcare legislation and Medicare reimbursement policies are aiming to decrease morbidity and healthcare expenditures. To meet these goals, considerable effort is needed across institutions to reduce the occurrence of postoperative pneumonia and hospital readmissions that are secondary to a diagnosis of pneumonia. “Adopting QI programs similar to ours can considerably reduce postoperative pneumonia rates,” says Dr. Wren. “The key is to commit to the program. This means using electronic medical record systems to facilitate and standardize the application of elements used in our program. All members the multidisciplinary care team must also be committed to following the QI protocols.”
According to Dr. Wren, no single specific element of the QI program that her study team initiated was critically important to achieving improvements in postoperative pneumonia rates. “Instead, it’s likely that the sum of its parts is what made our program successful,” she says. “It’s important for clinicians to recognize the importance of using each element of our QI program to reduce the burden of postoperative pneumonia. As these elements become more automatic, we can giving physicians more time to deal with other important medical issues in surgical patients.”
Readings & Resources (click to view)
Kazaure HS, Martin M, Yoon JK, Wren SM. Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward. JAMA Surg. 2014;149:914-918. Available at: http://archsurg.jamanetwork.com/article.aspx?articleid=1889571.
Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg. 2010;210:491-495.
Cassidy MR, Rosenkranz P, McCabe K, Rosen JE, McAneny D. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg. 2013;148:740-745.
Eber MR, Laxminarayan R, Perencevich EN, Malani A. Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch Intern Med. 2010;170:347-353.
Gupta H, Gupta PK, Schuller D, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88:1241-1249.