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The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital

Published online by Cambridge University Press:  23 November 2018

Sasha van Katwyk ,
Kednapa Thavorn ,
Doug Coyle ,
Husein Moloo ,
Alan J. Forster ,
Timothy Jackson  and
David Schramm
Sasha van Katwyk
Affiliation:
Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Kednapa Thavorn*
Affiliation:
Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada Institute for Clinical and Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada
Doug Coyle
Affiliation:
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Husein Moloo
Affiliation:
Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Surgery, Division of General Surgery, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Alan J. Forster
Affiliation:
Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Institute for Clinical and Evaluative Sciences (ICES uOttawa), Ottawa, Ontario, Canada Department of Medicine, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Timothy Jackson
Affiliation:
Department of Surgery, University of Toronto, Toronto, Ontario, Canada Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
David Schramm
Affiliation:
Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Otolaryngology - Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
*
Author for correspondence: Kednapa Thavorn, PhD, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, Canada K1H 8L6. E-mail: kthavorn@ohri.ca
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Abstract

Objective

We performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases.

Design

A retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses.

Setting

Data were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution.

Patients

We used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015.

Intervention

We estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP).

Results

From 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program.

Conclusions

The NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 125 - 132
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: van Katwyk S, et al. (2019). The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital. Infection Control & Hospital Epidemiology 2019, 40, 125–132. doi: 10.1017/ice.2018.294

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