Operating room staff and surgeon documentation curriculum improves wound classification accuracy

Abstract

BackgroundMisclassification of wounds in the operating room (OR) can adversely affect surgical site infection (SSI) reporting and reimbursement. This study aimed to measure the effects of a curriculum on documentation of surgical wound classification (SWC) for operating room staff and surgeons.MethodsAccuracy of SWC was determined by comparing SWC documented by OR staff during the original operation to SWC determined by in-depth chart review. Patients 18 years or older undergoing inpatient surgical procedures were included. Two plan-do-act-study (PDSA) cycles were implemented over the course of 9 months. A total of 747 charts were reviewed. Accuracy of SWC documentation was retrospectively assessed across 248 randomly selected surgeries during a 5-week period prior to interventions and compared to 244 cases and 255 cases of post-intervention data from PDSA1 and PDSA2, respectively. Changes in SWC accuracy were assessed pre- and post-intervention using the kappa coefficient. A p-value for change in agreement was computed by comparing pre- and post-intervention kappa.ResultsInaccurate documentation of surgical wound class decreased significantly following curriculum implementation (kappa improved from 0.553 to 0.739 and 0.757; p = 0.001). Classification accuracy improved across all wound classes; however, class III and IV wounds were more frequently misclassified than class I and II wounds, both before and after the intervention.ConclusionImplementation of a multidisciplinary documentation curriculum resulted in a significant decrease in SWC documentation error. Improved accuracy of SWC reporting may facilitate a better assessment of SSI risk in a complex patient population.

A Comparison of Interobserver Reliability Between Orthopedic Surgeons Using the Centers for Disease Control Surgical Wound Class Definitions

“…8 The authors demonstrated improved accuracy, although, after implementation, over 40% of cases were still misclassified by surgeons and allied health providers alike. 3,[6][7][8] The CDC offers little guidance by stating "The wound class must be applied according to the wound class schema that is adopted within each organization." 3 In addition to concerns with application, there is potential for errors with interpretation.…”

“…Currently, no standardized method of documentation of SWC exists among institutions; thus, the SWC is notoriously misidentified by surgeons and operating room nurses. 3,[6][7][8] For a classification system to be useful, it must be predictive and reliable. Historical data established a correlation between increasing SWC and postoperative complications, but nearly all of these studies were based on visceral tissue procedures.…”

“…Currently, no standardized method of documentation of SWC exists among institutions; thus, the SWC is notoriously misidentified by surgeons and operating room nurses. 3,6-8…”

Efficacy of Topical Epinephrine in Tympanoplasty

“…Many were found to have mucositis during surgery and some had mucoid or purulent effusions (Table III). Wounds were classified as contaminated or dirty 20 in the majority of patients. Many had prior surgery on the operated ear.…”

Promising Hydrogels-Based Dressings for Optimal Treatment of Cutaneous Lesions

“…Class I or clean wound includes injuries that are infectionfree, although current bacteria on the skin contaminate the injury [50]. Class II or clean-contaminated wound involves injuries, which affect the respiratory and digestive system, characterized by no loss of tissue fluid [51]. Class III or contaminated wound contains non-purulent inflammation and class IV or dirty/infected wound contains purulent inflammation [52].…”