Timeliness Of Antibiotic Administration In Open Fractures Of The Femur And Tibia: Performance Improvement In A Collaborative Quality Initiative
*Bryant W Oliphant1, *Jill L Jakubus1, *Judy N Mikhail1, *Anna N Miller2, *Naveen F Sangji1, *John W Scott1, Mark R Hemmila1
1University of Michigan, Ann Arbor, MI;2Washington University, Saint Louis, MO
OBJECTIVE(S): Open long-bone fractures represent a complex injury within the trauma system, and coordination of care is essential to optimizing patient care. Guidelines recommend antibiotics be given within 60 minutes of patient arrival to the ED. We sought to measure the timeliness of antibiotic administration and improve the overall antibiotic administration rate at the patient and hospital level as a process measure within a collaborative quality initiative (CQI).
METHODS: Trauma CQI data (1/2017-8/2020) were analyzed from 34 ACS-COT verified Level 1 and Level 2 trauma centers. Inclusion criteria were adult patients (≥16 years), ISS ≥ 5, and open tibia or femur fracture. Patients who were directly admitted, transferred in, died with no signs of life, or died in the ED were excluded. After establishing a baseline from 1/2017 to 6/2018, hospitals were scored annually from 0-10 points on a pay-for-performance metric based on their rate of achieving antibiotic administration within 120 minutes for patients with an open tibia or femur fracture. Univariate tests were performed to examine differences between baseline and subsequent year(s) performance.
RESULTS: There were 2,300 patients with an open lower extremity long-bone fracture. The baseline (2017) rate of antibiotic administration to patients <60 minutes after arrival was 62.5% (Table). 7 of 29 hospitals achieved administration of antibiotics within 120 minutes in ≥85% of patients, and 1 of 29 hospitals was within 60 minutes in ≥85% of patients. Implementation of CQI process measure targets led to significant increases in the patient and hospital level performance with regard to the timeliness of antibiotic administration for open long bone fractures in the subsequent years (2018, 2019, 2020).
CONCLUSIONS: Creation of a pay-for-performance process measure within a statewide trauma CQI can improve compliance with the timely administration of antibiotics to patients with open fractures. Work remains to align compliance with the published guideline target of < 60 minutes and to identify factors involved in the delay of timely administration.
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