-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/standalone_psi_casestudy.pdf
June 02, 2025 - staff for improvement
project
Ellen Robinson, PT, a clinical
quality specialist
Quality measure
Postoperative … More
specifically, the QI Toolkit was used to reduce the rate
of DVT/PE among postoperative patients … Initially, the
hospital used the Toolkit to focus on improving performance on PSI 12, postoperative … 03 Pressure Ulcer Rate
• PSI 07 Central Venous Catheter-Related Blood Stream Infection Rate
• PSI 11 Postoperative … Respiratory Failure Rate
• PSI 13 Postoperative Sepsis Rate
• PSI 15 Accidental Puncture or Laceration
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/132-gap-analysis-hospital-level.pdf
April 01, 2025 - infection preventionist
Discussion of challenging cases at a regular meeting
Comparison to postoperative … infection preventionist
Discussion of challenging cases at a regular meeting
Comparison to postoperative … infection preventionist
Discussion of challenging cases at a regular meeting
Comparison to postoperative … infection preventionist
Discussion of challenging cases at a regular meeting
Comparison to postoperative … infection preventionist
Discussion of challenging cases at a regular meeting
Comparison to postoperative
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/b2b_combo_ratesgenbywin.pdf
March 01, 2016 - 0 - 0.03771004
PDI8 PDI #8 Perioperative Hemorrhage or Hematoma Rate 0 0 - 0.00462178
PDI9 PDI #9 Postoperative … Respiratory Failure Rate 0 0 - 0.01018098
PDI10 PDI #10 Postoperative Sepsis Rate 0 0 - 0.01602384 … Sepsis Rate 0 0 - 0.01180386
PSI14 PSI #14 Postoperative Wound Dehiscence Rate 0 346 0 0.00186825 … Physiologic
and Metabolic Derangement Rate
0.00047
PSI #11 Postoperative Respiratory
Failure … Sepsis Rate 0.011804
PSI #14 Postoperative Wound
Dehiscence Rate
0 346 0 0.001265 0 0.001868
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/c2_pdi_prioritizationworksheetexample.pdf
June 02, 2025 - Hemorrhage or
Hematoma Rate
0.0 4.9 0 $75,932 $ - N 6 6 6 Y Y Y Y Y
PDI 09 Postoperative … Respiratory Failure Rate 0.0 11.0 0 $140,507 $ - N 7 7 7 Y Y Y Y Y
PDI 10 Postoperative … Sepsis Rate
0.0 16.2 0 $117,815 $ - N 9 10 10 Y Y Y Y Y
PDI 11 Postoperative
-
www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/womenhealth/wm-ptsafety.html
September 01, 2015 - Postoperative Catheter-Associated Urinary Tract Infection
Adult surgery patients age 18 and over with … postoperative catheter-associated urinary tract infection, by sex, 2009-2012
Year
Total … From 2009 to 2012, there was no statistically significant change in the percentage of women with postoperative … Groups With Disparities:
From 2009 to 2012, the percentage of adults with postoperative CAUTI was … In 2012, women were 1.5% more likely to have a postoperative CAUTI than men.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/a1b_combo_psifactsheet.pdf
October 01, 2015 - 0.34 0346 2012
PSI 07 Central Venous Catheter-related
Bloodstream Infection Rate
X 0.21
PSI 08 Postoperative … Hip Fracture Rate 0.04
PSI 09 Perioperative Hemorrhage or Hematoma
Rate
X 5.11
PSI 10 Postoperative … Physiologic and Metabolic
Derangement Rate
0.69
PSI 11 Postoperative Respiratory Failure Rate … PSI 12 Perioperative Pulmonary Embolism or
Deep Vein Thrombosis Rate
4.99 0450 2012
PSI 13 Postoperative … Sepsis Rate 9.61
PSI 14 Postoperative Wound Dehiscence Rate X 1.86
PSI 15 Accidental Puncture
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/44-sample-pathway-checklist.docx
June 01, 2023 - [Fill in postoperative nausea and vomiting prophylaxis that are a component of your intraoperative anesthesia … First postoperative VTE chemoprophylaxis dose
Date:
Time:
· Yes
· No
Multimodal pain management … Date:
Time:
If no, note reason:
· Yes
· No
Postoperative antibiotics administered for emergency … If no, note reason:
Abbreviations: IV = intravenous; N/A = not applicable; POD = postoperative day
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/020-ss-periop-infection-prevention.pptx
April 01, 2025 - AHRQ Safety Program for MRSA Prevention| Surgical Services
Perioperative Infection Prevention
25
Postoperative … Maintain postoperative blood glucose of 110 to 150 mg/dL for all patients, for 24 to 48 hours. … The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal … Postoperative tight glycemic control significantly reduces postoperative infection rates in patients … Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/020-perioperative-infection-prevention-strategies-slides.pptx
April 01, 2025 - AHRQ Safety Program for MRSA Prevention| Surgical Services
Perioperative Infection Prevention
25
Postoperative … Maintain postoperative blood glucose of 110 to 150 mg/dL for all patients, for 24 to 48 hours. … The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal … Postoperative tight glycemic control significantly reduces postoperative infection rates in patients … Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes
-
www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-proc-related-catheter-use-slides.html
December 01, 2017 - Slide 16
Postoperative Urinary Retention (POUR)
Incidence: varies widely:
General surgery … Slide 24
Duration of Postoperative Urinary Catheter Use
Question—Appropriate duration of IUC … Slide 25
Duration of Postoperative Urinary Catheter Use
Question—Duration of IUC use for patients … Slide 27
Duration of Postoperative Urinary Catheter Use
Q—Duration of post-op catheterization … Slide 30
Recommended Intervention
Develop a protocol for management of postoperative urinary
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/pfphac.pdf
September 01, 2014 - combined for 17 procedures based on CDC NHSN data
VAP MPSMS Ventilator-Associated Pneumonia
VTE MPSMS Postoperative … Clostridium difficile
MPSMS Mechanical Complications Associated With Central Venous Catheters
MPSMS Postoperative … Cardiac Events for Cardiac and Noncardiac Surgeries
MPSMS Postoperative Pneumonia
PSI Iatrogenic Pneumothorax … Cardiac Events
for Cardiac and Noncardiac
Surgeries
4.00 8.70 0.46
All Other
HACs
Postoperative … Cardiac Events
for Cardiac and Noncardiac
Surgeries
43,120 32,750,000 1.317
MPSMS Postoperative
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/a4a_combo_psi_casestudy.pdf
June 02, 2025 - More
specifically, the QI Toolkit was used to reduce the rate
of DVT/PE among postoperative patients … Initially, the
hospital used the Toolkit to focus on improving performance on PSI 12, postoperative … staff for improvement
project
Ellen Robinson, PT, a clinical
quality specialist
Quality measure
Postoperative … Pressure Ulcer Rate
• PSI 07 Central Venous Catheter-Related Blood Stream Infection Rate
• PSI 11 Postoperative … Respiratory Failure Rate
• PSI 13 Postoperative Sepsis Rate
• PSI 15 Accidental Puncture or Laceration
-
www.ahrq.gov/funding/grantee-profiles/grtprofile-hernandez-boussard.html
April 01, 2024 - carpal tunnel , and total hip and knee replacement , have helped to enhance clinical knowledge on postoperative … department discharges for opioid abuse, dependence, and poisoning; as well as studies of opioid-sparing postoperative … Her research focuses on older patients and aims to mitigate the risk of adverse outcomes related to postoperative … advancements in machine learning are leading to the development of prediction models for perioperative and postoperative
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/c2_pdi_prioritizationworksheetexample.xlsx
June 02, 2025 - 08 Perioperative Hemorrhage or Hematoma Rate 0.0 4.9 0 $75,932 $ - 0 N 6 6 6 Y Y Y Y Y
PDI 09 Postoperative … Respiratory Failure Rate 0.0 11.0 0 $140,507 $ - 0 N 7 7 7 Y Y Y Y Y
PDI 10 Postoperative Sepsis … Rate 0.0 16.2 0 $117,815 $ - 0 N 9 10 10 Y Y Y Y Y
PDI 11 Postoperative Wound Dehiscence Rate
-
www.ahrq.gov/research/findings/final-reports/stpra/stpraapa3.html
April 01, 2018 - Procedure level (for peri and postoperative surgeries): type and indication of surgery performed, type … Blood transfusion was a postoperative risk factor for nosocomial infection. … It is estimated that 325000 postoperative wound infections occur each year in the US (3). … The rate of postoperative infection after surgery for spinal tumors is in excess of 10%. … incontinence (bowel or bladder, or both), and any incontinence (preoperative or postoperative).
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/10-frontline-provider.pptx
June 01, 2023 - management of patients undergoing [specify procedures] that integrates the preoperative, intraoperative, postoperative … ISCR at [Hospital Name] 13
Key Elements Post Anesthesia Care Unit/Postoperative Day 0
Below are examples … of ISCR components that are relevant to the post anesthesia care unit (PACU)/postoperative day 0 work … receive VTE prophylaxis (if not already administered)
ISCR at [Hospital Name] 14
Key Elements Postoperative … Days 1–3
Below are examples of ISCR components that are relevant to patient care in postoperative days
-
www.ahrq.gov/research/findings/final-reports/stpra/stpraapa.html
April 01, 2018 - Maintenance of the postoperative dressing for 24–48 hours. … Aims
To identify the critical risk factors for postoperative wound infections. … Results
120 postoperative wound infections identified (6.5% rate). … Risk Factors for Postoperative Infection – Garibaldi et al. … Results
Overall, 120 postoperative wound infections were identified, for a rate of 6.5%.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c2_combo_prioritizationworksheetexample.pdf
June 02, 2025 - Physiologic and
Metabolic
Derangement
0.9 1.5 4 $120,629 $ 482,516 N 3 3 2 Y Y Y Y Y
PSI 11 Postoperative … Embolism or Deep
Vein Thrombosis
7.6 8.0 10 $64,476 $ 644,760 N 7 5 4 Y N Y Y Y
PSI 13 Postoperative … Sepsis 12.7 11.7 15 $49,215 $ 738,225 N 9 7 3 Y Y Y Y Y
PSI 14 Postoperative
Wound Dehiscence … Respiratory Failure
Rate
0.0 11.0 0 $140,507 $ - N 7 7 7 Y Y Y Y Y
PDI 10
Postoperative … Sepsis
Rate
0.0 16.2 0 $117,815 $ - N 9 10 10 Y Y Y Y Y
PDI 11
Postoperative
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/d4h_pdi10-sepsis-bestpractices.pdf
May 17, 2016 - Quality and Safety
1 Tool D.4h
Selected Best Practices and Suggestions for Improvement
PDI 10: Postoperative … Sepsis
Why focus on postoperative sepsis in children? … • Postoperative sepsis remains a major surgical complication in children, occurring in around
10 per … Trends in postoperative sepsis: are we improving
outcomes? … Sepsis
Why focus on postoperative sepsis in children?
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4v_combo_pdi10-sepsis-bestpractices.pdf
May 17, 2016 - Quality and Safety
1 Tool D.4v
Selected Best Practices and Suggestions for Improvement
PDI 10: Postoperative … Sepsis
Why focus on postoperative sepsis in children? … • Postoperative sepsis remains a major surgical complication in children, occurring in around
10 per … Trends in postoperative sepsis: are we improving
outcomes? … Sepsis
Why focus on postoperative sepsis in children?