Introduction

Welcome to the APSA Quality and Safety committee Bariatric Surgery Toolkit. This page is intended to help anyone who is interested in quality improvement of the management of obese patients.

Available toolkit projects are listed below. Many of the approaches described are evidence based - some are not. These approaches have not been approved by APSA.

Reduction of Surgical Site Infections

Brown University

The rate of surgical site infection (SSI) for sleeve gastrectomy was noted to be unacceptably high. Through a simple modification of our method of specimen retrieval, SSI
became a rare event for our sleeve patients.

Protocol

Universal adoption of the use of a wound protector for specimen extraction was achieved by modifying case cards for all providers to include wound protectors in the list of
disposables picked for sleeve cases.
Steps:

• agreement among all bariatric surgical providers of the importance of the problem and the adoption of use of wound protectors
• education of operating room staff
• modification of preference sheets
• stocking of appropriately sized wound protectors
• tracking of outcomes

Stakeholders: surgeons, operating room staff, center of excellence administrators, bariatric registrar

Challenges and solutions:

• This institution has a two system electronic medical record, one for inpatient and one for outpatient, which do not communicate. Tracking was an issue. Solution: Use of data collection through the bariatric database.
• Omission of use of the wound protector due to stock issues or surgeon practice. Solution: re-education and re-examination of stocking practices.

Submitted by: Elizabeth Renaud