Improve Wound Misclassification with Focused Education

Hi, it's Ray again. Surgical wound classification, a topic regularly highlighted and discussed during M&M conferences, continues to be followed closely due to its associated risk of surgical site infections. It is also often used as a surrogate to assess quality of care, but unfortunately, evidence shows wounds continue to be misclassified on a regular basis. With this in mind, lead author, Marilyn Butler, and senior author, Dagmar Rockstroh, created a cheat sheet for wound classification of 114 common pediatric surgical procedures under their corresponding wound class and used it during an educational intervention to examine the effect on wound classification accuracy. Their intervention first involved having all pediatric surgeons and OR nurses attend a class with educational slide presentations and case discussions. Then, they placed laminated posters of an OR and wound classification algorithms, and a reference list of the pediatric procedures sorted by wound class in each operating room. They compared 200 cases before and 200 cases after the intervention, using the operative report to determine the most accurate wound classification based on the CDC guidelines. The two study groups had equal number of class one wounds, but class two was greater in the pre-intervention group and classes three and four were greater in the post-intervention group. The number of cases that had to be corrected, decreased from 35 to 9%, with the number of cases upgraded down from 24.5 to 9%. Sub-analysis of appendectomies, one of the most commonly misclassified cases, showed number of wound classes corrected, down from 48.4% to 11.1%, and the number of cases that needed to be upgraded, decreased from 45 to 11%. The long and short of it is, education on how to classify wounds can increase accuracy, thereby improving our ability to assess the risk of surgical site infections. And the wound classification of common pediatric surgical procedures created by Butler and colleagues, may provide intraoperative guidance at your institution.