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Quality Improvement

Ontario Surgical Quality Improvement Network

Doctor and nurses performing operation

Learn more about best practices in surgical care and resources to inform your work in surgical quality improvement.


Central venous catheters (CVCs) disrupt the integrity of the skin, leaving the patient susceptible to infection with bacteria or fungi. Central Line-Associated Bloodstream Infections (CLABSI) may spread to the bloodstream, potentially causing hemodynamic changes and organ dysfunction, possibly leading to death. You can reduce CLABSIs with two bundles of evidence-based steps1:

  1. Central line insertion bundle

  2. Central line care bundle


Additional Resources


1Canadian Patient Safety Institute (CPSI). Central line infections [Internet]. Edmonton, AB: CPSI: 2016 [cited 2017 May 31]. Available from: http://www.saferhealthcarenow.ca/EN/Interventions/CLI/Pages/default.aspx.

Enhanced Recovery After Surgery (ERAS) pathways are designed to improve recovery times and outcomes in patients having elective surgery. They were initially used in patients having elective colorectal surgery, but over time they have been adopted for a range of surgical procedures. Implementing ERAS can decrease peri-operative stress, post-operative pain, gut dysfunction, and infection and promote early recovery in Ontario’s surgical patients.


Additional Resources

The Surgical Safety Checklist provides a list of the most common tasks operating room teams carry out during the perioperative period. The checklist improves teamwork and communication, increasing efficiency and reducing complications. Using the checklist, the surgical team performs key safety checks at three distinct phases of any surgical procedure:

  1. The period before induction of anesthesia (“Briefing”)

  2. The period after induction and before surgical incision (“Time Out”)

  3. The period during or immediately after wound closure but before the patient is transferred from the operating room (“Debriefing”)

Organizations across Canada have created regional versions of the Surgical Safety Checklist, which are often a combination of the checklists developed by the Canadian Patient Safety Institute (CPSI) and the World Health Organization (WHO).

Surgical site infection (SSI) is the most common health care–associated infection among surgical patients, with 77% of patient deaths reportedly related to infection. You can help to reduce SSIs with four key components of perioperative care2:

  1. Perioperative antimicrobial coverage

  2. Appropriate hair removal

  3. Maintenance of perioperative glucose control

  4. Perioperative normothermia


Additional Resources


2Safer Healthcare Now! Prevent surgical site infections—getting started kit [Internet]. Edmonton, AB: Canadian Patient Safety Institute (CPSI); 2014 [cited 2017 May 4]. Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Surgical%20Site%20Infection/SSI%20Getting%20Started%20Kit.pdf

Health care–associated urinary tract infection (UTI) is one of the most common health care–associated infections. Approximately 80% of UTIs are attributed to indwelling urinary catheters (catheter-associated UTI, or CAUTI) and have been associated with increased morbidity, mortality, hospital cost and length of stay. You can prevent CAUTIs by using evidence-based practices.3


Additional Resources


3 Canadian Patient Safety Institute (CPSI). UTI: introduction. Edmonton, AB: CPSI; 2016 [cited 2017 May 4]. Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-Harm-Measure/Improvement-Resources/UTI/Pages/default.aspx.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are common preventable complications of hospitalization and surgery. The prevention of VTE requires evidence-based thromboprophylaxis.4


Additional Resources


4 Canadian Patient Safety Institute (CPSI). Venous thromboembolism: introduction. Edmonton, AB: CPSI; 2016 [cited 2017 May 4]. Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-Harm-Measure/Improvement-Resources/VTEOverview/Pages/default.aspx.

Pneumonia is one of the most common hospital-acquired infections. Hospital-acquired pneumonia, including ventilator-associated pneumonia (VAP), can contribute to prolonged hospital stays and serious patient morbidity and mortality. There are proven interventions that can help prevent pneumonia.5


Additional Resources


5 Canadian Patient Safety Institute (CPSI). Pneumonia: introduction. Edmonton, AB: CPSI; 2016 [cited 2017 May 4]. Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Hospital-Harm-Measure/Improvement-Resources/Pneumonia/Pages/default.aspx.

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