Safe Critical Care: Testing Improvement Strategies
| Status: | Completed |
|---|---|
| Conditions: | Pneumonia |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 1 - Any |
| Updated: | 4/21/2016 |
| Start Date: | February 2006 |
| End Date: | April 2008 |
One group of hospitals participated in a collaborative approach for healthcare quality
improvement while another group was provided only a tool kit. The investigators' objective
was to determine if the Collaborative would perform better at preventing central
line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonias (VAP).
Hospitals were randomized to the Tool Kit or Collaborative conditions. The investigators'
study evaluated the effects on care processes and outcomes of a multi-institutional quality
improvement initiative focused on preventing hospital associate infections. The
investigators' hypothesis was that the strategies for implementing safe critical care
practice will differ in level of achievement whereby the Collaborative group will perform
better than the Tool Kit group. The outcome measure comprised clinical event rates and an
index of safe practices that represent a bundling of key process measures related to
evidence-based practices for preventing catheter-related blood-stream infections and
ventilator-associated pneumonia in the intensive care unit.
improvement while another group was provided only a tool kit. The investigators' objective
was to determine if the Collaborative would perform better at preventing central
line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonias (VAP).
Hospitals were randomized to the Tool Kit or Collaborative conditions. The investigators'
study evaluated the effects on care processes and outcomes of a multi-institutional quality
improvement initiative focused on preventing hospital associate infections. The
investigators' hypothesis was that the strategies for implementing safe critical care
practice will differ in level of achievement whereby the Collaborative group will perform
better than the Tool Kit group. The outcome measure comprised clinical event rates and an
index of safe practices that represent a bundling of key process measures related to
evidence-based practices for preventing catheter-related blood-stream infections and
ventilator-associated pneumonia in the intensive care unit.
Continuous quality improvement (CQI) methodologies provide a framework for initiating and
sustaining improvements in complex systems.1 By definition, CQI engages frontline staff in
iterative problem solving using plan-do-study-act cycles of learning, with decision-making
based on real-time process measurements. The Institute for Healthcare Improvement (IHI) has
sponsored Breakthrough Series (BTS) Collaboratives since 1996 to accelerate the uptake and
impact of quality improvement. These collaboratives are typically guided by evidence-based
clinical practice guidelines, incorporate change methodologies, and rely on clinical and
process improvement subject matter experts. Organizations have been adopting the
collaborative model, and there is a growing literature on its positive impact. This
collaborative approach to healthcare improvement has appealing face validity but lacks
definitive evidence of its effectiveness. A recent derivative of collaboratives has been
deployment of tool kits for quality improvement. Intuition suggests that such tools kits may
help to enable change, and, thus some agencies advocate the simpler approach of
disseminating tool kits as a change strategy. We sought to compare the collaborative model
with the tool kit model for improving care. Recommendations and guidelines for central
line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP)
prevention have not been implemented reliably, resulting in unnecessary ICU morbidity and
mortality and fostering a national call for improvement. Our study evaluated the effects on
care processes and outcomes of a multi-institutional quality improvement initiative focused
on preventing CLABSI and VAP in the intensive care unit (ICU).
sustaining improvements in complex systems.1 By definition, CQI engages frontline staff in
iterative problem solving using plan-do-study-act cycles of learning, with decision-making
based on real-time process measurements. The Institute for Healthcare Improvement (IHI) has
sponsored Breakthrough Series (BTS) Collaboratives since 1996 to accelerate the uptake and
impact of quality improvement. These collaboratives are typically guided by evidence-based
clinical practice guidelines, incorporate change methodologies, and rely on clinical and
process improvement subject matter experts. Organizations have been adopting the
collaborative model, and there is a growing literature on its positive impact. This
collaborative approach to healthcare improvement has appealing face validity but lacks
definitive evidence of its effectiveness. A recent derivative of collaboratives has been
deployment of tool kits for quality improvement. Intuition suggests that such tools kits may
help to enable change, and, thus some agencies advocate the simpler approach of
disseminating tool kits as a change strategy. We sought to compare the collaborative model
with the tool kit model for improving care. Recommendations and guidelines for central
line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP)
prevention have not been implemented reliably, resulting in unnecessary ICU morbidity and
mortality and fostering a national call for improvement. Our study evaluated the effects on
care processes and outcomes of a multi-institutional quality improvement initiative focused
on preventing CLABSI and VAP in the intensive care unit (ICU).
Inclusion Criteria:
- Medical centers with at least one adult or pediatric ICU.
- Medical centers within the Hospital Corporation of America (HCA) were eligible for
enrollment.
Exclusion Criteria:
- Nonresponse to invitation to participate in our Safe Critical Care Initiative.
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