A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center

Wooller, Krista; Backman, Chantal; Gupta, Sanjiv; Jennings, Alison; Hasimja-Saraqini, Delvina; Forster, Alan J.

doi:10.1186/s12913-018-3421-2

Cited by 21 publications

(19 citation statements)

References 18 publications

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“…Of the included papers, 61 focussed on clinical audits, 17 on accreditation/certification and 7 on peer reviews. In terms of the evidence levels established by EPOC review group [ 30 ], one randomised trial was found [ 35 ], two controlled studies [ 36 , 37 ], 66 case studies [ 38 – 103 ], and 16 descriptive studies [ 104 – 119 ]. Using the QI-MQCS, the completeness of reporting scores ranged from 4 to 16 (16 being the highest possible score) ( S1 Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Having a sense of urgency seems to be an important precondition for healthcare professionals to engage: if healthcare professionals perceive the current situation as untenable for themselves or for the safety of patients, this will urge them to take action [ 82 , 105 ]. Several studies have described local audits that were started by intrinsically motivated healthcare professionals on issues they felt to impact on patient care [ 48 , 53 , 61 , 63 , 69 , 82 , 88 , 97 , 99 , 103 ]. In contrast, if healthcare professionals perceive an audit as a ‘side-line’ or ‘mandatory exercise’, rather than a process to contribute to improved quality of care, they will not feel engaged and not put significant effort into the change [ 77 , 118 ].…”

Section: Resultsmentioning

confidence: 99%

“…Champions are those healthcare professionals who are committed to implementing change, act as a role model for the intended change and are enthusiastic in convincing others in the organisation of the necessity of change [ 69 , 82 , 86 , 89 , 101 , 103 , 109 ]. Two kinds of champions were identified, those that initiated an audit [ 36 , 49 , 54 , 59 , 69 , 74 , 82 , 89 ] and those nominated by the leadership of an organisation and given responsibility for carrying the audit forward [ 43 , 47 , 53 , 57 , 85 , 86 , 90 , 91 , 95 , 101 , 103 , 104 , 109 , 119 ]. In successful audits champions challenge, educate and lead their colleagues to improve the quality of care [ 69 , 90 , 91 , 95 , 101 , 119 ].…”

Section: Resultsmentioning

confidence: 99%

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Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

et al. 2021

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Background Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. Methods A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context–mechanism–outcome configurations (CMOcs). Results From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. Conclusions This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO registration CRD42016039882.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

et al. 2021

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“…Most importantly, it provides rich details about the events allowing for timely identification and assessment of cases which can be used to prioritise opportunities for improvement. 33 34…”

Section: Introductionmentioning

confidence: 99%

Study of a multisite prospective adverse event surveillance system

et al. 2019

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BackgroundWe have designed a prospective adverse event (AE) surveillance method. We performed this study to evaluate this method’s performance in several hospitals simultaneously.ObjectivesTo compare AE rates obtained by prospective AE surveillance in different hospitals and to evaluate measurement factors explaining observed variation.MethodsWe conducted a multicentre prospective observational study. Prospective AE surveillance was implemented for 8 weeks on the general medicine wards of five hospitals. To determine if population factors may have influenced results, we performed mixed-effects logistic regression. To determine if surveillance factors may have influenced results, we reassigned observers to different hospitals midway through surveillance period and reallocated a random sample of events to different expert review teams.ResultsDuring 3560 patient days of observation of 1159 patient encounters, we identified 356 AEs (AE risk per encounter=22%). AE risk varied between hospitals ranging from 9.9% of encounters in Hospital D to 35.8% of encounters in Hospital A. AE types and severity were similar between hospitals—the most common types were related to clinical procedures (45%), hospital-acquired infections (21%) and medications (19%). Adjusting for age and comorbid status, we observed an association between hospital and AE risk. We observed variation in observer behaviour and moderate agreement between clinical reviewers, which could have influenced the observed rate difference.ConclusionThis study demonstrated that it is possible to implement prospective surveillance in different settings. Such surveillance appears to be better suited to evaluating hospital safety concerns within rather than between hospitals as we could not definitively rule out whether the observed variation in AE risk was due to population or surveillance factors.

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“…Previous pilot work on the general internal medicine units at a large academic health science centre showed a decrease in the incidence of catheter use from approximately 25% of patients down to 12-15% after implementation of a standardized protocol [15]. This was also associated with decreased antibiotic prescribing for catheter-associated bacteriuria on these units, which was sustained for over a year [15].…”

Section: Protocolmentioning

confidence: 97%

Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A theory-based process evaluation

Backman

Wooller

Hasimja-Saraqini

et al. 2020

Preprint

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Background: Inappropriate use of urinary catheters can increase the risk of catheter-associated urinary tract infections (CAUTI) leading to increased morbidity and increased costs. The overall purpose of this study was to evaluate an intervention to reduce unnecessary urinary catheter use and prevent CAUTI in hospitalized patients across a large academic health science centre. Methods: This was a two-phase study, which took place between 2017 and 2019. Phase 1 was a pre- and post-intervention design to test the impact of a CAUTI protocol across the organization. Audits on 4 units pre and post were conducted, and data were analyzed descriptively. Phase 2 was a theory-based process evaluation to understand the barriers and enablers to the implementation. Semi-structured interviews were conducted and then analyzed using a systematic approach. Results: Phase 1: All inpatients with urinary catheters admitted on the four selected units during the study period (n=99, pre) and (n=99, post) were included. CAUTI prevalence rate was 18.2% pre vs 14.1% post (p=.563). Phase 2: participants (n=18) who worked during the study period on the four audit units were interviewed, and a total of 13 barriers and 19 enablers were found across the participant groups. Conclusion: No statistically significant difference in CAUTI prevalence rates were noted. The theory-based process evaluation provided insights into barriers and enablers to the implementation which may help reformulate the intervention in the future.

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A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center

Cited by 21 publications

References 18 publications

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

Study of a multisite prospective adverse event surveillance system

Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A theory-based process evaluation

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