Developing Evidence for New Patient Safety Bundles Through Multihospital Collaboration

Abstract

Objective: Multihospital collaboration for safety improvements is increasingly common, but strategies for developing bundles when effective evidence-based practices are not well described are limited. The Children's Hospitals' Solutions for Patient Safety (SPS) Network sought to further reduce patient harm by developing improvement bundles when preliminary evidence was limited.Methods: As part of the novel Pioneer process, cohorts of volunteer SPS hospitals collaborated to identify a harm reduction bundle for carefully selected hospital-acquired harm categories where evidence-based practices were limited. For each harm type, a leadership team selected interventions (factors) for testing and guided the work throughout the Pioneer process. Using fundamental quality improvement techniques and a planned experimentation design, each participating hospital submitted outcome and process compliance data for the factor implemented. Data from all hospitals implementing that factor were analyzed together using Shewhart charts, response plots, and analysis of covariance to identify whether reliable implementation of the factor influenced outcomes. Factors were categorized based on strength of evidence and other clinical or evidentiary support. Factors with strong support were included in a final bundle and disseminated to all SPS hospitals. Results:The SPS began the bundle identification process for nine harm types and three have completed the process. The analytic approach resulted in four scenarios that along with clinical input guided the inclusion or rejection of the factor in the final bundle. Conclusions:In this multihospital collaborative, quality improvement methods and planned experimentation were effective at developing evidence-based harm reduction bundles in situations where limited data for interventions exist.

Catheter-Associated Urinary Tract Infection Reduction in a Pediatric Safety Engagement Network

“…31 SPS hospitals concurrently participated in other SPS-sponsored efforts to reduce health care-associated harm. 1,14,15 Nonetheless, we cannot exclude the possibility that implementation of this QI initiative had unintended consequences, such as discouraging diagnostic cultures or increasing use of empirical antibiotics. Although this was perhaps defensible…”

“…[11][12][13] Children's Hospitals' Solutions for Patient Safety (SPS) is a network of .135 children's hospitals collaborating to reduce health care-associated complications among children. 1,14,15 SPS evaluated best practices in CAUTI prevention to develop and implement IBs and MBs for use in children. Our assessment was that bundles developed for use in adults were being introduced by children's hospitals and were largely applicable for pediatric use.…”

Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative

“…Centralized network leadership oversaw the identification and dissemination of HAC prevention best practices. The methodology for generating and disseminating HAC prevention strategies as well as the network’s approach for engaging members in shared improvement work have been described previously . In brief, volunteer leaders and subject matter experts for each HAC were recruited to partner with centralized clinical improvement experts, data analysts, and project management staff to establish best practice prevention bundles as well as standardized outcome and process measure definitions.…”

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

“…[13][14][15] Improvement science has been used to implement published evidence, shorten the estimated 17-year gap between research publication and adoption, and generate evidence where none exists. 16,17 In these scenarios, adherence to improvement science methodology and purposeful design and interpretation of planned experimentation are essential to success. Methodologies developed in production industries have been applied in healthcare settings, and numerous frameworks and approaches have been published and publicized through organizations like the Institute for Healthcare Improvement (IHI).…”