Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

Lipitz‐Snyderman, Allison; Steinwachs, Donald; Colantuoni, Elizabeth; Morlock, Laura L.; Pronovost, Peter J.

doi:10.1136/bmj.d219

Cited by 98 publications

(72 citation statements)

References 24 publications

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“…Extra articles were selected from the reference lists of these 193 articles. Of the set of articles thus identified, 24 met the inclusion criteria: the study was conducted in an industrialized country and published in English, included observational fieldwork as part of the data collection, T he sustained clinical and policy interest in the United States and worldwide on quality and safety activities 1 initiated by the release of To Err Is Human 2 has resulted in some high-profile successes 3,4 and much disappointment. Both clinicians and the social scientists seeking to help clinicians have begun to call for more attention to interprofessional care and the context in which quality and safety interventions are implemented.…”

Section: Methodsmentioning

confidence: 99%

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Paradis¹,

Leslie²,

Puntillo³

et al. 2014

American Journal of Critical Care

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BackgroundThe sustained clinical and policy interest in the United States and worldwide in quality and safety activities initiated by the release of To Err Is Human has resulted in some high-profile successes and much disappointment. Despite the energy and good intentions poured into developing new protocols and redesigning technical systems, successes have been few and far between, leading some to argue that more attention should be given to the context of care. Objective To examine the insights provided by qualitative studies of interprofessional care delivery in intensive care. Methods A total of 532 article abstracts were reviewed. Of these, 24 met the inclusion criteria. Results Articles focused on the nurse-physician relationship, patient safety, patients' families and end-of-life care, and learning and cognition. The findings indicated the complexities and nuances of interprofessional life in intensive care and also that much needs to be learned about team processes. Conclusion The fundamental insight that interprofessional interactions in intensive care do not happen in a historical, social, and technological vacuum must be brought to bear on future research in intensive care if patient safety and quality of care are to be improved.

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Section: Methodsmentioning

confidence: 99%

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Paradis¹,

Leslie²,

Puntillo³

et al. 2014

American Journal of Critical Care

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“…Checklists and guidelines designed for these scenarios can be grouped together under the term 'cognitive aids'. Such aids appear to be beneficial; there is evidence demonstrating reduced mortality with checklists for central venous access on intensive care units [1] and surgical safety checklists in operating theatres [2][3][4]. The probability of demonstrating that cognitive aids reduce morbidity or mortality in emergency care is limited by the rarity of these events; however, in the field of anaesthesia and surgery, checklists have been shown to improve the management of simulated intra-operative crises [5,6].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

et al. 2015

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Summary Applying human factors principles to the design of clinical emergency guidelines is important. The UK Civil Aviation Authority uses a Checklist Assessment Tool for evaluating the content and usability of emergency drills before introduction into service on aircraft. We hypothesised that this model could be used to develop a generic medical tool. A three‐stage modified Delphi process was used to adapt the above tool for use in designing medical emergency guidelines. The resulting Cognitive aids in Medicine Assessment Tool was then used to score and rank seven published difficult airway guidelines; the scores were used to assess its validity and reliability. Pearson's rank coefficient between these scores and scores from independent assessors was 0.89 (p = 0.007). Internal consistency, as assessed by Cronbach's alpha, was 0.74, 0.96 and 0.72 for the tool's three constituent domains of physical characteristics, content and layout/format, respectively. Inter‐rater reliability, as assessed by Cohen's kappa, ranged from 0.33 to 0.72. The adoption of our tool has the potential to improve the usability of medical emergency guidelines.

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“…[27][28][29] More importantly, CLABSI prevention can reduce morbidity. 30 Following implementation and maintenance of the bundle in LTACHs, the CLABSI rate was reduced significantly (29%), from a SIR of 1.28 to a SIR less than 1.0 and no different from the expected CLABSI rate, because the mean 95% CI of the CLABSI SIR includes the expected value of 1.0. During the time of this study, the Centers for Medicare and Medicaid Services' National Action Plan to Prevent HAIs set a national 5-year goal for CLABSI SIR reduction at 25%.…”

Section: Discussionmentioning

confidence: 99%

Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals

Grigonis

Dawson

Burkett

et al. 2016

American Journal of Critical Care

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Objective Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). Methods A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. Results The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η2 = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85–7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (−0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. Conclusion The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.

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Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

Cited by 98 publications

References 24 publications

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids

Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals

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