Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality‐improvement approach

Abstract

BACKGROUND The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution’s IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction. DESIGN Observational study. SETTING Academic tertiary care hospital. PATIENTS Consecutive inpatients from 2006 to 2014. INTERVENTION Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services. MEASUREMENTS CVC-associated IAP, all-cause IAP rate. RESULTS We achieved both a short-term (years 2006 to 2008) and long-term (years 2006 to 2008–2014) reduction in our CVC-associated and all-cause IAP rates. Our short-term reduction in our CVC-associated IAP was 53% (P = 0.088), and our long-term reduction was 85% (P < 0.0001). Our short-term reduction in the all-cause IAP rate was 26% (P < 0.0001), and our long-term reduction was 61% (P < 0.0001). CONCLUSIONS A multidisciplinary team, focused on evidence, patient safety, and standardization, can use a set of multifaceted interventions to sustainably improve patient outcomes for several years after implementation. Our hospital was in the highest performance UHC quartile for all-cause IAP in 2012 to 2014.

Central venous catheterization training: current perspectives on the role of simulation

“…Simulation-based educational initiatives for CVC training improve learner performance and confidence, and have led to improvement in some patient outcomes. 8 , 9 , 12 – 14 Simulation is among the most frequently studied educational modes for procedural instruction in invasive bedside procedures. 15 …”

Comparison of Treatment Efficacy of the Pigtail Catheter and the Chest Tube in the Treatment of Iatrogenic Pneumothorax

“…Bu durum hastanede kalış süresini de etkilemektedir. Hastanede kalış süresinin kısalması ile morbiditemortalite oranları azalmakta ve hasta maliyeti de düşmektedir (18)(19)(20) .…”

Agitated Saline Bubble−Enhanced Ultrasound for Assessing Appropriate Position of Hemodialysis Central Venous Catheter in Critically Ill Patients

“… 9 Three prospective studies reported a sensitivity of 75% and a specificity of 100% for assessing inappropriate catheter positioning compared to bedside chest radiography. 10 , 11 , 12 The second method, based on the rapid flush of a saline−air mixture through the inserted catheter, is more sensitive. 4 , 5 Correct catheter positioning is detected as the appearance within 2 seconds of multiple micobubbles in the right atrium.…”