Sentara Norfolk General Hospital: Accelerating Improvement by Focusing on Building a Culture of Safety

Yates, Gary R.; Hochman, Rodney F.; Sayles, Shannon M.; Stockmeier, Carole A.

doi:10.1016/s1549-3741(04)30063-8

Cited by 19 publications

(12 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10 During interviews, intensive care unit teams noted several factors that were important in sustaining this project, including continued feedback of infection data that the team perceived as valid, improvements in safety culture that occurred as part of the overall Keystone ICU project, an unremitting belief in the preventability of bloodstream infections, involvement of senior leaders who reviewed infection data and provided teams with the resources needed, and a shared goal rather than a competition to reduce infection rates throughout the state of Michigan. Other studies describe similar methods to facilitate sustainability, such as active support from leaders and an infrastructure that supports quality improvement methods, training of staff, involving key internal and external stakeholders,6 20 21 22 23 alignment of project and organisational goals,21 multidisciplinary teams and collaborations,6 and inclusion of change management that also encourages local adaptation and rewards innovation and change 21. Quality improvement initiatives that demonstrate value are more likely to be sustained 21…”

Section: Discussionmentioning

confidence: 99%

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

Pronovost

Goeschel

Colantuoni

et al. 2010

BMJ

471

247

View full text Add to dashboard Cite

Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%). ConclusionsThe reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.

show abstract

Section: Discussionmentioning

confidence: 99%

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

Pronovost

Goeschel

Colantuoni

et al. 2010

BMJ

471

247

View full text Add to dashboard Cite

show abstract

“…29,30 Evidence from the available literature and expert opinion were then used to develop a key driver diagram (Fig 1).…”

Section: Diagnostic Phasementioning

confidence: 99%

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Muething

Goudie

Schoettker³

et al. 2012

Pediatrics

106

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVE: Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. METHODS:A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture.RESULTS: SSEs per 10 000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P , .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P , .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. CONCLUSIONS: Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions. Pediatrics 2012;130:e423-e431 AUTHORS:

show abstract

“…Researchers, with 866 surveys from nurses in 25 critical care units within eight hospitals, suggested that a perceived lack of power within the work environment contributes to less desired patient outcomes (Manojlovich & DeCicco 2007). Yates et al (2004) linked the organizationÕs PSC to decreased infections. Knowledge of the link between the work environment and these errors increases control over the environment in which these errors occur.…”

Section: Literature Reviewmentioning

confidence: 99%

Structural empowerment and patient safety culture among registered nurses working in adult critical care units

Armellino

Griffin

Fitzpatrick

2010

Journal of Nursing Management

View full text Add to dashboard Cite

show abstract

Sentara Norfolk General Hospital: Accelerating Improvement by Focusing on Building a Culture of Safety

Cited by 19 publications

References 2 publications

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Structural empowerment and patient safety culture among registered nurses working in adult critical care units

Contact Info

Product

Resources

About