The Safe Critical Care Initiative - PowerPoint PPT Presentation

Loading...

PPT – The Safe Critical Care Initiative PowerPoint presentation | free to download - id: 668e20-N2Y1N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

The Safe Critical Care Initiative

Description:

The Safe Critical Care Initiative An HCA-Vanderbilt Quality Improvement Project On Healthcare Associated Infection Partnerships in Implementing Patient Safety (PIPS) – PowerPoint PPT presentation

Number of Views:28
Avg rating:3.0/5.0
Slides: 28
Provided by: TedSp8
Learn more at: http://archive.ahrq.gov
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: The Safe Critical Care Initiative


1
The Safe Critical Care Initiative
  • An HCA-Vanderbilt
  • Quality Improvement Project
  • On Healthcare Associated Infection
  • Partnerships in Implementing Patient Safety
    (PIPS)
  • Funded by AHRQ
  • ted.speroff_at_vanderbilt.edu

2
Safe Critical Care Team
  • Vanderbilt
  • Ted Speroff
  • Robert Dittus
  • Jay Deshpande
  • E. Wesley Ely
  • Dan France
  • Robert Greevy
  • Shirley Liu
  • Samuel K Nwosu
  • Thomas R. Talbot
  • Richard Wall
  • Matthew B. Weinger
  • Hospital Corp of America
  • Laurie Brewer
  • Hayley Burgess
  • Jane Englebright
  • Steve Horner
  • Frank Houser
  • Jeanne James
  • Susan Littleton
  • Patsy McFadden
  • Steve Mok
  • Joan Reischel
  • Sheri Tejedor
  • Mark Williams

3
Aims of Safe Critical Care
  • To prevent catheter-related blood stream
    infections (BSI) and ventilator-associated
    pneumonia (VAP) in the ICU.
  • To implement a campaign for Improving Critical
    Care (Blood-Stream Infections and
    Ventilator-Associated Pneumonia) as part of the
    IHI 100,000 Lives Campaign.

4
Aims of Safe Critical Care
  • To compare a Collaborative approach to a Local
    Hospital Quality Improvement approach for
    implementing an improvement initiative.
  • To examine the organizational and provider
    factors that contribute toward and enable
    successful performance improvement.

5
Methods
  • Hospital Corporation of America (HCA)
  • 172 Medical and Surgical Centers
  • 60 suburban and 32 urban
  • Recruited 61 Hospitals

6
Methods RCT Design
  • HCA-Vanderbilt Toolkits
  • HCA core development of Meditech tools
  • Feedback reports from surveys and data collection
  • Safe Critical Care Project Atlas Site
  • HCA-Vanderbilt Toolkits
  • HCA core development of Meditech tools
  • Feedback reports from surveys and data collection
  • Safe Critical Care Project Atlas Site
  • Collaborative communications
  • Social networking
  • Content experts
  • Collaborative teleconference meetings

7
Methods Tool Kit HCA Intranet-Atlas
Site Keyword Safe Critical Care
  • Continuing Education Programs
  • BSI Tool Kit
  • VAP Tool Kit
  • Project Metrics
  • FAQ/Fact sheet Quick links
  • QI/PDSA Tools
  • Statistical Control Chart Tools

8
(No Transcript)
9
Methods Measures
  • Clinical Outcomes BSI and VAP rates
  • Administrative Data
  • Safety Attitude Questionnaire ICU safety climate
  • Organizational Culture
  • Survey of ICU Practices and Quality Improvement
    Activities
  • Post-Project Evaluation Survey

10
Results Characteristics of HCA ICUs
  • 80 have lt 20 ICU beds
  • 35 are medical-surgical-coronary ICU, 20
    medical-surgical
  • 65 have physician medical director, 95 have a
    nurse manager
  • 27 intensivist required, 36 intensivist
    optional, 37 no intensivist
  • 67 have pharmacist rounding
  • 65 have daily, integrated interdisciplinary team

11
Results Baseline
Baseline Characteristics Collaborative N 31 Tool Kit N 30 P-value
in IHI Campaign 96 100 1.0
Hospital Vol median (IQR) 2720 (1499,3827) 2616 (1242,3360) .90
ICU Volume median (IQR) 595 (337,909) 578 (244,1077) .80
ICU LOS median (IQR) 4026 (1978,5824) 4228 (1645,6725) .82
ICU Mortality (sd) 5.9 (2.9) 7.1 (3.6) .19
Medicare/Medicaid (sd) 68.4 (9.6) 68.4 (10) 1.0
Emer.Dept Admit (sd) 72 (14) 67 (20) .2
Female (sd) 49.7 (5.6) 50.3 (7.7) .83
Charge weight mean (sd) 1258 (1004) 1295 (1110) .94
SAQ mean (sd) 3.60 (.29) 3.67 (.28) .21
BSI VAP Projects 68 60 .54
BSI Rate per 1000 days 2.3 (2.5) 4.4 (5.8) .26
VAP Rate per 1000 days 3.4 (3.5) 4.7 (5.9) .73
12
BSI Results Relative Risk 1.14 (95 CI 0.93,
1.40), p .20
13
VAP Results Relative Risk 1.28 95 CI (1.03,
1.57), p .023
14
Safe Critical Care QI Interventions
  • Adoption of bundles for patient care
  • Interdisciplinary team rounding
  • Rounding form/checklist
  • Empower nurses to encourage physician compliance
  • Unit champions
  • Nurses empowered to stop procedure if break in
    sterile field
  • Checklist implementation
  • Kit changes cart
  • Checklist in kits
  • Standards of Practice revised
  • Order set protocols
  • Alcohol gel dispensers
  • Hand wash campaign
  • Evaluate performance and practices
  • Audits surveillance
  • Difference between standard audits and peer group
    observation
  • Case reviews of BSI and VAP
  • Reporting bundle compliance
  • Feedback reports
  • Monthly ICU newsletter
  • Encourage staff feedback

15
Webcast Seminars
Collaborative Group participated in more data
topic seminars (52 vs 22) and rated them as
useful (78 vs 54)
16
Usefulness of Tools
A greater proportion of the Collaborative Group
accessed the BSI and VAP Tools, accessed the SPC
methods tools, and found the tools useful.
17
BSI Bundle Process
82 of the Collaborative Group implemented all
components of The CVC Bundle compare to 56 of
the Tool Kit Group (p.027)
18
VAP Bundle Process
76 of the Collaborative Group implemented all
components of The CVC Bundle compare to 64 of
the Tool Kit Group (p.30)
19
Collaborative Qualitative Results Challenges -
Physicians
  • Challenges
  • Resistance
  • Use of barriers
  • Use of checklists
  • Site of insertion
  • Multiple private MDs, Involvement
  • Resistance to change vendors
  • Solutions
  • MD buy in, approval from MEC
  • Hire Physician champion
  • Intensivists
  • Nurse empowerment
  • Physician involvement in case review
  • New order sets

20
Collaborative Qualitative Results Challenges -
Staff
  • Challenges
  • Commitment
  • Empowerment
  • Resistance to tools
  • Resistance to change in behavior
  • Solutions
  • Champions
  • Enlist
  • Hire
  • Storyboard with examples so staff could
    conceptualize their roles
  • Holding each other accountable is painful at
    times

21
Collaborative Qualitative Results Challenges -
Data
  • Challenges
  • How to
  • Data collection tools
  • Access to data
  • Solutions
  • Meditech/PCM documentation of protocols
  • Design tools
  • Monitoring

22
Findings from Surveys
  • ICU Staffing is variable
  • Most HCA ICUs are multipurpose
  • diagnostic diversity requires task and workload
    diversity
  • diverse demands on education and training
    requirements
  • Intensivists available in 63 of HCA ICUs but
    with variable models of care delivery
  • Documentation is nearly split between paper and
    computer
  • Significant variability in the extent of ICU
    participation in quality improvement

23
Findings from Surveys
  • Use of the NNIS definitions
  • 98 for BSI
  • 96 for VAP
  • Difficulty obtaining IC denominator data
  • 48 for BSI rates
  • 23 hospitals reported having months where BSI
    rates could not be reported due to incomplete
    denominator reporting.
  • 30 for VAP rates
  • 13 hospitals reported having months where VAP
    rates could not be reported due to incomplete
    denominator reporting.
  • 31 use Infection Control software for
    surveillance

24
SAQ Results Variation in Safety Climate
25
SAQ Survey findings
  • Overall Safety Climate is positively correlated
    with QI Measurement r .39
  • SAQ and Hospital Size
  • Safety Climate and QI support varies with
    hospital size.
  • Smaller hospitals show more positive safety
    climate.
  • Smaller hospitals show need for administrative
    support in resources and measurement.
  • Larger hospitals give more empowerment to the
    team.
  • ICU teams provided with resources and training by
    the administration have more positive perceptions
    of safety climate.

26
Conclusions
  • Monitoring outcomes such as hospital acquired
    infections is complicated and time consuming.
  • While there was a trend for improvement and
    better outcomes for the Collaborative group,
    there was appreciable variability and the pattern
    of results varied over time
  • These differences were associated with the Tool
    Kit group participating in fewer educational
    opportunities and making less use of Tool Kit
    elements than the Collaborative group.
  • The Collaborative group paid greater attention to
    the methodological seminars and measurement
    tools.
  • Once sites engaged in these resources they found
    the information and tools useful and sustained
    their use.
  • The Collaborative group used more improvement
    strategies and more complete implementation of
    BSI and VAP evidence-based interventions.

27
Conclusions
  • Real world studies bring to the surface the
    variation across hospitals and ICU settings.
    Whereas clinical, methodological, and informatics
    tools (Tool Kits) offer standardized core
    support, the solutions and approaches for tool,
    quality improvement, and patient safety
    implementation remain context dependent. A
    Collaborative seems to provide a social network
    that reinforces personal effort despite
    resistance and workload pressures, shares and
    facilitates problem solving, and fosters
    accountability for behavioral change in such a
    way that the participant can tailor it all to
    their home organization.
  • Our preliminary results support the ability of a
    participatory collaborative and support tools to
    decrease the incidence of catheter-related blood
    stream infections and ventilator-associated
    pneumonia in a diverse population of ICUs.
About PowerShow.com