1
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Sultan M, Zewdie A, Priyadarshani D, Hassen E, Tilahun M, Geremew T, Beane A, Haniffa R, Berenholtz SM, Checkley W, Hansoti B, Laytin AD. Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement. J Crit Care 2024; 81:154525. [PMID: 38237203 PMCID: PMC10996997 DOI: 10.1016/j.jcrc.2024.154525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia. MATERIALS AND METHODS A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality. RESULTS Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%). CONCLUSIONS In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.
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Affiliation(s)
- Menbeu Sultan
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia; Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Ephrem Hassen
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Melkamu Tilahun
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Tigist Geremew
- Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Sean M Berenholtz
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA.
| | - William Checkley
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
| | - Adam D Laytin
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
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2
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Klompas M, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1540-1554. [PMID: 37606298 PMCID: PMC10587377 DOI: 10.1017/ice.2023.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Deborah S. Yokoe
- University of California San Francisco School of Medicine, UCSF Health-UCSF Medical Center, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- Norton Healthcare, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michael Klompas
- Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Healthcare, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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3
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Deloney VM, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1533-1539. [PMID: 37855077 PMCID: PMC10587365 DOI: 10.1017/ice.2023.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 10/20/2023]
Abstract
Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
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Affiliation(s)
- Deborah S. Yokoe
- School of Medicine, UCSF Health-UCSF Medical Center, University of California, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- University of Louisville School of Medicine, Norton HealthcareLouisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Valerie M. Deloney
- Society for Healthcare Epidemiology of America, Arlington, Virginia, United States
| | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Health Care, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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4
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Stierman EK, O'Brien BT, Stagg J, Ouk E, Alon N, Engineer LD, Fabiyi CA, Liu TM, Chew E, Benishek LE, Harding B, Terhorst RG, Latif A, Berenholtz SM, Mistry KB, Creanga AA. Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas. Qual Manag Health Care 2023; 32:177-188. [PMID: 36913770 PMCID: PMC10290572 DOI: 10.1097/qmh.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas. METHODS In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation. RESULTS Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001). CONCLUSIONS Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.
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Affiliation(s)
- Elizabeth K Stierman
- Departments of International Health (Drs Stierman and Creanga) and Health Policy and Management (Drs Engineer and Berenholtz), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Oklahoma Perinatal Quality Improvement Collaborative, Oklahoma City, (Mss O'Brien and Ouk); The University of Oklahoma Health Sciences Center, Oklahoma City (Mss O'Brien and Ouk); Community Health Improvement Division, Texas Department of State Health Services, Austin (Ms Stagg); Alliance for Innovation on Maternal Health, American College of Obstetricians and Gynecologists, Washington, District of Columbia (Ms Alon); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs Engineer, Benishek, Latif, and Berenholtz, Ms Liu, and Mr Terhorst); Departments of Anesthesiology and Critical Care Medicine (Drs Engineer, Benishek, Latif, and Berenholtz) and Gynecology and Obstetrics (Dr Creanga), Johns Hopkins School of Medicine, Baltimore, Maryland; and Agency for Healthcare Research and Quality, Rockville, Maryland (Drs Fabiyi and Mistry and Mss Chew and Harding)
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5
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Arabi YM, Al Aseri Z, Alsaawi A, Al Khathaami AM, Al Qasim E, Alzahrani AA, Al Qarni M, Abdukahil SAI, Al-Dorzi HM, Alattasi A, Mandourah Y, Alaama TY, Alabdulaali MK, Alqahtani A, Shuaibi A, Al Qarni A, Alkatheri M, Al Hazme RH, Vishwakarma RK, Aldibasi O, Alshahrani MS, Attia A, Alharthy A, Mady A, Abdelrahman BA, Mhawish HA, Abdallah HA, Al-Hameed F, Alghamdi K, Alghamdi A, Almekhlafi GA, Qasim SAH, Al Haji HA, Al Mutairi M, Tashkandi N, Alabbasi SO, Al Shehri T, Moftah E, Kalantan B, Matroud A, Naidu B, Al Zayer S, Burrows V, Said Z, Soomro NA, Yousef MH, Fattouh AA, Tahoon MA, Muhammad M, Alruwili AM, Al Hanafi HA, Dandekar PB, Ibrahim K, AlHomsi M, Al Harbi AR, Saleem A, Masih E, Al Rashidi NM, Amanatullah AK, Al Mubarak J, Al Radwan AAA, Al Hassan A, Al Muoalad S, Alzahrani AA, Chalabi J, Qureshi A, Al Ansari M, Sallam H, Elhazmi A, Alkhaldi F, Malibary A, Ababtain A, Latif A, Berenholtz SM. Impact of a national collaborative project to improve the care of mechanically ventilated patients. PLoS One 2023; 18:e0280744. [PMID: 36716310 PMCID: PMC9886257 DOI: 10.1371/journal.pone.0280744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).
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Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- * E-mail:
| | - Zohair Al Aseri
- Department of Emergency, Department of Intensive Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmohsen Alsaawi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali M. Al Khathaami
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A. Alzahrani
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Qarni
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheryl Ann I. Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaleem Alattasi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- Department of Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Tareef Y. Alaama
- Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Abdulrahman Alqahtani
- Executive Director of Medical Affairs Department, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmad Shuaibi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Ali Al Qarni
- Department of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mufareh Alkatheri
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed H. Al Hazme
- Department of Health Informatics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biomedical Informatics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Ramesh Kumar Vishwakarma
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Omar Aldibasi
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Saeed Alshahrani
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Ashraf Attia
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | | | - Ahmed Mady
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Anesthesiology and Intensive Care, Tanta University Hospital, Tanta, Egypt
| | | | - Huda Ahmad Mhawish
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Al-Hameed
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Adnan Alghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb A. Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saleh Abdorabo Haider Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Ali Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nabiha Tashkandi
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shatha Othman Alabbasi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tariq Al Shehri
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad Moftah
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basim Kalantan
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Matroud
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Brintha Naidu
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salha Al Zayer
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Victoria Burrows
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zayneb Said
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | - Majdi Muhammad
- Department of Intensive Care, Gurayat General Hospital, AlGurayat, Saudi Arabia
| | | | | | | | - Kamel Ibrahim
- Department of Intensive Care, King Khalid General Hospital, Majmaah, Saudi Arabia
| | - Mwafaq AlHomsi
- Department of Intensive Care, Buraydah Central Hospital, AlQassim, Saudi Arabia
| | - Asma Rayan Al Harbi
- Department of Intensive Care, King Fahad Specialist Hospital, AlQassim, Saudi Arabia
| | - Adel Saleem
- Department of Intensive Care, King Faisal Hospital, Makkah, Saudi Arabia
| | - Ejaz Masih
- Department of Intensive Care, King Khaled Hospital, Tabuk, Saudi Arabia
| | | | | | - Jaffar Al Mubarak
- Respiratory Services, King Khalid General Hospital, Hafer Al Batin, Saudi Arabia
| | | | - Ali Al Hassan
- Department of Intensive Care, King Khalid Hospital, Najran, Saudi Arabia
| | - Sadiyah Al Muoalad
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ammar Abdullah Alzahrani
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Ahmad Qureshi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia
| | - Maryam Al Ansari
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Hend Sallam
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fawziah Alkhaldi
- Nursing Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrauf Malibary
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Ababtain
- Respiratory Services, Royal Commission Health Services Program, Jubayl, Saudi Arabia
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sean M. Berenholtz
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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6
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Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:687-713. [PMID: 35589091 PMCID: PMC10903147 DOI: 10.1017/ice.2022.88] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Branson
- Department of Surgery, University of Cincinnati Medicine, Cincinnati, Ohio
| | - Kelly Cawcutt
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda R Greene
- Highland Hospital, University of Rochester, Rochester, New York
| | - Grace Lee
- Stanford University School of Medicine, Palo Alto, California
| | - Lisa L Maragakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory P Priebe
- Department of Anesthesiology, Critical Care and Pain Medicine; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Kathleen Speck
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah S Yokoe
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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7
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Sick-Samuels AC, Linz M, Bergmann J, Fackler JC, Berenholtz SM, Ralston SL, Hoops K, Dwyer J, Colantuoni E, Milstone AM. Diagnostic Stewardship of Endotracheal Aspirate Cultures in a PICU. Pediatrics 2021; 147:peds.2020-1634. [PMID: 33827937 PMCID: PMC8086005 DOI: 10.1542/peds.2020-1634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinicians commonly obtain endotracheal aspirate cultures (EACs) in the evaluation of suspected ventilator-associated infections. However, bacterial growth in EACs does not distinguish bacterial colonization from infection and may lead to overtreatment with antibiotics. We describe the development and impact of a clinical decision support algorithm to standardize the use of EACs from ventilated PICU patients. METHODS We monitored EAC use using a statistical process control chart. We compared the rate of EACs using Poisson regression and a quasi-experimental interrupted time series model and assessed clinical outcomes 1 year before and after introduction of the algorithm. RESULTS In the preintervention year, there were 557 EACs over 5092 ventilator days; after introduction of the algorithm, there were 234 EACs over 3654 ventilator days (an incident rate of 10.9 vs 6.5 per 100 ventilator days). There was a 41% decrease in the monthly rate of EACs (incidence rate ratio [IRR]: 0.59; 95% confidence interval [CI] 0.51-0.67; P < .001). The interrupted time series model revealed a preexisting 2% decline in the monthly culture rate (IRR: 0.98; 95% CI 0.97-1.0; P = .01), immediate 44% drop (IRR: 0.56; 95% CI 0.45-0.70; P = .02), and stable rate in the postintervention year (IRR: 1.03; 95% CI 0.99-1.07; P = .09). In-hospital mortality, hospital length of stay, 7-day readmissions, and All Patients Refined Diagnosis Related Group severity and mortality scores were stable. The estimated direct cost savings was $26 000 per year. CONCLUSIONS A clinical decision support algorithm standardizing EAC obtainment from ventilated PICU patients was associated with a sustained decline in the rate of EACs, without changes in mortality, readmissions, or length of stay.
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Affiliation(s)
- Anna C. Sick-Samuels
- Departments of Pediatrics and,Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
| | - Matthew Linz
- New Jersey Medical School, Rutgers University, Newark, New Jersey; and
| | - Jules Bergmann
- Anesthesiology and Critical Care Medicine, School of Medicine, and
| | - James C. Fackler
- Anesthesiology and Critical Care Medicine, School of Medicine, and
| | - Sean M. Berenholtz
- Anesthesiology and Critical Care Medicine, School of Medicine, and,Departments of Health Policy and Management and,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Katherine Hoops
- Anesthesiology and Critical Care Medicine, School of Medicine, and
| | - Joe Dwyer
- Extra-Corporeal Membrane Oxygenation Services, Division of Respiratory Care, Departments of Pediatrics and
| | - Elizabeth Colantuoni
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Aaron M. Milstone
- Departments of Pediatrics and,Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
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8
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Arabi YM, Al Aseri Z, Alaama T, Alqahtani A, Alharthy A, Almotairi A, Al Qasim E, Alzahrani AA, Al Qarni M, Abdukahil SAI, Al-Hameed FM, Mandourah Y, Maghrabi K, Ghamdi A, Almekhalfi G, Mady A, Qureshi AS, Qushmaq I, Alshahrani MS, Alkatheri M, Saawi A, AlHazme RH, Berenholtz SM, Latif A, Al-Moamary MS, Mohrij S. National Approach to Standardize and Improve Mechanical Ventilation. Ann Thorac Med 2019; 14:101-105. [PMID: 31007760 PMCID: PMC6467017 DOI: 10.4103/atm.atm_63_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and 27 cities. The leadership support in all health sectors for NASAM speaks of the commitment to improve the care of mechanically ventilated patients across the kingdom.
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Affiliation(s)
- Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, Medical City, King Saud University, Adult Intensive Care Development Program Ministry of Health, Riyadh, Saudi Arabia
| | - Tareef Alaama
- Deputyship of Curative Services, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alqahtani
- National Emergency Medicine Development Program, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah Almotairi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah A Alzahrani
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Al Qarni
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sheryl Ann I Abdukahil
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad M Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Madinah, Saudi Arabia
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Adnan Ghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb Almekhalfi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Mady
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed S Qureshi
- Prince Mohammed Bin Abdul Aziz Hospital, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, Medical and Clinical Affairs, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University (M.S.A.), Dammam, Saudi Arabia
| | - Mufareh Alkatheri
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulmohsen Saawi
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raed H AlHazme
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean M Berenholtz
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mohamed S Al-Moamary
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Development and Quality Management, Medical Services King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saad Mohrij
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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9
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Lee J, Austin JM, Kim J, Miralles PD, Kaafarani HMA, Pronovost PJ, Ghimire V, Berenholtz SM, Donelan K, Martinez E. Developing and Testing a Chart Abstraction Tool for ICU Quality Measurement. Am J Med Qual 2018; 34:324-330. [PMID: 30264579 DOI: 10.1177/1062860618800596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Quality measures are increasingly used to measure the performance of providers, hospitals, and health care systems. Intensive care units (ICUs) are an important clinical area in hospitals, given that they generate high costs and present high risks to patients. Yet, currently, few valid and clinically significant ICU-specific outcome measures are reported nationally. This study reports on the creation and evaluation of new abstraction tools that evaluate ICU patients for the following clinically important outcomes: central line-associated bloodstream infection, methicillin-resistant Staphylococcus aureus, gastrointestinal bleed, and pressure ulcer. To allow ICUs and institutions to compare their outcomes, the tools include risk-adjustment variables that can be abstracted from the chart.
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Affiliation(s)
- Jarone Lee
- 1 Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Jungyeon Kim
- 3 Harvard University School of Public Health, Boston, MA
| | | | | | | | | | | | - Karen Donelan
- 1 Massachusetts General Hospital/Harvard Medical School, Boston, MA
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10
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Edrees HH, Ismail MNM, Kelly B, Goeschel CA, Berenholtz SM, Pronovost PJ, Al Obaidli AAK, Weaver SJ. Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates. Int J Qual Health Care 2018; 29:948-960. [PMID: 29186417 DOI: 10.1093/intqhc/mzx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. Results A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. Conclusions Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.
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Affiliation(s)
- Hanan H Edrees
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,National Guard Health Affairs, Quality and Patient Safety/King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohd Nasir Mohd Ismail
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
| | - Bernadette Kelly
- SEHA (Abu Dhabi Health Services Company), Das Tower, Sultan Bin Zayed St, Abu Dhabi, UAE
| | - Christine A Goeschel
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA.,Medstar Health, 3007 Tilden St NW, Washington, DC 20008, USA
| | - Sean M Berenholtz
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Peter J Pronovost
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 624 N. Broadway, Baltimore, MD 21205, USA.,Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA.,Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | | | - Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, Baltimore, MD 21202, USA
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11
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Allegranzi B, Aiken AM, Zeynep Kubilay N, Nthumba P, Barasa J, Okumu G, Mugarura R, Elobu A, Jombwe J, Maimbo M, Musowoya J, Gayet-Ageron A, Berenholtz SM. A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study. Lancet Infect Dis 2018. [PMID: 29519766 DOI: 10.1016/s1473-3099(18)30107-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa. METHODS We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders. FINDINGS Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8·0% (95% CI 6·8-9·5; n=129) to 3·8% (3·0-4·8; n=70; p<0·0001), and this decrease persisted in the sustainability period (3·9%, 2·8-5·4; n=35). A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods. The likelihood of SSI during follow-up was significantly lower than pre-intervention (odds ratio [OR] 0·40, 95% CI 0·29-0·54; p<0·0001), but the likelihood of death was not significantly reduced (0·72, 0·42-1·24; p=0·2360). INTERPRETATION Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes. FUNDING US Agency for Healthcare Research and Quality, WHO.
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Affiliation(s)
- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, World Health Organization, Geneva, Switzerland.
| | | | - Nejla Zeynep Kubilay
- Infection Prevention and Control Global Unit, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | - Angèle Gayet-Ageron
- Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sean M Berenholtz
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Pronovost PJ, Weaver SJ, Berenholtz SM, Lubomski LH, Maragakis LL, Marsteller JA, Pham JC, Sawyer MD, Thompson DA, Weeks K, Rosen MA. Reducing preventable harm: observations on minimizing bloodstream infections. J Health Organ Manag 2017; 31:2-9. [PMID: 28260406 DOI: 10.1108/jhom-10-2016-0197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms. Design/methodology/approach An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA. Findings The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions. Practical implications This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms. Originality/value Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.
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Affiliation(s)
- Peter J Pronovost
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.,Department of Surgery, Johns Hopkins University , Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA
| | - Sally J Weaver
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA
| | - Sean M Berenholtz
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.,Department of Surgery, Johns Hopkins University , Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA
| | - Lisa H Lubomski
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA
| | - Lisa L Maragakis
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University , Baltimore, Maryland, USA
| | - Jill A Marsteller
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA
| | - Julius Cuong Pham
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.,Queens Medical Center, Honolulu, Hawaii, USA
| | - Melinda D Sawyer
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - David A Thompson
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.,Johns Hopkins School of Nursing, Division of Acute and Chronic Care, Johns Hopkins University , Baltimore, Maryland, USA
| | - Kristina Weeks
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA
| | - Michael A Rosen
- Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA
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13
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Rawat N, Yang T, Ali KJ, Catanzaro M, Cohen MD, Farley DO, Lubomski LH, Thompson DA, Winters BD, Cosgrove SE, Klompas M, Speck KA, Berenholtz SM. Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events. Crit Care Med 2017; 45:1208-1215. [PMID: 28448318 DOI: 10.1097/ccm.0000000000002463] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Ventilator-associated events are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the National Institute of Health and Agency for Healthcare Research and Quality funded a two-state collaborative to reduce ventilator-associated events. We describe the collaborative's impact on ventilator-associated event rates in 56 ICUs. DESIGN Longitudinal quasi-experimental study. SETTING Fifty-six ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. INTERVENTIONS We organized a multifaceted intervention to improve adherence with evidence-based practices, unit teamwork, and safety culture. Evidence-based interventions promoted by the collaborative included head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care, and daily spontaneous awakening and breathing trials. Each unit established a multidisciplinary quality improvement team. We coached teams to establish comprehensive unit-based safety programs through monthly teleconferences. Data were collected on rounds using a common tool and entered into a Web-based portal. MEASUREMENTS AND RESULTS ICUs reported 69,417 ventilated patient-days of intervention compliance observations and 1,022 unit-months of ventilator-associated event data. Compliance with all evidence-based interventions improved over the course of the collaborative. The quarterly mean ventilator-associated event rate significantly decreased from 7.34 to 4.58 cases per 1,000 ventilator-days after 24 months of implementation (p = 0.007). During the same time period, infection-related ventilator-associated complication and possible and probable ventilator-associated pneumonia rates decreased from 3.15 to 1.56 and 1.41 to 0.31 cases per 1,000 ventilator-days (p = 0.018, p = 0.012), respectively. CONCLUSIONS A multifaceted intervention was associated with improved compliance with evidence-based interventions and decreases in ventilator-associated event, infection-related ventilator-associated complication, and probable ventilator-associated pneumonia. Our study is the largest to date affirming that best practices can prevent ventilator-associated events.
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Affiliation(s)
- Nishi Rawat
- 1Armstrong Institute, Johns Hopkins School of Medicine, Baltimore, MD.2Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.3The Hospital and Healthsystem Association of Pennsylvania, Harrisburg, PA.4Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.5Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.6Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.7Department of Medicine, Brigham and Women's Hospital, Boston, MA.8Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Khan RM, Aljuaid M, Aqeel H, Aboudeif MM, Elatwey S, Shehab R, Mandourah Y, Maghrabi K, Hawa H, Khalid I, Qushmaq I, Latif A, Chang B, Berenholtz SM, Tayar S, Al-Harbi K, Yousef A, Amr AA, Arabi YM. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units. Ann Thorac Med 2017; 12:11-16. [PMID: 28197216 PMCID: PMC5264166 DOI: 10.4103/1817-1737.197765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.
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Affiliation(s)
- Raymond M Khan
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Aljuaid
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hanan Aqeel
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed M Aboudeif
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Shaimaa Elatwey
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Rajeh Shehab
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Yasser Mandourah
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Intensive Care, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hassan Hawa
- Department of Intensive Care, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Imran Khalid
- Department of Medicine, Section of Critical Care Medicine, King Faisal Hospital and Research Center- Gen Org., Jeddah, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, Section of Critical Care Medicine, King Faisal Hospital and Research Center- Gen Org., Jeddah, Saudi Arabia
| | - Asad Latif
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Bickey Chang
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sean M Berenholtz
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sultan Tayar
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khloud Al-Harbi
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amin Yousef
- Department of Intensive Care, Al-Emam Abdulrahman Al-Faisal Hospital, Riyadh, Saudi Arabia
| | - Anas A Amr
- Department of Intensive Care, Al-Emam Abdulrahman Al-Faisal Hospital, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Ali KJ, Farley DO, Speck K, Catanzaro M, Wicker KG, Berenholtz SM. Measurement of implementation components and contextual factors in a two-state healthcare quality initiative to reduce ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2016; 35 Suppl 3:S116-23. [PMID: 25222890 DOI: 10.1086/677832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention of ventilator-associated pneumonia (VAP) in a two-state collaborative, including data on actions implemented by participating teams and contextual factors that may influence their efforts. Using the data collected, learn how implementation actions can be improved and analyze effects of implementation progress on outcome measures. DESIGN We developed the tool as an interview protocol that included quantitative and qualitative items addressing actions on the Comprehensive Unit-based Safety Program (CUSP) and clinical interventions for use in guiding data collection via telephone interviews. SETTING We conducted interviews with leaders of improvement teams from units participating in the two-state VAP prevention initiative. METHODS We collected data from 43 hospital units as they implemented actions for the VAP initiative and performed descriptive analyzes of the data with comparisons across the 2 states. RESULTS Early in the VAP prevention initiative, most units had made only moderate progress overall in using many of the CUSP actions known to support their improvement processes. For contextual factors, a relatively small number of barriers were found to have important negative effects on implementation progress (in particular, barriers related to workload and time issues). We modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified. CONCLUSION These assessments provided important new knowledge regarding the implementation science of quality improvement projects, including feedback during implementation, and give a better understanding of which factors most affect implementation.
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Affiliation(s)
- Kisha Jezel Ali
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
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16
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Berenholtz SM, Lubomski LH, Weeks K, Goeschel CA, Marsteller JA, Pham JC, Sawyer MD, Thompson DA, Winters BD, Cosgrove SE, Yang T, Louis TA, Lucas BM, George CT, Watson SR, Albert-Lesher MI, Andre JRS, Combes JR, Bohr D, Hines SC, Battles JB, Pronovost PJ. Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative. Infect Control Hosp Epidemiol 2016; 35:56-62. [DOI: 10.1086/674384] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.Methods.We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.Results.A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.Conclusion.Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
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Septimus E, Yokoe DS, Weinstein RA, Perl TM, Maragakis LL, Berenholtz SM. Maintaining the Momentum of Change: The Role of the 2014 Updates to the Compendium in Preventing Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2016; 35:460-3. [DOI: 10.1086/675820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Preventing healthcare-associated infections (HAIs) is a national priority. Although substantial progress has been achieved, considerable deficiencies remain in our ability to efficiently and effectively translate existing knowledge about HAI prevention into reliable, sustainable, widespread practice. “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates” is the product of a highly collaborative endeavor designed to support hospitals' efforts to implement and sustain HAI prevention strategies.
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Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35:915-36. [DOI: 10.1086/677144] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates "Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Pronovost PJ, Holzmueller CG, Callender T, Demski R, Winner L, Day R, Austin JM, Berenholtz SM, Miller MR. Sustaining Reliability on Accountability Measures at The Johns Hopkins Hospital. Jt Comm J Qual Patient Saf 2016; 42:51-60. [DOI: 10.1016/s1553-7250(16)42006-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pronovost PJ, Holzmueller CG, Molello NE, Paine L, Winner L, Marsteller JA, Berenholtz SM, Aboumatar HJ, Demski R, Armstrong CM. The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice. Acad Med 2015; 90:1331-1339. [PMID: 25993278 DOI: 10.1097/acm.0000000000000760] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.
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Affiliation(s)
- Peter J Pronovost
- P.J. Pronovost is senior vice president of quality and safety, Johns Hopkins Medicine; director, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine; and professor, Departments of Anesthesiology and Critical Care Medicine and Surgery, School of Medicine; professor, Department of Health Policy and Management, Bloomberg School of Public Health; and professor, School of Nursing and Carey Business School, Johns Hopkins University, Baltimore, Maryland.C.G. Holzmueller is senior medical writer and editor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and senior research program coordinator II, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.N.E. Molello is administrator, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.L. Paine is director of patient safety, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Johns Hopkins University School of Medicine, Baltimore, Maryland.L. Winner is director of Lean Sigma deployment, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.J.A. Marsteller is associate professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.S.M. Berenholtz is professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Departments of Anesthesiology and Critical Care Medicine and Surgery, School of Medicine, and Department of Health Policy and Management, School of Public Health, Johns Hopkins University, Baltimore, Maryland.H.J. Aboumatar is assistant professor, Department of Medicine, Johns Hopkins University School of Medicine, and Armstron
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Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, Gerding DN, Haas JP, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle LE, Salgado CD, Bryant K, Classen D, Crist K, Deloney VM, Fishman NO, Foster N, Goldmann DA, Humphreys E, Jernigan JA, Padberg J, Perl TM, Podgorny K, Septimus EJ, VanAmringe M, Weaver T, Weinstein RA, Wise R, Maragakis LL. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2015; 35:967-77. [PMID: 25026611 DOI: 10.1086/677216] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).
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Affiliation(s)
- Deborah S Yokoe
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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22
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Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson K, Gerding DN, Haas J, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Salgado C, Bryant K, Classen D, Crist K, Foster N, Humphreys E, Padberg J, Podgorny K, VanAmringe M, Weaver T, Wise R, Maragakis LL. Introduction to "A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates". Infect Control Hosp Epidemiol 2015; 35 Suppl 2:S1-5. [PMID: 25264563 DOI: 10.1086/678903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).
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Pronovost PJ, Armstrong CM, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Yang T, Peterson RR, Reitz JA, Bennett RG, Broccolino VA, Davis RO, Gragnolati BA, Green GE, Rothman PB. Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins Medicine. Acad Med 2015; 90:165-172. [PMID: 25517699 DOI: 10.1097/acm.0000000000000610] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning.
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Affiliation(s)
- Peter J Pronovost
- Dr. Pronovost is senior vice president of quality and safety, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, and professor, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, School of Nursing and Carey Business School, Johns Hopkins University, Baltimore, Maryland. Mr. Armstrong is chairman, Johns Hopkins Medicine Patient Safety and Quality Board Committee, and, until October 2013, was chairman, Johns Hopkins Medicine Board of Trustees, Baltimore, Maryland. Ms. Demski is vice president of quality improvement, Armstrong Institute for Patient Safety and Quality and Johns Hopkins Health System, Baltimore, Maryland. Ms. Callender is senior quality and innovation coach, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Ms. Winner is director of Lean Sigma deployment, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Miller is Johns Hopkins Medicine chief quality officer for pediatrics, vice chair of quality and safety, and professor, Department of Pediatrics, Johns Hopkins University, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. Dr. Austin is assistant professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Dr. Berenholtz is professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Departments of Anesthesiology and Critical Care Medicine, Surgery, and School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Dr. Yang is senior biostatistician, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
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Klompas M, Berenholtz SM. Oral hygiene with chlorhexidine in critically ill patients—reply. JAMA Intern Med 2015; 175:316-7. [PMID: 25642677 DOI: 10.1001/jamainternmed.2014.7020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Klompas
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts2Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland4Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland5Department of Health Policy and Managemen
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Pronovost PJ, Watson SR, Goeschel CA, Hyzy RC, Berenholtz SM. Sustaining Reductions in Central Line-Associated Bloodstream Infections in Michigan Intensive Care Units: A 10-Year Analysis. Am J Med Qual 2015; 31:197-202. [PMID: 25609646 DOI: 10.1177/1062860614568647] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article describes the interventions that sustained low central line-associated bloodstream infection (CLABSI) rates in the Michigan Keystone ICU Project. This analysis included data from March 2004 to December 2013 for 121 intensive care units (ICUs) in 73 hospitals. The Keystone Project was a cohort collaborative with an improvement team in each ICU. During the sustainability period, teams integrated the intervention into staff orientation, collected and submitted monthly data, and reported infection rates to leaders. The annual mean rate of BSIs dropped from 2.5 infections/1000 catheter-days in 2004 to 0.76 in 2013. A subset analysis found nearly double the percentage of ICUs with a mean rate of <1 infection/1000 catheter-days in 2013 compared with baseline. Active involvement of hospital leaders and the Keystone Center as well as ongoing monitoring and feedback of performance were important in sustaining results. These findings suggest that large-scale improvement projects can be sustained, establishing a new normal for care.
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Affiliation(s)
- Peter J Pronovost
- Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sam R Watson
- Michigan Health and Hospital Association Keystone Center, Lansing, MI
| | - Christine A Goeschel
- Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert C Hyzy
- University of Michigan Medical School, Ann Arbor, MI
| | - Sean M Berenholtz
- Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD
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Berenholtz SM, Pham JC, Thompson DA, Needham DM, Lubomski LH, Hyzy RC, Welsh R, Cosgrove SE, Sexton JB, Colantuoni E, Watson SR, Goeschel CA, Pronovost PJ. Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 32:305-14. [DOI: 10.1086/658938] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective.To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.Design.Collaborative cohort before-after study.Setting.Intensive care units (ICUs) predominantly in Michigan.Interventions.We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.Results.One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16–18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41–0.64) at 16–18 months after implementation and 0.29 (95% confidence interval, 0.24–0.34) at 28–30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16–18 months after implementation (P < .001) and 84% at 28–30 months after implementation (P < .001).Conclusions.A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.
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Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson K, Gerding DN, Haas J, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Salgado C, Bryant K, Classen D, Crist K, Foster N, Humphreys E, Padberg J, Podgorny K, Vanamringe M, Weaver T, Wise R, Maragakis LL. Introduction to "A Compendium of Strategies To Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 updates". Infect Control Hosp Epidemiol 2014; 35:455-9. [PMID: 24709713 DOI: 10.1086/675819] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).
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Affiliation(s)
- Deborah S Yokoe
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Septimus E, Yokoe DS, Weinstein RA, Perl TM, Maragakis LL, Berenholtz SM. Maintaining the momentum of change: the role of the 2014 updates to the compendium in preventing healthcare-associated infections. Infect Control Hosp Epidemiol 2014; 35 Suppl 2:S6-S9. [PMID: 25376063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Preventing healthcare-associated infections (HAIs) is a national priority. Although substantial progress has been achieved, considerable deficiencies remain in our ability to efficiently and effectively translate existing knowledge about HAI prevention into reliable, sustainable, widespread practice. "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates" is the product of a highly collaborative endeavor designed to support hospitals' efforts to implement and sustain HAI prevention strategies.
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Goutier JM, Holzmueller CG, Edwards KC, Klompas M, Speck K, Berenholtz SM. Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a systematic literature review. Infect Control Hosp Epidemiol 2014; 35:998-1005. [PMID: 25026616 DOI: 10.1086/677152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is among the most lethal of all healthcare-associated infections. Guidelines summarize interventions to prevent VAP, but translating recommendations into practice is an art unto itself. OBJECTIVE Summarize strategies to enhance adoption of VAP prevention interventions. METHODS We conducted a systematic literature review of articles in the MEDLINE database published between 2002 and 2012. We selected articles on the basis of specific inclusion criteria. We used structured forms to abstract implementation strategies and inserted them into the "engage, educate, execute, and evaluate" framework. RESULTS Twenty-seven articles met our inclusion criteria. Engagement strategies included multidisciplinary teamwork, involvement of local champions, and networking among peers. Educational strategies included training sessions and developing succinct summaries of the evidence. Execution strategies included standardization of care processes and building redundancies into routine care. Evaluation strategies included measuring performance and providing feedback to staff. CONCLUSION We summarized and organized practical implementation strategies in a framework to enhance adoption of recommended evidence-based practices. We believe this work fills an important void in most clinical practice guidelines, and broad use of these strategies may expedite VAP reduction efforts.
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Affiliation(s)
- Jente M Goutier
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Murphy DJ, Pronovost PJ, Lehmann CU, Gurses AP, Whitman GJR, Needham DM, Berenholtz SM. Red blood cell transfusion practices in two surgical intensive care units: a mixed methods assessment of barriers to evidence-based practice. Transfusion 2014; 54:2658-67. [PMID: 24846447 DOI: 10.1111/trf.12718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/04/2014] [Accepted: 04/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite evidence supporting restrictive red blood cell (RBC) transfusion thresholds and the associated clinical practice guidelines, clinical practice has been slow to change in the intensive care unit (ICU). Our aim was to identify barriers to conservative transfusion practice adherence. STUDY DESIGN AND METHODS A mixed-methods study involving observation of prescriber (i.e., physicians, physician assistants, nurse practitioners) and bedside nurse daily bedside rounds, provider survey, and medical record abstraction was conducted in one cardiac surgical ICU (CSICU) and one surgical ICU (SICU) in an academic hospital in Baltimore, Maryland. RESULTS Of 52 patient encounters observed during bedside rounds, 38 (73%) involved patients without evidence of active bleeding or cardiac ischemia. Surveys were completed by 52 (93%) of the 56 providers participating in rounds. Prescribers in the CSICU and SICU (87 and 90%, respectively) indicated the ideal pretransfusion hemoglobin (Hb) to be not more than 7 g/dL in nonbleeding and/or nonischemic patients compared to a minority of nurses (8% [p = 0.002] and 42% [p = 0.015], respectively). Prescribers and nurses in both ICUs overestimated the typical pretransfusion Hb in their units (CSICU, p < 0.001; SICU, p = 0.019). During rounds, providers infrequently explicitly discussed Hb monitoring or transfusion thresholds (33%) despite most (60%) reporting significant variation in transfusion thresholds between individual prescribers. CONCLUSIONS Our study identified several provider and system barriers to evidence-based transfusion practices including knowledge differences, overly optimistic estimates of current practice, and heterogeneous transfusion practice in each ICU. Further work is necessary to develop targeted interventions to improve evidence-based RBC transfusion practices.
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Affiliation(s)
- David J Murphy
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, Georgia
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Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 2014; 174:751-61. [PMID: 24663255 DOI: 10.1001/jamainternmed.2014.359] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Regular oral care with chlorhexidine gluconate is standard of care for patients receiving mechanical ventilation in most hospitals. This policy is predicated on meta-analyses suggesting decreased risk of ventilator-associated pneumonia, but these meta-analyses may be misleading because of lack of distinction between cardiac surgery and non-cardiac surgery studies, conflation of open-label vs double-blind investigations, and insufficient emphasis on patient-centered outcomes such as duration of mechanical ventilation, length of stay, and mortality. OBJECTIVE To evaluate the impact of routine oral care with chlorhexidine on patient-centered outcomes in patients receiving mechanical ventilation. DATA SOURCES PubMed, Embase, CINAHL, and Web of Science from inception until July 2013 without limits on date or language. STUDY SELECTION Randomized clinical trials comparing chlorhexidine vs placebo in adults receiving mechanical ventilation. Of 171 unique citations, 16 studies including 3630 patients met inclusion criteria. DATA EXTRACTION AND SYNTHESIS Eligible trials were independently identified, evaluated for risk of bias, and extracted by 2 investigators. Differences were resolved by consensus. We stratified studies into cardiac surgery vs non-cardiac surgery and open-label vs double-blind investigations. Eligible studies were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Ventilator-associated pneumonia, mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay, antibiotic prescribing. RESULTS There were fewer lower respiratory tract infections in cardiac surgery patients randomized to chlorhexidine (relative risk [RR], 0.56 [95% CI, 0.41-0.77]) but no significant difference in ventilator-associated pneumonia risk in double-blind studies of non-cardiac surgery patients (RR, 0.88 [95% CI, 0.66-1.16]). There was no significant mortality difference between chlorhexidine and placebo in cardiac surgery studies (RR, 0.88 [95% CI, 0.25-2.14]) and nonsignificantly increased mortality in non-cardiac surgery studies (RR, 1.13 [95% CI, 0.99-1.29]). There were no significant differences in mean duration of mechanical ventilation or intensive care length of stay. Data on hospital length of stay and antibiotic prescribing were limited. CONCLUSIONS AND RELEVANCE Routine oral care with chlorhexidine prevents nosocomial pneumonia in cardiac surgery patients but may not decrease ventilator-associated pneumonia risk in non-cardiac surgery patients. Chlorhexidine use does not affect patient-centered outcomes in either population. Policies encouraging routine oral care with chlorhexidine for non-cardiac surgery patients merit reevaluation.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts2Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathleen Speck
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael D Howell
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Linda R Greene
- Highland Hospital, University of Rochester Medical Center Affiliate, Rochester, New York
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland6Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland7Department of Health Policy and Management, B
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Pronovost PJ, Demski R, Callender T, Winner L, Miller MR, Austin JM, Berenholtz SM, Abundo C, Allen S, Applestein M, Atha W, Baca K, Baker D, Baxter J, Bessman E, Brinkman M, Brown J, Brown T, Bryant B, Carmody B, Carroll K, Carver B, Castellani J, Choi YH, Clarke C, Coker M, Cuccia M, Dalgetty R, Day R, DelRosario A, Deruggiero K, Duda D, Dudas R, Dunn J, Duquaine D, Dwyer J, Edwards A, Flowers D, Garger C, Goldsborough K, Groman S, Guzman F, Hack L, Hackett M, Hagan L, Haynos J, Heck E, Heitmiller G, Hill P, Hoffman A, Horvath K, Jensen R, Johnson P, Jonas I, Kelly K, Kemmerer T, Khan S, Landrum M, Leonard B, Lieberman K, Lobien J, Maritim C, Markovich G, Marquis B, McClammer B, McDonough D, McGuiness B, McIntyre J, McQuigg D, Means M, Michaels K, Miller J, Minor V, Morton R, Moyer J, Nimako H, Owens S, Park E, Peck J, Petrucci P, Petty B, Post M, Rasmussen S, Raynor J, Renjel J, Resar J, Rossi S, Rotello L, Russell S, Saheed M, Schultz J, Schwartz P, Servis K, Shrout A, Sidone L, Smith N, Smith R, Smith T, Martin ES, Taffe E, Thomas C, Tolson T, Trost J, Walters C, Ware C, Wessels R, Whitman G, Wyman C. Demonstrating High Reliability on Accountability Measures at The Johns Hopkins Hospital. Jt Comm J Qual Patient Saf 2013; 39:531-44. [DOI: 10.1016/s1553-7250(13)39069-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Arabi YM, Taher S, Berenholtz SM, Alamry A, Hijazi R, Alatassi A, Marini AM. Building capacity for quality and safety in critical care: A roundtable discussion from the second international patient safety conference in April 9-11, 2013, Riyadh, Saudi Arabia. Ann Thorac Med 2013; 8:183-5. [PMID: 24250730 PMCID: PMC3821276 DOI: 10.4103/1817-1737.118480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/10/2022] Open
Abstract
This paper summarizes the roundtable discussion from the Second International Patient Safety Conference held in April 9-11, 2013, Riyadh, Saudi Arabia. The objectives of the roundtable discussion were to: (1) review the conceptual framework for building capacity in quality and safety in critical care. (2) examine examples of leading international experiences in building capacity. (3) review the experience in Saudi Arabia in this area. (4) discuss the role of building capacity in simulation for patient safety in critical care and (5) review the experience in building capacity in an ongoing improvement project for severe sepsis and septic shock.
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Affiliation(s)
- Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia ; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences Riyadh, Kingdom of Saudi Arabia
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Hong AL, Sawyer MD, Shore A, Winters BD, Masuga M, Lee H, Mathews SC, Weeks K, Goeschel CA, Berenholtz SM, Pronovost PJ, Lubomski LH. Decreasing Central-Line–Associated Bloodstream Infections in Connecticut Intensive Care Units. J Healthc Qual 2013; 35:78-87. [DOI: 10.1111/j.1945-1474.2012.00210.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Martinez EA, Donelan K, Henneman JP, Berenholtz SM, Miralles PD, Krug AE, Iezzoni LI, Charnin JE, Pronovost PJ. Identifying meaningful outcome measures for the intensive care unit. Am J Med Qual 2013; 29:144-52. [PMID: 23892372 DOI: 10.1177/1062860613491823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time. To a large extent, ICU outcome measures deemed valid, important, and preventable by clinicians are unavailable, and abstracting clinical data from the medical record is excessively burdensome. Even if a set of outcomes garnered consensus, ensuring adequate risk adjustment to facilitate fair comparisons across institutions presents another challenge. This study reports on a consensus process to build 5 outcome measures for broad use to evaluate the quality of ICU care and inform quality improvement efforts.
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Sexton JD, Pennebaker JW, Holzmueller CG, Wu AW, Berenholtz SM, Swoboda SM, Pronovost PJ, Sexton JB. Care for the caregiver: benefits of expressive writing for nurses in the United States. Progress in Palliative Care 2013. [DOI: 10.1179/096992609x12455871937620] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Matar DS, Pham JC, Louis TA, Berenholtz SM. Achieving and sustaining ventilator-associated pneumonia-free time among intensive care units (ICUs): evidence from the Keystone ICU Quality Improvement Collaborative. Infect Control Hosp Epidemiol 2013; 34:740-3. [PMID: 23739079 DOI: 10.1086/670989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative demonstrated that adult ICUs could achieve and sustain a zero rate of ventilator-associated pneumonia (VAP) for a considerable number of ventilator and calendar months. Moreover, the results highlight the importance of adjustment for ventilator-days before comparing VAP-free time among ICUs.
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Affiliation(s)
- Dany S Matar
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Bixenstine PJ, Zarbo RJ, Holzmueller CG, Yenokyan G, Robinson R, Hudson DW, Prescott AM, Hubble R, Murphy MM, George CT, D’Angelo R, Watson SR, Lubomski LH, Berenholtz SM. Developing and Pilot Testing Practical Measures of Preanalytic Surgical Specimen Identification Defects. Am J Med Qual 2013; 28:308-14. [DOI: 10.1177/1062860612469824] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Ron Hubble
- The Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
| | - Mary M. Murphy
- The Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
| | - Chris T. George
- The Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
| | | | - Sam R. Watson
- The Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
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Bundy DG, Marsteller JA, Wu AW, Engineer LD, Berenholtz SM, Caughey AH, Silver D, Tian J, Thompson RE, Miller MR, Lehmann CU. Electronic health record-based monitoring of primary care patients at risk of medication-related toxicity. Jt Comm J Qual Patient Saf 2012; 38:216-23. [PMID: 22649861 DOI: 10.1016/s1553-7250(12)38027-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Timely laboratory monitoring may reduce the potential harm associated with chronic medication use. A study was conducted to determine the proportion of patients receiving National Committee for Quality Assurance (NCQA)-recommended laboratory medication monitoring in a primary care setting and to assess the effect of electronic health record (EHR)-derived, paper-based, provider-specific feedback bulletins on subsequent patient receipt of medication monitoring. METHODS In a single-arm, pre-post intervention in two federally qualified community health centers in Baltimore, patients targeted were adults prescribed at least 6 months (in the preceding year) for at least one index medication (digoxin, statins, diuretics, angiotensin-converting enzyme inhibitors/ angiotensin II-receptor blockers) in a 12-month period (August 2008-July 2009). RESULTS Among the 2,013 patients for whom medication monitoring was recommended, 42% were overdue for monitoring at some point during the study. As the number of index medications the patient was prescribed increased, the likelihood of ever being overdue for monitoring decreased. Being listed on the provider-specific monitoring bulletin doubled the odds of a patient receiving recommended laboratory monitoring before the next measurement period (1-2 months). Limiting the intervention to the most overdue patients, however, mitigated its overall impact. CONCLUSIONS Recommended laboratory monitoring of chronic medications appears to be inconsistent in primary care, resulting in potential harm for individuals at risk for medication-related toxicity. EHRs may be an important component of systems designed to improve medication monitoring, but multimodal interventions will likely be needed to achieve high reliability.
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Affiliation(s)
- David G Bundy
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
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Munoz M, Pronovost P, Dintzis J, Kemmerer T, Wang NY, Chang YT, Efird L, Berenholtz SM, Golden SH. Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice. Jt Comm J Qual Patient Saf 2012; 38:195-206. [PMID: 22649859 DOI: 10.1016/s1553-7250(12)38025-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. CONCEPTUAL MODEL COMPONENTS: The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staffwhile incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. OUTCOMES Overall the average patient-day-weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. CONCLUSION Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.
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Affiliation(s)
- Miguel Munoz
- Johns Hopkins University School of Medicine, Baltimore, USA
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Bandari J, Schumacher K, Simon M, Cameron D, Goeschel CA, Holzmueller CG, Makary MA, Welsh RJ, Berenholtz SM. Surfacing safety hazards using standardized operating room briefings and debriefings at a large regional medical center. Jt Comm J Qual Patient Saf 2012; 38:154-60. [PMID: 22533127 DOI: 10.1016/s1553-7250(12)38020-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Briefings and debriefings, previously shown to be a practical and feasible strategy to improve interdisciplinary communication and teamwork in the operating room (OR), was then assessed as a strategy to prospectively surface clinical and operational defects in surgical care--and thereby prevent patient harm. METHODS A one-page, double-sided briefing and debriefing tool was used by surgical teams during cases at the William Beaumont Hospital Royal Oak (Royal Oak, Michigan) campus to surface clinical and operational defects during the study period (October 2006-May 2010). Defects were coded into six categories (with each category stratified by briefing or debriefing period) during the first six months, and refinement of coding resulted in expansion to 16 defect categories and no further stratification. A provider survey was used in January 2008 to interview a sample of 40 caregivers regarding the perceived effectiveness of the tool in surfacing defects. FINDINGS The teams identified a total of 6,202 defects--an average of 141 defects per month--during the entire study period. Of 2,760 defects identified during the six-defect coding period, 1,265 (46%) surfaced during briefings, and the remaining 1,495 (54%) during debriefings. Equipment (48%) and communication (31%) issues were most prominent. Of 3,442 defects identified during the 16-defect coding period, the most common were Central Processing Department (CPD) instrumentation (22%) and Communication/Safety (15%). Overall, 70 (87%) of the 80 responses were in agreement that briefings were effective for surfacing defects, as were 59 (76%) of the 78 responses for debriefings. CONCLUSIONS Briefings and debriefings were a practical and effective strategy to surface potential surgical defects in the operating rooms of a large medical center.
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Affiliation(s)
- Jathin Bandari
- Johns Hopkins University School of Medicine, Baltimore, USA
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Mayer RS, Streiff MB, Hobson DB, Halpert DE, Berenholtz SM. Evidence-based venous thromboembolism prophylaxis is associated with a six-fold decrease in numbers of symptomatic venous thromboembolisms in rehabilitation inpatients. PM R 2012; 3:1111-1115.e1. [PMID: 22192320 DOI: 10.1016/j.pmrj.2011.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 06/04/2011] [Accepted: 07/01/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To measure the impact of a standardized risk assessment tool and specialty-specific, risk-adjusted venous thromboembolism (VTE) order sets on compliance with American College of Chest Physicians (ACCP) guidelines and the number of symptomatic VTE as assessed by administrative data. DESIGN Prospective cohort study. SETTING Academic hospital inpatient rehabilitation unit. PATIENTS AND PARTICIPANTS All patients on the rehabilitation unit. METHODS AND INTERVENTIONS Assessment of VTE risk factors and evaluated admission VTE prophylaxis orders before and after implementation of an ACCP guideline-based, specialty-specific VTE risk assessment, and prophylaxis order set by using a standardized data collection form. MAIN OUTCOME MEASURES Discharge diagnostic codes for VTE and pulmonary embolism were tracked by ICD-9 (International Classification of Diseases, 9th edition) discharge diagnosis codes for the 12 months before and 36 months after the intervention. RESULTS Before implementation of the VTE order set, 27% of patients received VTE prophylaxis in compliance with the 2004 ACCP VTE guidelines. By following implementation of specialty-specific, risk-adjusted VTE order sets, compliance increased to 98%. In the year before VTE order-set implementation, the number of VTEs per admission was 49 per 1000. By following implementation, the number of VTEs steadily decreased each year to 8 per 1000 in 2007 (χ(2) = 14.985; P = .0001). CONCLUSIONS Implementation of a standardized VTE risk assessment tool and prophylaxis order set resulted in a substantial improvement in compliance with ACCP guidelines for VTE prophylaxis and was associated with a 6-fold reduction in the number of symptomatic VTEs in a hospital-based rehabilitation unit.
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Affiliation(s)
- R Samuel Mayer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21208, USA.
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Schwengel DA, Winters BD, Berkow LC, Mark L, Heitmiller ES, Berenholtz SM. A novel approach to implementation of quality and safety programmes in anaesthesiology. Best Pract Res Clin Anaesthesiol 2012; 25:557-67. [PMID: 22099921 DOI: 10.1016/j.bpa.2011.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/10/2011] [Indexed: 11/26/2022]
Abstract
Far too many patients suffer preventable harm from medical errors that add to needless suffering and cost of care. Underdeveloped residency training programmes in patient safety are a major contributor to preventable harm. Consequently, the Institute of Medicine has called for health professionals to reform their educational programmes to advance health-care safety and quality. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) now requires education in 'systems-based practice' and 'practice-based learning and improvement' as core competencies of residency training programmes. The specific aim of this article is to describe the implementation of a novel programme designed to enhance residency education, meet ACGME core competencies and improve quality and safety education in one residency programme at an academic medical institution.
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Affiliation(s)
- Deborah A Schwengel
- Department of Anesthesiology, Critical Care and Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA.
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Duval-Arnould J, Mathews SC, Weeks K, Colantuoni E, Mukherjee A, Nundy S, Watson SR, Holzmueller CG, Lubomski LH, Goeschel CA, Pronovost PJ, Pham JC, Berenholtz SM. Using the Opportunity Estimator Tool to Improve Engagement in a Quality and Safety Intervention. Jt Comm J Qual Patient Saf 2012; 38:41-7, 1. [DOI: 10.1016/s1553-7250(12)38006-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Waters HR, Korn R, Colantuoni E, Berenholtz SM, Goeschel CA, Needham DM, Pham JC, Lipitz-Snyderman A, Watson SR, Posa P, Pronovost PJ. The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs. Am J Med Qual 2011; 26:333-9. [PMID: 21856956 DOI: 10.1177/1062860611410685] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care-associated infections affect an estimated 5% of hospitalized patients and represent one of the leading causes of illness and death in the United States. This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is $3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from $12 208 to $56 167 per infection episode. These results do not take into account the additional effect of the Michigan Keystone program in terms of reducing cases of sepsis or its effects in terms of preventing mortality, improving teamwork, and reducing nurse turnover.
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Affiliation(s)
- Hugh R Waters
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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46
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Lin DM, Weeks K, Bauer L, Combes JR, George CT, Goeschel CA, Lubomski LH, Mathews SC, Sawyer MD, Thompson DA, Watson SR, Winters BD, Marsteller JA, Berenholtz SM, Pronovost PJ, Pham JC. Eradicating Central Line–Associated Bloodstream Infections Statewide. Am J Med Qual 2011; 27:124-9. [DOI: 10.1177/1062860611414299] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Della M. Lin
- Hawaii Medical Services Association, Honolulu, HI
| | - Kristina Weeks
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura Bauer
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - John R. Combes
- American Hospital Association, Center for Healthcare Governance, Chicago, IL
| | - Christine T. George
- Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
| | - Christine A. Goeschel
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - David A. Thompson
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Sam R. Watson
- Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, MI
| | | | | | - Sean M. Berenholtz
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter J. Pronovost
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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47
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Lipitz-Snyderman A, Needham DM, Colantuoni E, Goeschel CA, Marsteller JA, Thompson DA, Berenholtz SM, Lubomski LH, Watson S, Pronovost PJ. The ability of intensive care units to maintain zero central line-associated bloodstream infections. ACTA ACUST UNITED AC 2011; 171:856-8. [PMID: 21555666 DOI: 10.1001/archinternmed.2011.161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Allison Lipitz-Snyderman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21231, USA.
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Abstract
As the stakes grow for evaluating the quality of health care delivery, so too should greater attention be paid to the integrity of the design, conduct, and inferences made from QI projects. QI projects that seek to make inferences, especially public inferences, about the impact of an intervention to improve quality of care should be rigorously designed and evaluated, and limitations and potential biases transparently reported to understand how they may affect the conclusions suggested by the project. Our patients deserve nothing less.
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Affiliation(s)
- Sean M Berenholtz
- Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Quality & Safety Research Group, Baltimore, USA.
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Pronovost PJ, Cardo DM, Goeschel CA, Berenholtz SM, Saint S, Jernigan JA. A research framework for reducing preventable patient harm. Clin Infect Dis 2011; 52:507-13. [PMID: 21258104 DOI: 10.1093/cid/ciq172] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Programs to reduce central line-associated bloodstream infections (CLABSIs) have improved the safety of hospitalized patients. Efforts are underway to disseminate these successes broadly to reduce other types of hospital-acquired infectious and noninfectious preventable harms. Unfortunately, the ability to broadly measure and prevent other types of preventable harms, especially infectious harms, needs enhancement. Moreover, an overarching research framework for creating and integrating evidence will help expedite the development of national prevention programs. This article outlines a 5-phase translational (T) framework to develop robust research programs that reduce preventable harm, as follows: phase T0, discover opportunities and approaches to prevent adverse health care events; phase T1, use T0 discoveries to develop and test interventions on a small scale; phase T2, broaden and strengthen the evidence base for promising interventions to develop evidence-based guidelines; phase T3, translate guidelines into clinical practice; and phase T4, implement and evaluate T3 work on a national and international scale. Policy makers should use this framework to fill in the knowledge gaps, coordinate efforts among federal agencies, and prioritize research funding.
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Affiliation(s)
- Peter J Pronovost
- Department of Anesthesiology and Critical Care, School of Medicine, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA.
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Abstract
Board accountability for quality and patient safety is widely accepted but the science for how to measure it is immature, and differences between measuring performance, identifying hazards, and monitoring progress are often misunderstood. Hospital leaders often provide scorecards to assist boards with their oversight role yet, in the absence of national standards, little evidence exists regarding which measures are valid and useful to boards to assess quality improvement. The authors describe results of a cross-sectional board study, identifying the measures used to monitor quality. The measures varied widely and many were of uncertain validity, generally identifying hazards rather than measuring rates. This article identifies some important policy implications regarding boards' oversight of quality and acknowledges existing limits to how we can measure quality and safety progress on the national or hospital level. If boards and their hospitals are to monitor progress in improving quality, they need more valid outcome measures.
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