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Article first published online: 10 FEB 2011
Copyright © 2011 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 6, Issue 5, pages 271–278, May/June 2011
How to Cite
Speroff, T., Ely, E. W., Greevy, R., Weinger, M. B., Talbot, T. R., Wall, R. J., Deshpande, J. K., France, D. J., Nwosu, S., Burgess, H., Englebright, J., Williams, M. V. and Dittus, R. S. (2011), Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches. J. Hosp. Med., 6: 271–278. doi: 10.1002/jhm.873
This project was supported by Partnerships in Implementing Patient Safety (PIPS) from the Agency for Healthcare Research and Quality (AHRQ) Grant Award Number: U18 HS015934.
Trial Registration: Clinicaltrials.gov, registration number NCT 00975923.
Role of the Sponsor: The Agency for Healthcare Research and Quality had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Disclosure: Nothing to report.
- Issue published online: 2 JUN 2011
- Article first published online: 10 FEB 2011
- Manuscript Accepted: 15 OCT 2010
- Manuscript Revised: 14 OCT 2010
- Manuscript Received: 8 JUN 2010
- patient safety;
- quality improvement;
- central line–associated bloodstream infection;
- ventilator-associated pneumonia
Collaborative and toolkit approaches have gained traction for improving quality in health care.
To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line–associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs).
DESIGN AND SETTING:
Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007.
CLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement.
A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty-six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80).
The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve. © Society of Hospital Medicine Journal of Hospital Medicine 2011