Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches§

Authors

  • Theodore Speroff PhD,

    Corresponding author
    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
    3. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
    4. Center for Perioperative Research in Quality, Vanderbilt University School of Medicine, Nashville, Tennessee
    5. Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee
    • Department of Medicine, Center for Health Services Research, 6000 Medical Center East, Vanderbilt University School of Medicine, Nashville, TN 37232
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    • Telephone: 615-636-9476; Fax: 615-873-7981

  • E. Wes Ely MD, MPH,

    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
    3. Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
    4. Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Robert Greevy PhD,

    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Matthew B. Weinger MD, MS,

    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
    3. Departments of Biomedical Informatics and Medical Information, Vanderbilt University School of Medicine, Nashville, Tennessee
    4. Center for Perioperative Research in Quality, Vanderbilt University School of Medicine, Nashville, Tennessee
    5. Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Thomas R. Talbot MD, MPH,

    1. Division of Infectious Diseases, Departments of Medicine and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Richard J. Wall MD, MPH,

    1. Pulmonary, Critical Care and Sleep Disorders Medicine, Southlake Clinic, Valley Medical Center, Renton, Washington
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  • Jayant K. Deshpande MD, MPH,

    1. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
    2. Division of Pediatric Critical Care, Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Daniel J. France PhD, MPH,

    1. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
    2. Center for Perioperative Research in Quality, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Sam Nwosu MS,

    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • Hayley Burgess PharmD, BCPP,

    1. Department of Quality, Safety, and Performance Improvement, Hospital Corporation of America Inc. (HCA), Nashville, Tennessee
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  • Jane Englebright RN, PhD,

    1. Department of Quality, Safety, and Performance Improvement, Hospital Corporation of America Inc. (HCA), Nashville, Tennessee
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  • Mark V. Williams MD, FHM, FACP,

    1. Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Robert S. Dittus MD, MPH

    1. Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
    2. Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
    3. Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee
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  • 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.

Abstract

BACKGROUND:

Collaborative and toolkit approaches have gained traction for improving quality in health care.

OBJECTIVE:

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.

MEASUREMENT:

CLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement.

RESULTS:

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).

CONCLUSION:

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

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