An intensive care unit quality improvement collaborative in nine department of veterans affairs hospitals: Reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates

Robert S. Bonello, Carol E. Fletcher, William K. Becker, Kay L. Clutter, Shelley L. Arjes, Jennifer J. Cook, Robert A. Petzel

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Background: Measured adherence to evidence-based best practice in the intensive care unit (ICU) setting, as in all of health care, remains unacceptably low. In 2005 to 2006, the VA Midwest Health Care Network used a quality improvement collaborative (QIC) model to improve adherence with ICU best practices in widely varying ICU and hospital settings in nine Department of Veterans Affairs (VA) hospitals. Methods: Interdisciplinary performance improvement teams at each of the participating sites implemented evidence-based ventilator and central line insertion bundles, interdisciplinary team rounds, and use of a daily patient ICU bedside checklist. Results: Adherence with all five elements of the ventilator bundle improved from 50% in the first three months to 82% in the final three months of the intervention. Mean ventilator-associated pneumonia (VAP) rates decreased by 41% over the same time frame. Use of a central line insertion checklist to monitor adherence with the central line bundle increased from 58% in the first three months to 74% in the final three months of the intervention. Mean catheter-related bloodstream infection (CRBSI) rates decreased by 48% over the same time frame. Following completion of the collaborative, eight of the nine sites continued to report on adherence with the ventilator and central line bundles, the practice of interdisciplinary team rounds, and the use of an ICU patient checklist. The incidence of VAP and CRBSI in these eight sites declined in the 12-month period following the collaboratives completion, compared with the previous 12-month period. Discussion: Implementing the ventilator and central line bundles was associated with a reduction in rates of VAPs and CRBSIs.

Original languageEnglish (US)
Pages (from-to)639-645
Number of pages7
JournalJoint Commission Journal on Quality and Patient Safety
Volume34
Issue number11
DOIs
StatePublished - Nov 2008

Bibliographical note

Funding Information:
The work for this study was performed at the following sites: VA Midwest Health Care Network: Minneapolis VA Medical Center, Minneapolis; Fargo VA Medical Center, Fargo, North Dakota; Central Iowa VA Medical Center, Des Moines, Iowa; Iowa City VA Medical Center, Iowa City, Iowa; Omaha VA Medical Center, Omaha; Sioux Falls VA Medical Center, Sioux Falls, South Dakota; Fort Meade VA Medical Center, Fort Meade, South Dakota; Hot Springs VA Medical Center, Hot Springs, South Dakota; and Loma Linda VA Medical Center, Loma Linda, California. Financial support for this study was provided by the VA Midwest Health Care Network as a 2005–2006 Network quality improvement strategic priority.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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