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Safe Critical Care Project: Testing Improvement Strategies

 

A Tool Kit Site in collaboration with Partnerships for Implementing Patient Safety (PIPS) -- A Project funded by the Agency for Healthcare Research and Quality

 

HCA and Vanderbilt University are collaborating on a project comparing the effectiveness of two approaches to implementing evidence-based medicine practices in Critical Care.

 

Project Aims

  1. Implement a campaign for Improving Critical Care (bloodstream infections and ventilator-associated pneumonia) as part of the IHI (Institute for Healthcare Improvement) 100,000 Lives Campaign.
  2. Develop toolkits for reducing bloodstream infections and ventilator-associated pneumonia.
  3. Conduct a randomized controlled trial to compare the effectiveness of a Collaborative versus Campaign and Toolkit strategy for implementing an improvement initiative.
  4. Examine the organizational and provider factors that contribute toward and enable successful performance improvement.

Team

HCA:

Hayley Burgess, PharmD, Director of Medication Safety and Use

Jane Englebright, PhD, RN, Vice President, Quality

Susan Littleton, Project Manager

Mark Williams, MD, Professfor of Medicine, Executive Medical Director, EHCA, Emory Healthcare

Jonathan Perlin, MD, PhD, MSHA, FACP, HCA Chief Medical Officer and Senior Vice President, Quality, Safety and Performance Improvement

Patsy McFadden, RN, CIC, Infection Control, Centennial Medical Center

Joan Reischel, RN, ICU Manager, Medical Center of Aurora

Sherri Tejedor, MD, Cartersville Medical Center

Laurie Brewer, RN, Supply Chain Director

Steve Mok, PharmD, Clinical Pharmacist, Centennial Medical Center

Steve Horner, RN, AVP, Outcomes Measurement

 

Vanderbilt:

Ted Speroff, PhD, Director of the VA Tennessee Valley Healthcare System Health Services Research Center for Patient Healthcare Behavior

Robert Dittus, MD MPH, Director of the Vanderbilt Center for Health Services Research

Jay Deshpande, MD MPH, Professor of Anesthesiology and Pediatrics

Wes Ely, MD MPH , Associate Professor of Medicine

Tom Talbot, MD MPH, Assistant Professor of Medicine and Preventive Medicine, Associate Hospital Epidemiologist

Matt Weinger, MD, Director of the Vanderbilt Center for Patient Safety

Dan France, PhD, MPH, Assistant Director for Improving Patient Safety

Robert Alan Greevy, Jr, PhD, Assistant Professor, Department of Biostatistics

 

University of Washington, Seattle, Washington

Richard Wall, MD MPH, Senior Research Fellow in Pulmonary and Crirtical Care

 

Education:

 

The following education programs were delivered across all HCA facilities as webcasts to watch live or to view later as a recording.  Each program was or will be transferred to an on-line learning program on HealthStream.com and available nationally.  The PowerPoint presentations are available for viewing. 

 

Prevention of Catheter-Related Bloodstream Infections (November 2005)

Prevention of Ventilator-Associated Pneumonia - Part 1 (March 2006)

Prevention of Ventilator-Associated Pneumonia - Part 2 (May 2006)

Sedation and Delirium: Monitoring and Management (October 2006)
Prevention of Ventilator Associated Pneumonia (April 2007)
Central Venous Catheter Insertion and Maintenance (April 2007)

 

 

 

Inventories (Surveys):

 

ICU Overview Survey: Distributed July 2005 to all HCA facilities to provide a description of current critical care practices in HCA hospitals and ICU involvement in quality improvement.

 

Infection Control Surveillance Survey: Distributed December 2005 to all HCA facilities to collect information about hospital ICU infection control measurement, reporting and practices.

 

Safety Attitude Survey: Distributed May 2006 to the participants of the Safe Critical Care Project to assess the perceived patient safety climate within intensive care units.  The SAQ and Safety Climate Scale by Sexton, Thomas, Provonost et al. are published instruments validated for the ICU.

 

Sedation and Delirium Survey: Distributed October 2006 to all HCA facilities to assess current practices that will help the field of critical care identify steps for improving ICU sedation and delirium care.

Paper Checklists:

 

To ensure our staff is equipped with the essential evidenced based medicine process, we provided paper checklists as an intervention tool and to assist teams in monitoring IHI bundled processes of care. 

Statistical Process Control:

 

Spreadsheet templates are provided to collect and display process and outcomes data for central-line catheter related blood stream infections and ventilator associated pneumonia.  These templates are pre-programmed for easy minimal data entry and charting of control charts for quality improvement.  The shared documents include the Excel files and the power point tutorial.

 

Tools:

 

Surveillance Guides

 

How to Collect and Monitor Bloodstream Infection Rates

How to Collect and Monitor Ventilator-Associated Pneumonia Rates

 

Quality Improvement

 

These worksheets are templates for initiating a Quality Improvement Team and maintaining the continuous action plans of a Quality Improvement Team.

 

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