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Published on: July 13, 2019
The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and
Vera A DePalo1, Lynn McNicoll, Margaret Cornell
1Department of Internal Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island 02860, USA. Vera_DePalo@brown.edu
Background:
Implementing bundles of best practices has been shown to provide patients with recommended care and reduce medical errors. Rhode Island's (RI) hospital leaders, quality organisations and insurers discussed the results of a quality improvement initiative in Michigan, the Keystone project, and explored the possibility of replicating these results statewide in RI.
Design:
Hospital executives and intensive care unit (ICU) staff, RI's quality organisations, RI Quality Institute, Quality Partners of RI, and Hospital Association of RI and consultants from Johns Hopkins University, worked together to implement evidence-based interventions and change safety culture in RI's ICUs.
Objectives:
The authors describe the RI ICU Collaborative, funded by insurers and hospitals, and report on statewide central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates between 1 January 2006 and 30 June 2008.
Subjects:
All adult ICU patients in RI.
Measures:
CLABSI and VAP rates.
Results:
100% of 23 ICUs in 11 hospitals participated in the RI ICU Collaborative. The statewide mean CLABSI rate decreased 74% from 3.73 (median 1.95) infections per 1000 catheter days to 0.97 (median 0) in quarter (Q) 2 (March-June) 2008 (p = 0.0032). The VAP rate fell 15% from 3.44 (median 0.58) to 2.92 VAPs (median 0) per 1000 ventilator days in Q2, 2008.
Conclusion:
The RI ICU Collaborative, a statewide quality improvement initiative, served as the platform by which multifaceted interventions were associated with reductions in CLABSI and VAP rates, and an increase in the use of evidence-based interventions. Completing Phase II, the RI ICU Collaborative continues to sustain these statewide reductions.
Insights
Rhode Island
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Infectious Disease Prevention
Background:
- Bundles of best practices improve patient care and reduce medical errors.
- Rhode Island (RI) leaders aimed to replicate the successful Keystone project statewide.
- Focus on implementing evidence-based interventions and enhancing safety culture in ICUs.
Purpose of the Study:
- Describe the RI ICU Collaborative, a statewide quality improvement initiative.
- Report on central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates.
- Evaluate the impact of multifaceted interventions on infection rates.
Main Methods:
- Collaboration between hospital executives, ICU staff, quality organizations, and consultants.
- Implementation of evidence-based interventions across all adult ICUs in RI.
- Monitoring of CLABSI and VAP rates from January 2006 to June 2008.
Main Results:
- 100% participation from 23 ICUs in 11 hospitals.
- Statewide CLABSI rates decreased by 74% (p = 0.0032).
- Statewide VAP rates decreased by 15%.
Conclusions:
- The RI ICU Collaborative effectively reduced CLABSI and VAP rates.
- Multifaceted interventions and a focus on safety culture were key.
- The initiative demonstrated sustained statewide reductions in infections.
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