The evolution of knowledge exchanges enabling successful practice change in two intensive care units
Pavani Rangachari1, Michael Madaio, R Karl Rethemeyer
1Pavani Rangachari, PhD, is Associate Professor and MPH Program Director, Department of Health Management and Informatics, Georgia Regents University, Augusta. E-mail: prangachari@gru.edu. Michael Madaio, MD, is Professor of Medicine and Chair, Department of Medicine, Medical College of Georgia, Georgia Regents University, Augusta. E-mail: mmadaio@gru.edu. R. Karl Rethemeyer, PhD, is Associate Dean and Chair, Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York. E-mail: kretheme@albany.edu. Peggy Wagner, PhD, is Clinical Professor and Director, Institute for Advancement of Healthcare, School of Medicine-Greenville, University of South Carolina. E-mail: pwagner@ghs.org. Lauren Hall, MPH, is Graduate Research Assistant, Department of Health Management and Informatics, Georgia Regents University, Augusta. E-mail: lauhall@gru.edu. Siddharth Roy, MPH, is Graduate Research Assistant, Department of Health Management and Informatics, Georgia Regents University, Augusta. E-mail: s.roy5@gmail.com. Peter Rissing, MD, is Professor of Medicine and Section Chief (Infectious Diseases), Department of Medicine, Medical College of Georgia, Georgia Regents University, Augusta.
Implementing the central line bundle (CLB) effectively reduces catheter-related bloodstream infections (CRBSIs). This study shows that proactive communication and identifying change champions are key to successful practice change in hospitals.
Area of Science:
- Healthcare Management
- Organizational Change
- Infection Prevention
Background:
- Hospitals struggle with consistent implementation of evidence-based practices, such as the central line bundle (CLB).
- Failure to implement practices like CLB contributes to catheter-related bloodstream infections (CRBSIs).
- Understanding how to facilitate practice change at the unit level is crucial for healthcare organizations.
Purpose of the Study:
- To investigate mechanisms by which top-down communications foster practice change in healthcare units.
- To identify evidence-based management strategies for successful unit-level practice change.
- To address gaps in understanding how communication influences learning and change in healthcare.
Main Methods:
- A 52-week prospective study in two intensive care units with low CLB adherence.
- Implementation of periodic top-down quality improvement communications to promote CLB.
- Weekly "communication logs" and chart reviews to assess communication patterns and CLB adherence.
Main Results:
- Both units showed significant improvements in CLB adherence and reductions in CRBSIs and catheter days.
- A statistically significant increase in proactive communication between physicians and nurses was observed.
- Emergence of "champions" within units who initiated process improvements was noted.
Conclusions:
- Top-down communication and fostering change champions are effective strategies for practice change.
- Screening for and enabling "champions" within units is vital for successful implementation.
- Evidence-based management strategies can improve adherence to practices like the CLB.
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