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Cumulative impact of periodic top-down communications on infection prevention practices and outcomes in two 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. 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. Peggy Wagner, PhD, is Clinical Professor and Director, Institute for Advancement of Healthcare, School of Medicine-Greenville, University of South Carolina. Lauren Hall, MPH, is Graduate Research Assistant, Department of Health Management and Informatics, Georgia Regents University, Augusta. Siddharth Roy, MPH, is Graduate Research Assistant, Department of Health Management and Informatics, Georgia Regents University, Augusta. Peter Rissing, MD, is Professor of Medicine and Section Chief, Infectious Diseases, Department of Medicine, Medical College of Georgia, Georgia Regents University, Augusta.
Background:
The problem of interest in this study is the challenge of consistent implementation of evidence-based infection prevention practices at the unit level, a challenge broadly characterized as "change implementation failure." The theoretical literature suggests that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Our study sought to both validate the theoretical literature and address this gap.
Purpose:
Correspondingly, this study posed two research questions. (1) What is the impact of periodic "top-down" communications on practice change at the unit level? (2) What are the "unit-level" communication dynamics enabling practice changes? Whereas this article focuses on addressing the first question, the second question has been addressed in an earlier Health Care Management Review article (Rangachari et al., 2013).
Methods:
A prospective study was conducted in two intensive care units at an academic health center. Both units had low baseline adherence to central line bundle (CLB) and higher-than-expected catheter-related bloodstream infections (CRBSIs). Periodic top-down communication interventions were conducted over 52 weeks to promote CLB adherence in both units. Simultaneously, the study examined (a) unit-level communication dynamics related to CLB through weekly "communication logs," completed by unit physicians, nurses, and managers, and (b) unit outcomes, that is, CLB adherence and CRBSI rates.
Findings:
Both units showed increased adherence to CLB and significant, sustained declines in CRBSIs. Results showed that the interventions cumulatively had a significant negative (desired) impact on "catheter days," that is, central catheter use.
Practice Implications:
Results help validate the theoretical literature and identify evidence-based management strategies for practice change at the unit level. They suggest that periodic top-down communications have the potential to modify interprofessional knowledge exchanges and enable practice change at the unit level, leading to significantly improved outcomes and reduced costs.
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