Benefit of TeamSTEPPS Rounding Improvement Project on Infection-Related Monitoring

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was developed to improve teamwork and patient safety. It was shown to benefit patient care in complex clinical settings including intensive care units (ICUs). Our two trauma/surgical ICUs received TeamSTEPPS training, but only Unit 1 participated in a TeamSTEPPS Rounding Improvement Project (TRIP). Our goal was to assess any unintended benefit to infection-related monitoring and prevention from TRIP. We hypothesized that TRIP implementation in ICUs would be associated with increased monitoring, resulting in improved antibiotic and invasive catheter/tube stewardship.

From September through November 2014, observers prospectively collected data on rounds in both units. Unit personnel were blinded to the data collection process. Monitoring parameters obtained for each patient encounter included review of invasive catheter/tube presence and review of antibiotic indication and course. For patients who received antibiotic and had invasive catheter/tube, we conducted a retrospective review for treatment parameters such as antibiotic duration and adherence to treatment plan, inappropriate antibiotics duration, and invasive catheter/tube duration.

A total of 416 patient encounters were observed. The use of invasive catheter/tube was reviewed on rounds substantially more in Unit 1 than Unit 2 (83% vs. 51%, p < 0.005). In the 135 encounters with patients on antibiotic, review of antibiotic indication, stop date, day into course, and all three components occurred substantially more in Unit 1. On the basis of the 65 different antibiotic courses encompassed by the 135 encounters, antibiotic duration, adherence to antibiotic treatment plan, and inappropriate antibiotic days were not substantially different between the units. From the same 135 encounters, 125 encounters also had invasive catheter/tube placement. Substantially more discussion of catheter/tube presence occurred in Unit 1, but the duration of its presence was not substantially different.

The TeamSTEPPS Rounding Improvement Project was associated with an unintended, increased discussion and monitoring of antibiotic and invasive catheter/tube usage. However, this did not translate into substantial immediate treatment differences.