• J Hosp Med · May 2011

    Randomized Controlled Trial Multicenter Study Comparative Study

    Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches.

    • Theodore Speroff, E Wes Ely, Robert Greevy, Matthew B Weinger, Thomas R Talbot, Richard J Wall, Jayant K Deshpande, Daniel J France, Sam Nwosu, Hayley Burgess, Jane Englebright, Mark V Williams, and Robert S Dittus.
    • Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA. ted.speroff@vanderbilt.edu
    • J Hosp Med. 2011 May 1; 6 (5): 271-8.

    BackgroundCollaborative and toolkit approaches have gained traction for improving quality in health care.ObjectiveTo determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs).Design And SettingCluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007.MeasurementCLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement.ResultsA total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty-six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80).ConclusionThe intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve.Copyright © 2011 Society of Hospital Medicine.

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