Saint Sanjay, Fowler Karen E, Sermak Kelley, Gaies Elissa, Harrod Molly, Holland Penny, Bradley Suzanne F, Hancock J Brian, Krein Sarah L
Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Hospital Outcomes Program of Excellence (HOPE) Initiative, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Hospital Outcomes Program of Excellence (HOPE) Initiative, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
Am J Infect Control. 2015 Mar 1;43(3):254-9. doi: 10.1016/j.ajic.2014.11.016.
Endemic health care-associated safety problems, including health care-associated infection, account for substantial morbidity and mortality. We outline a regional No Preventable Harms campaign to reduce these safety problems and describe the initial results from the first initiative focusing on catheter-associated urinary tract infection (CAUTI) prevention.
We formed a think tank composed of multidisciplinary experts from within a 7-hospital Midwestern Veterans Affairs network to identify hospital-acquired conditions that had strong evidence on how to prevent the harm and outcome data that could be easily collected to evaluate improvement efforts. The first initiative of this campaign focused on CAUTI prevention. Quantitative data on CAUTI rates and qualitative data from site visit interviews were used to evaluate the initiative.
Quantitative data showed a significant reduction in CAUTI rates per 1,000 catheter days for nonintensive care units across the region (2.4 preinitiative and 0.8 postinitiative; P = .001), but no improvement in the intensive care unit rate (1.4 preinitiative and 2.1 postinitiative; P = .16). Themes that emerged from our qualitative data highlight the need for considering local context and the importance of communication when developing and implementing regional initiatives.
A regional collaborative can be a valuable strategy for addressing important endemic patient safety problems.
包括医疗保健相关感染在内的地方性医疗保健相关安全问题导致了大量的发病和死亡。我们概述了一项旨在减少这些安全问题的区域性“无可预防伤害”运动,并描述了首个专注于预防导管相关尿路感染(CAUTI)的倡议的初步结果。
我们组建了一个由来自中西部一个拥有7家医院的退伍军人事务网络的多学科专家组成的智囊团,以确定有确凿证据表明如何预防伤害的医院获得性疾病,以及可以轻松收集以评估改进工作的结果数据。该运动的首个倡议聚焦于CAUTI预防。使用CAUTI发生率的定量数据和现场访问访谈的定性数据来评估该倡议。
定量数据显示,该地区非重症监护病房每1000个导管日的CAUTI发生率显著降低(倡议前为2.4,倡议后为0.8;P = .001),但重症监护病房的发生率没有改善(倡议前为1.4,倡议后为2.1;P = .16)。我们的定性数据中出现的主题突出了在制定和实施区域倡议时考虑当地情况的必要性以及沟通的重要性。
区域合作可能是解决重要的地方性患者安全问题的一项有价值的策略。