Rosenbluth Glenn, Garritson Susan, Green Adrienne L, Milev Dimiter, Vidyarthi Arpana R, Auerbach Andrew D, Baron Robert B
University of California, San Francisco, CA
UCSF Medical Center, San Francisco, CA.
Am J Med Qual. 2016 Nov;31(6):577-583. doi: 10.1177/1062860615596567. Epub 2015 Jul 22.
Engaging physicians in hand hygiene programs is a challenge faced by many academic medical centers. Partnerships between education and academic leaders present opportunities for effective collaboration and improvement. The authors developed a robust hand hygiene quality improvement program, with attention to rapid-cycle improvements, including all levels of staff and health care providers. The program included a defined governance structure, clear data collection process, educational interventions, rapid-cycle improvements, and financial incentive for staff and physicians (including residents and fellows). Outcomes were measured on patients in all clinical areas. Run charts were used to document compliance in aggregate and by subgroups throughout the project duration. Institutional targets were achieved and then exceeded, with sustained hand hygiene compliance >90%. Physician compliance lagged behind aggregate compliance but ultimately was sustained at a level exceeding the target. Successfully achieving the institutional goal required collaboration among all stakeholders. Physician-specific data and physician champions were essential to drive improvement.
让医生参与手部卫生计划是许多学术医疗中心面临的一项挑战。教育部门与学术领袖之间的合作关系为有效协作与改进提供了机会。作者制定了一个强有力的手部卫生质量改进计划，注重快速循环改进，涵盖各级工作人员和医疗服务提供者。该计划包括明确的治理结构、清晰的数据收集流程、教育干预措施、快速循环改进，以及针对工作人员和医生（包括住院医师和研究员）的经济激励措施。对所有临床区域的患者进行了结果测量。在整个项目期间，使用运行图记录总体和各亚组的依从情况。实现了并随后超过了机构目标，手部卫生依从率持续保持在90%以上。医生的依从率落后于总体依从率，但最终维持在超过目标的水平。成功实现机构目标需要所有利益相关者之间的合作。医生特定的数据和医生倡导者对于推动改进至关重要。
