Saade Elie A, Thatcher Esther J, Lewis Tina, Carr Susan, Cornell Marcia, Arnold Rachel, Albar Zainab, Pronovost Peter
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Division of Infectious Diseases and HIV Medicine, Department of Internal Medicine, University Hospitals, Cleveland, OH, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Sep 25;4(1):e147. doi: 10.1017/ash.2024.386. eCollection 2024.
Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements.
Quality improvement with multiple levels of interventions.
A health system in northern Ohio with 21 affiliated hospitals across 16 counties.
Adult patients admitted to the hospital between June 2020 and June 2023.
A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023).
Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices.
A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.
尽管可通过既定的感染控制措施预防，但导尿管相关尿路感染（CAUTIs）在急性护理环境中仍然普遍存在。我们的目标是通过在多家医院实施可持续措施来提高CAUTIs发生率，包括加强沟通、提高医护人员参与度、明确责任以及在报告中保持透明度，以实现长期改善。
多层次干预的质量改进。
俄亥俄州北部的一个医疗系统，在16个县有21家附属医院。
2020年6月至2023年6月期间入院的成年患者。
一个跨学科团队制定了一系列广泛的质量改进（QI）策略，并以分形管理系统框架为指导，以确保各团队和设施之间的责任、沟通和协调一致。关键驱动因素包括留置导尿管（IUC）替代方案、插入、维护、拔除和智能诊断。主要结局指标是标准化感染率（SIR）和标准化使用率（SUR），比较第1阶段（P1，2020年6月至2021年12月）和第2阶段（P2，2022年1月至2023年6月）。
加强沟通和管理在尽量减少IUC放置方面发挥了关键作用。更新的政策和规程以及明确的指南和决策支持工具促进了有效的尿液管理。绩效跟踪和可视化管理板提供了实时见解，而包括员工碰头会和多学科团队合作在内的协作努力确保了对最佳实践的一致遵守。
一项全系统的QI倡议，重点是加强沟通、管理和协作，有助于提高SIR并降低多家医院的CAUTIs发生率，突出了强大沟通和积极管理在医疗环境中的影响。
