Safe Critical Care: Testing Improvement Strategies

NCT00975923 | Completed Results

• 2 other identifiers: VU050413AHRQ U18 HS015934
• Study Type: interventional
• Target: 59
• Locations: 1 country
• Sites: 1

Brief Summary

One group of hospitals participated in a collaborative approach for healthcare quality improvement while another group was provided only a tool kit. The investigators' objective was to determine if the Collaborative would perform better at preventing central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonias (VAP). Hospitals were randomized to the Tool Kit or Collaborative conditions. The investigators' study evaluated the effects on care processes and outcomes of a multi-institutional quality improvement initiative focused on preventing hospital associate infections. The investigators' hypothesis was that the strategies for implementing safe critical care practice will differ in level of achievement whereby the Collaborative group will perform better than the Tool Kit group. The outcome measure comprised clinical event rates and an index of safe practices that represent a bundling of key process measures related to evidence-based practices for preventing catheter-related blood-stream infections and ventilator-associated pneumonia in the intensive care unit.

Conditions

Central Line-associated Bloodstream Infection (CLABSI); Ventilator Associated Pneumonia

Keywords

Quality Improvement; Critical Care; Collaboratives; Patient Safety; Tool Kit

Outcome Measures

Primary Outcomes (1)

• CLABSI and VAP Rates

  Central line associated bloodstream infections(CLABSI) and ventilator associated pneumonias (VAP) using Centers for Disease Control and Prevention definitions as number of events per 1,000 device days, data collection and surveillance methods.

  18 Months: 3-month baseline and quarterly post-intervention periods

Secondary Outcomes (1)

• Access of Tools and Use of Quality Improvement Strategies

  18 months

Study Arms (2)

Collaborative Group

EXPERIMENTAL

Quality Improvement Virtual Learning Collaborative with Interactive Teleconferences and Tool Kit

Behavioral: Collaborative Group

Tool Kit Group

ACTIVE COMPARATOR

Tool Kit of Evidence-Based Guidelines, Education Seminars, and Aide for Quality Improvement Methods

Behavioral: Tool Kit

Interventions

Collaborative Group BEHAVIORAL

In addition to the Tool Kit materials and web site support, facility leaders and managers in this group agreed to participate in a Collaborative to improve critical care. The Collaborative differed from the IHI BTS model in that teams did not come together for face-to-face educational and planning sessions but instead attended web seminars and teleconferences. Between these "virtual" learning sessions, teams implemented some of the suggested change ideas, measured the results of those changes, and reported back to the larger group. Teams were supported through monthly educational and troubleshooting conference calls, individual coaching by faculty members, and an e-mail listserver designed to stimulate interaction among teams.

Also known as: Collaborative Breakthrough Groups, Collaborative Quality Improvement Groups

Collaborative Group

Tool Kit BEHAVIORAL

Hospitals received a tool kit:evidence-based guidelines, CLABSI/VAP fact sheets, change ideas,quality improvement and teamwork methods, standardized data collection and charting tools. Periodic reminders of their commitment to the Safe Critical Care Initiative and access to web site containing all of the educational seminars, clinical tools, and quality improvement tools. ICUs in this group were on their own to initiate and implement a local hospital quality improvement initiative preventing CLABSI and VAP.

Also known as: Quality Improvement

Tool Kit Group

Eligibility Criteria

• Age: 1 Year+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Medical centers with at least one adult or pediatric ICU.
• Medical centers within the Hospital Corporation of America (HCA) were eligible for enrollment.

You may not qualify if:

• Nonresponse to invitation to participate in our Safe Critical Care Initiative.

Sponsors & Collaborators

• Vanderbilt University: lead

Study Sites (1)

HCA Hospital Corporation of America

Nashville, Tennessee, 37203, United States

Location

Related Publications (5)

• Talbot TR, Tejedor SC, Greevy RA, Burgess H, Williams MV, Deshpande JK, McFadden P, Weinger MB, Englebright J, Dittus RS, Speroff T. Survey of infection control programs in a large national healthcare system. Infect Control Hosp Epidemiol. 2007 Dec;28(12):1401-3. doi: 10.1086/523867. Epub 2007 Nov 1.

  PMID: 17994522 RESULT

• Wall RJ, Ely EW, Talbot TR, Weinger MB, Williams MV, Reischel J, Burgess LH, Englebright J, Dittus RS, Speroff T, Deshpande JK. Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia. J Hosp Med. 2008 Sep;3(5):409-22. doi: 10.1002/jhm.317.

  PMID: 18951395 RESULT

• Patel RP, Gambrell M, Speroff T, Scott TA, Pun BT, Okahashi J, Strength C, Pandharipande P, Girard TD, Burgess H, Dittus RS, Bernard GR, Ely EW. Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med. 2009 Mar;37(3):825-32. doi: 10.1097/CCM.0b013e31819b8608.

  PMID: 19237884 RESULT

• France DJ, Greevy RA Jr, Liu X, Burgess H, Dittus RS, Weinger MB, Speroff T. Measuring and comparing safety climate in intensive care units. Med Care. 2010 Mar;48(3):279-84. doi: 10.1097/MLR.0b013e3181c162d6.

  PMID: 20125046 RESULT

• Speroff T, Ely EW, Greevy R, Weinger MB, Talbot TR, Wall RJ, Deshpande JK, France DJ, Nwosu S, Burgess H, Englebright J, Williams MV, Dittus RS. Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches. J Hosp Med. 2011 May;6(5):271-8. doi: 10.1002/jhm.873. Epub 2011 Feb 10.

  PMID: 21312329 RESULT

MeSH Terms

Conditions

Pneumonia, Ventilator-Associated

Interventions

Quality Improvement

Condition Hierarchy (Ancestors)

Healthcare-Associated Pneumonia; Cross Infection; Infections; Pneumonia; Respiratory Tract Infections; Lung Diseases; Respiratory Tract Diseases; Iatrogenic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Engineering; Technology, Industry, and Agriculture; Quality of Health Care; Health Services Administration

Limitations and Caveats

Each participant tailored their interventions; we were not able to test the components of CQI. Data were dependent on self-reports. Our collaborative was virtual and does not address benefits from face-to-face networking of large scale projects.

Results Point of Contact

• Title: Dr. Theodore Speroff
• Organization: Vanderbilt University School of Medicine

ted.speroff@vanderbilt.edu

615-636-9476

Study Officials

• Theodore Speroff, PhD

  Vanderbilt University School of Medicine

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: September 10, 2009
• First Posted: September 14, 2009
• Study Start: February 1, 2006
• Primary Completion: April 1, 2008
• Study Completion: April 1, 2008
• Last Updated: January 12, 2016
• Results First Posted: January 12, 2016

Record last verified: 2015-12

Locations

US (1)