The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide
- Vera A DePalo1,2,
- Lynn McNicoll1,3,4,
- Margaret Cornell4,
- Jean Marie Rocha5,
- Laura Adams6,
- Peter J Pronovost7
- 1Department of Internal Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
- 2Memorial Hospital of Rhode Island, Pawtucket, Rhode Island, USA
- 3Rhode Island Hospital, Providence, Rhode Island, USA
- 4Quality Partners of Rhode Island, Providence, Rhode Island, USA
- 5Hospital Association of Rhode Island, Cranston, Rhode Island, USA
- 6Rhode Island Quality Institute, Providence, Rhode Island, USA
- 7Johns Hopkins University, Baltimore, Maryland, USA
- Correspondence to Dr Vera A De Palo, Pulmonary, Critical Care, & Sleep Division, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA;
- Accepted 1 May 2010
Background Implementing bundles of best practices has been shown to provide patients with recommended care and reduce medical errors. Rhode Island's (RI) hospital leaders, quality organisations and insurers discussed the results of a quality improvement initiative in Michigan, the Keystone project, and explored the possibility of replicating these results statewide in RI.
Design Hospital executives and intensive care unit (ICU) staff, RI's quality organisations, RI Quality Institute, Quality Partners of RI, and Hospital Association of RI and consultants from Johns Hopkins University, worked together to implement evidence-based interventions and change safety culture in RI's ICUs.
Objectives The authors describe the RI ICU Collaborative, funded by insurers and hospitals, and report on statewide central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates between 1 January 2006 and 30 June 2008.
Subjects All adult ICU patients in RI.
Measures CLABSI and VAP rates.
Results 100% of 23 ICUs in 11 hospitals participated in the RI ICU Collaborative. The statewide mean CLABSI rate decreased 74% from 3.73 (median 1.95) infections per 1000 catheter days to 0.97 (median 0) in quarter (Q) 2 (March–June) 2008 (p=0.0032). The VAP rate fell 15% from 3.44 (median 0.58) to 2.92 VAPs (median 0) per 1000 ventilator days in Q2, 2008.
Conclusion The RI ICU Collaborative, a statewide quality improvement initiative, served as the platform by which multifaceted interventions were associated with reductions in CLABSI and VAP rates, and an increase in the use of evidence-based interventions. Completing Phase II, the RI ICU Collaborative continues to sustain these statewide reductions.
- ICU complications
- catheter infection
- ventilator associated pneumonia
- quality collaborative
- healthcare quality improvement
Funding This projected was funded by Blue Cross & Blue Shield of Rhode Island (Providence, Rhode Island) and United Health Care of New England (Warwick, Rhode Island). Additional support for education was provided by Neighbourhood Health Plan of Rhode Island. While the authors individually have no financial conflicts of interest to disclose, the RIQI and QPRI participate in other projects funded by BCBSRI and UHCNE.
Competing interests None.
Ethics approval Ethics approval was provided by the Institutional Review Board of the Memorial Hospital of Rhode Island.
Provenance and peer review Not commissioned; externally peer reviewed.