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Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit
  1. R J Wall1,
  2. E W Ely2,3,
  3. T A Elasy1,2,4,
  4. R S Dittus1,2,4,
  5. J Foss5,
  6. K S Wilkerson6,
  7. T Speroff1,2,4
  1. 1Veterans Affairs National Quality Scholars Program, Tennessee Valley Healthcare System, Nashville, TN, USA
  2. 2VA Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC) and VA Tennessee Valley Healthcare System Health Services Research Center for Patient Healthcare Behavior, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
  3. 3Division of Allergy/Pulmonary/Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
  4. 4Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
  5. 5Vanderbilt University School of Nursing, Nashville, TN, USA
  6. 6Department of Infection Control, Vanderbilt University Medical Center, Nashville, TN, USA
  1. Correspondence to:
 Dr R J Wall
 Division of Pulmonary and Critical Care Medicine, University of Washington, Box 359762, 325 Ninth Avenue, Seattle, WA 98104; brickwu.washington.edu

Abstract

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.

Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers.

Setting: Adult medical intensive care unit (MICU).

Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff.

Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs.

Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low.

Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time.

  • CR-BSI, catheter related bloodstream infection
  • CQI, continuous quality improvement
  • CVC, central venous catheter
  • MICU, medical intensive care unit
  • central venous catheterization
  • critical care
  • infection control
  • process assessment
  • quality improvement
  • CR-BSI, catheter related bloodstream infection
  • CQI, continuous quality improvement
  • CVC, central venous catheter
  • MICU, medical intensive care unit
  • central venous catheterization
  • critical care
  • infection control
  • process assessment
  • quality improvement
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Footnotes

  • Dr Wall was supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program and with resources at the VA Tennessee Valley Healthcare System, Nashville, TN. Dr Ely is the Associate Director of Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center (GRECC). He is a recipient of the Paul Beeson Faculty Scholar Award from the Alliance for Aging Research and is a recipient of a K23 from the National Institute of Health (#AG01023-01A1).

  • Competing interests: none declared.

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