Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches

Abstract

BACKGROUND: Collaborative and toolkit approaches have gained traction for improving quality in health care. OBJECTIVE: To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit‐only approach at preventing central line–associated bloodstream infections (CLABSIs) and ventilator‐associated pneumonias (VAPs). DESIGN AND SETTING: Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007. MEASUREMENT: CLABSI and VAP rates. Follow‐up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement. RESULTS: A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty‐six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80). CONCLUSION: The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context‐dependent, and may take longer than 18 months to achieve. © Society of Hospital Medicine Journal of Hospital Medicine 2011

Project BOOST: Effectiveness of a multihospital effort to reduce rehospitalization

“…An integral aspect of QI projects is the contribution of local context to translation of best practices to disparate settings. [14][15][16] Most available reports of successful interventions to reduce rehospitalization have not fully described the specifics of either the intervention context or design. Moreover, the available evidence base for common interventions to reduce rehospitalization was developed in the academic setting.…”

Multimethod Evaluation of the VA’s Peer-to-Peer Toolkit for Patient-Centered Medical Home Implementation

“…20 Supporters view toolkits as empowering staff to customize solutions, 21 while others view toolkits as passive resources requiring staff motivation to adopt change. 20 DeWalt found clinic staff were willing to adopt "concise and actionable" tools but required some knowledge of QI methods to succeed.…”

“…20 Supporters view toolkits as empowering staff to customize solutions, 21 while others view toolkits as passive resources requiring staff motivation to adopt change. 20 DeWalt found clinic staff were willing to adopt "concise and actionable" tools but required some knowledge of QI methods to succeed. 22 Our study did not measure clinical outcomes, but is the first to examine the combination of an online toolkit containing concise, actionable tools with in-person collaboratives.…”

Decreasing unnecessary utilization in acute bronchiolitis care: Results from the value in inpatient pediatrics network

“…One of the most popular models for learning collaboratives remains the Institute for Healthcare Improvement's Breakthrough Series; however, this model is resource intensive in that it typically involves large teams and several yearly face‐to‐face meetings, with significant monetary investment on the part of hospitals. On the other hand, virtual collaboratives have produced mixed results with respect to quality improvement,33 so there is a continued need to maximize our learning about what works efficiently. Our collaborative was able to successfully disseminate tools developed in large academic institutions to be applied in smaller and more varied settings, where resources for quality improvement activities were limited.…”