Cumulative impact of periodic top-down communications on infection prevention practices and outcomes in two units.
Cumulative impact of periodic top-down communications on infection prevention practices and outcomes in two units.
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定期自上而下沟通对两个单位感染预防实践和结果的累积影响。
DOI：
10.1097/hmr.0000000000000038
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发表时间：
2015
影响因子：
2.5
通讯作者：
Rissing,Peter
中科院分区：
文献类型：
--
作者：
Rangachari,Pavani;Madaio,Michael;Rethemeyer,RKarl;Wagner,Peggy;Hall,Lauren;Roy,Siddharth;Rissing,Peter
背景：本研究感兴趣的问题是在单位层面一致实施循证感染预防实践的挑战，这一挑战被广泛地描述为“变革实施失败”。理论文献表明，定期的自上而下的沟通促进了专业小组之间的隐性知识交流，可能有效地促进了医疗保健组织的变革。然而，在理解自上而下的通信使实践在单位级别发生变化的机制方面仍然存在差距。我们的研究试图验证理论文献并解决这一差距。目的：本研究相应地提出了两个研究问题。(1)定期“自上而下”的沟通对单位层面的实践变化有什么影响？(2)促成实践变化的“单位级”沟通动态是什么？虽然本文侧重于解决第一个问题，但第二个问题已经在早期的医疗保健管理评论文章中得到了解决（Rangachari et al., 2013）。方法：前瞻性研究在一个学术卫生中心的两个重症监护室进行。这两个单位的基线中线束（CLB）依从性较低，导管相关血流感染（crbsi）高于预期。在52周的时间里，定期进行自上而下的沟通干预，以促进两个单位的CLB依从性。同时，该研究检查了(a)通过每周“沟通日志”与CLB相关的单位层面的沟通动态，由单位医生、护士和管理人员完成，以及(b)单位结果，即CLB依从性和CRBSI率。结果：两个单位均显示CLB依从性增加，crbsi显著持续下降。结果显示，这些干预措施累积起来对“导尿管天数”（即中心导尿管使用）有显著的负面（预期）影响。实践启示：结果有助于验证理论文献，并确定以证据为基础的管理策略，以适应单位层面的实践变化。他们认为，定期的自上而下的沟通有可能改变专业间的知识交流，并使单位层面的实践变化成为可能，从而显著改善结果并降低成本。
Background:The problem of interest in this study is the challenge of consistent implementation of evidence-based infection prevention practices at the unit level, a challenge broadly characterized as “change implementation failure.” The theoretical literature suggests that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Our study sought to both validate the theoretical literature and address this gap.Purpose:Correspondingly, this study posed two research questions.(1) What is the impact of periodic “top-down” communications on practice change at the unit level?(2) What are the “unit-level” communication dynamics enabling practice changes? Whereas this article focuses on addressing the first question, the second question has been addressed in an earlier Health Care Management Review article (Rangachari et al., 2013).Methods:A prospective study was conducted in two intensive care units at an academic health center. Both units had low baseline adherence to central line bundle (CLB) and higher-than-expected catheter-related bloodstream infections (CRBSIs). Periodic top-down communication interventions were conducted over 52 weeks to promote CLB adherence in both units. Simultaneously, the study examined (a) unit-level communication dynamics related to CLB through weekly “communication logs,” completed by unit physicians, nurses, and managers, and (b) unit outcomes, that is, CLB adherence and CRBSI rates.Findings:Both units showed increased adherence to CLB and significant, sustained declines in CRBSIs. Results showed that the interventions cumulatively had a significant negative (desired) impact on “catheter days,” that is, central catheter use.Practice Implications:Results help validate the theoretical literature and identify evidence-based management strategies for practice change at the unit level. They suggest that periodic top-down communications have the potential to modify interprofessional knowledge exchanges and enable practice change at the unit level, leading to significantly improved outcomes and reduced costs.