Effective communication network structures for hospital infection prevention: a study protocol.
Effective communication network structures for hospital infection prevention: a study protocol.
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预防医院感染的有效通信网络结构：一项研究协议。
DOI：
10.1097/qmh.0b013e31827dea7d
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发表时间：
2013
影响因子：
1.2
通讯作者：
Rangachari,Pavani
中科院分区：
文献类型：
--
作者：
Rangachari,Pavani
许多医院无法在单位一级成功实施“循证实践”。例如，经证明可预防导管相关血流感染（CRBSI）的中心线束（CLB）的一致实施通常很困难。这个问题已经被广泛地定性为“改变实施失败”的医疗保健组织。一些研究使用回顾性设计来研究这个问题;然而，很少有前瞻性研究来研究成功实施变革的沟通动力学（例如，循证实践）。这项前瞻性研究将在一个学术医学中心的2个重症监护室进行。在基线时，两个单位对CLB的依从性较低，CRBSI高于预期。将在52周内进行定期质量改进干预，以促进两个单位实施CLB。同时，将检查以下参数：（1）通过护士，医生和管理人员每周完成的“沟通日志”，在两个单位中与CLB相关的沟通的结构和内容;（2）结果，即通过每周图表审查，在两个单位中CLB的依从性。导管利用率和CRBSI（感染）率将作为额外的单位水平结局指标。目的有两个：（1）检查QI干预与单位层面沟通的结构和内容之间的关联;（2）检查单位层面沟通的结构和内容与结果之间的关联。定期的QI干预预计将通过对沟通结构和内容的影响来提高CLB的依从性并减少CRBSI。前瞻性的设计将有助于研究单位层面的沟通结构和内容的动态与CLB，以及单位层面的成果。这项研究有可能作出重大贡献的理论和实践，特别是如果干预措施被发现是有效的，使成功的做法改变在单位一级。为此，这项研究有可能提供深入了解与集体学习和文化变革在单位一级的通信结构和内容。预期成果和见解将为制定对环境敏感的“循证管理”战略奠定基础，以便在单位一级成功改变做法。最终的预期交付成果是为在卫生保健组织中成功实施循证实践制定一个“行动学习框架”。
Many hospitals are unable to successfully implement “evidence-based practices” at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as “change implementation failure” in health care organizations. Several studies have used retrospective designs to examine the problem; however, there are few prospective studies examining communication dynamics underlying successful implementation of change (eg, evidence-based practices). This prospective study will be set in 2 intensive care units at an academic medical center. At baseline, both units have low compliance with CLB and higher-than-expected CRBSIs. Periodic quality improvement (QI) interventions will be conducted over a 52-week period to promote implementation of CLB in both units. Simultaneously, the following parameters will be examined:(1) Structure and content of communication related to CLB in both units through “communication logs” completed weekly by nurses, physicians, and managers; and (2) outcomes, that is, CLB adherence in both units through weekly chart review. Catheter utilization and CRBSI (infection) rates will serve as additional unit-level outcome measures. The aim is 2-fold:(1) to examine associations between QI interventions and structure and content of communication at the unit level; and (2) to examine associations between structure and content of communication and outcomes at the unit level. The periodic QI interventions are expected to increase CLB adherence and reduce CRBSIs through their influence on structure and content of communication. The prospective design would help examine dynamics in unit-level communication structure and content related to CLB, as well as unit-level outcomes. The study has potential to make significant contributions to theory and practice, particularly if interventions are found to be effective in enabling successful practice change at the unit level. To this effect, the study has potential to provide insights into communication structure and content associated with collective learning and culture change at the unit level. Results and insights are expected to lay a foundation for generating context-sensitive “evidence-based management” strategies for successful practice change at the unit level. An ultimate expected deliverable is the development of an “action-learning framework” for successful implementation of evidence-based practices in health care organizations.