Safe Critical Care: Testing Improvement Strategies

描述（由申请人提供）：安全重症监护：测试改进策略。我们的项目利用了IHI全国“10万人生命运动”，该运动针对六项更安全和更安全的倡议

DESCRIPTION (provided by the applicant): Safe Critical Care: Testing Improvement Strategies. Our project leverages the IHI national "100,000 Lives Campaign" directed at six initiatives for safer and improved healthcare. Our focus will be on two of these initiatives bundled together to Improve Critical Care - reduction of catheter-related blood stream infections and ventilator-associated pneumonia - across 147 of the medical/surgical and children's hospitals of the Hospital Corporation of America (HCA). The pragmatic purpose of this project is to implement evidence-based practices for improvement of critical care in the intensive care unit (ICU), collect information that will inform others on strategic approaches to such implementation, and plan for sustained spread across the large HCA healthcare network. Embedded in this project is research evaluating "Breakthrough Collaboratives." Deliverables for the AHRQ "Partnerships in Implementing Patient Safety" include an implementation toolkit to assist uptake and spread of these safe practices across the system of health care. In this study, one group of HCA medical centers will participate in the Campaign to Improve Critical Care and receive a Tool Kit for implementing this initiative. Although Tool Kits may help to enable change, similar to continuing medical education, providing tool kits is a passive approach to change that does not assure transfer to frontline behavior. Our comparative strategy is to conduct a collaborative that actively engages teams in the work of improvement and, in this case, safe practices for critical care. Thus, our project not only directs its focus on implementing safe practice for critical care but tests the incremental value of a collaborative for improvement to a tool kit and safe practice campaign. Our hypothesis is that the strategies for implementing safe critical care practice will differ in level of achievement whereby the Collaborative group will perform better than the Tool Kit - Campaign group. The outcome measure will be clinical event rates and an index of safe practices that represent a bundling of key process measures related to evidence-based practices for preventing catheter-related blood-stream infections and ventilator-associated pneumonia in the intensive care unit. Thus, our project aims are to: 1. Implement a campaign for Improving Critical Care (blood-stream infections and ventilator-associated pneumonia) as part of the IHI 100,000 Lives Campaign. 2. Develop tool kits for reducing blood-stream infections and ventilator-associated pneumonia. 3. Conduct a randomized controlled trial to compare the effectiveness of a Collaborative versus Campaign and Tool Kit strategy for implementing an improvement initiative. 4. Examine the organizational and provider factors that contribute toward and enable successful performance improvement.