Safe Critical Care: Testing Improvement Strategies

安全重症监护：测试改进策略

• 批准号: 7011021
• 负责人: THEODORE SPEROFF
• 金额: $ 28.9万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7011021
• 关键词: behavioral /social science research tag; clinical research; clinical trials; cooperative study; critical care; health care quality; health service demonstration project; health services research tag; human subject; nosocomial infection control; patient oriented research; patient safety /medical error

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.

描述(由申请人提供)：安全危重护理：测试改进策略。我们的项目利用了IHI全国“100,000人的生命运动”，旨在六项倡议，以更安全和 改善了医疗保健。我们将把重点放在其中两项举措上，以改善美国医院公司(HCA)147家内科/外科医院和儿童医院的危重护理工作--减少导管相关血流感染和呼吸机相关肺炎。这个项目的实际目的是实施循证做法，以改善重症监护病房(ICU)的危重护理，收集信息，向其他人介绍实施这种做法的战略方法，并计划在大型HCA医疗网络中持续传播。在这个项目中嵌入了评估“突破性协作”的研究。 AHRQ“实施患者安全的伙伴关系”的交付成果包括一个实施工具包，以帮助在整个医疗保健系统中吸收和传播这些安全做法。在这项研究中，一组HCA医疗中心将参与改善危重护理活动，并获得实施这一倡议的工具包。虽然工具包可能有助于实现改变，类似于继续医学教育，但提供工具包是一种被动的改变方法，不能确保转移到一线行为。我们的比较战略是开展协作，积极让团队参与改进工作，在这种情况下，是危重护理的安全实践。 因此，我们的项目不仅将重点放在实施重症监护的安全实践上，而且还测试了协作改进工具包和安全实践运动的增量价值。我们的假设是，实施安全危重护理实践的策略将在成就水平上有所不同，因此协作组将比工具包运动组表现更好。结果衡量标准将是临床事件发生率和安全做法指数，这些安全做法代表了与循证做法相关的关键流程措施的捆绑，以防止重症监护病房中导管相关血流感染和呼吸机相关肺炎。 因此，我们的项目目标是： 1.开展改善重症监护(血液感染和呼吸机相关)的活动 肺炎)，作为IHI 100,000人生命运动的一部分。 2.开发减少血液感染和呼吸机相关性肺炎的工具包。 3.进行随机对照试验，比较协作策略与活动和工具包策略在实施改进计划方面的有效性。 4.检查促成和促成成功的组织和供应商因素 性能提升。