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IHI全国“100，000条生命运动”，针对六项倡议， 改善医疗保健。我们的重点将是其中两项举措捆绑在一起，以改善重症监护-减少导管相关的血流感染和呼吸机相关肺炎-在美国医院公司（HCA）的147家内科/外科和儿童医院。该项目的实际目的是实施循证实践，以改善重症监护室（ICU）的重症监护，收集信息，告知其他人实施此类实施的战略方法，并计划在大型HCA医疗保健网络中持续传播。嵌入在这个项目是研究评估“突破合作。" AHRQ“实施患者安全伙伴关系”的可供选择的项目包括一个实施工具包，以协助在整个卫生保健系统中采用和推广这些安全做法。在这项研究中，一组HCA医疗中心将参与改善重症护理运动，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，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。我们的比较策略是进行合作，积极参与团队的改进工作，在这种情况下，重症监护的安全实践。 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活动的增量价值。我们的假设是，实施安全的重症监护实践的策略将在不同的成就水平，从而协作组将比工具包-运动组表现更好。结果指标将是临床事件发生率和安全实践指数，代表与重症监护室预防导管相关血流感染和呼吸机相关肺炎的循证实践相关的关键过程指标。 因此，我们的项目目标是： 1.开展改善重症护理运动（血流感染和呼吸机相关疾病） 作为IHI 100，000生命运动的一部分。 2.开发减少血流感染和呼吸机相关性肺炎的工具包。 3.进行一项随机对照试验，比较协作与活动和工具包策略在实施改进计划方面的有效性。 4.检查有助于并实现成功的组织和提供商因素 性能改进。

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.