Study Shows Quality Improvement Collaborative Improves ICU Care for Veterans
The Quality Improvement Collaborative (QIC) calls upon care providers and others at the front line of care to learn and apply team-based improvement principles and strategies in the workplace. The VA Midwest Health Care Network (VISN 23) sought to determine if the QIC methods could be extended across a highly diverse group of hospitals that included eight VAMCs in Minnesota, North and South Dakota, Iowa, and Nebraska. This study focused on two “bundles” (ventilator bundle and central line insertion bundle) – tools designed to facilitate the application of best practices and evidence-based care at the bedside. Using these bundles, the goals were to increase adherence with specific evidence-based ICU practices, and to determine whether this would promote additional and sustained quality improvement across this VA network. From 1/05 through 6/06, investigators implemented and measured adherence with key components of both bundles.
Findings show that adherence with all five elements of the ventilator bundle improved from 50% in the first three months to 82% in the final three months of the intervention. The use of a central line insertion checklist to monitor adherence with the central line bundle increased from 58% in the first three months to 74% in the final three months of the intervention. In addition, the implementation of the ventilator and central line bundles was associated with a reduction in rates of ventilator-associated pneumonias and catheter-related blood stream infections, respectively.
Bonello R, Fletcher C, Becker W, Clutter K, Arjes S, Cook J, and Petzel R. An ICU quality improvement collaborative in nine VA hospitals. Joint Commission Journal on Quality and Patient Safety November 2008;34(11):639-45.
This study was supported by the VA Midwest Health Care Network. Drs. Bonello and Clutter, and Ms. Arjes are part of the Minneapolis VAMC; Dr. Fletcher is with the Ann Arbor VAMC; Ms. Cook and Dr. Petzel are part of the VA Midwest Health Care Network.