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Abstract
Background Through a system-wide, modified IHI Breakthrough Series Collaborative, staff at the Hamad Medical Corporation aimed to increase the reliability of bundle compliance to reduce hospital acquired infections in critical care units, general wards and for peri-operative patients.
Objectives The aim of the collaborative was to achieve 95% reliable use of care bundles and 0 incidence or 300+days between patient harm events in participating units by December 2016.
Methods In October 2013, The Best Care Always Collaborative was launched, focusing on improving the reliability of evidence-based care processes and thus improved outcomes for patients. Participating teams apply quality improvement methods to test change packages and aim to implement context-specific care bundles to reduce hospital acquired conditions. All sites submitted qualitative and quantitative data in monthly progress reports.
Results Through focused improvement efforts in workstreams the improvement teams were able to reduce instances of hospital acquired infections and in most cases improve process reliability. Please see attached data for detailed analysis.
Conclusions The IHI team learned how to work and apply the Science of Improvement in a new cultural context in Doha, Qatar. Reliably applying all elements of evidence-based care bundles can lead to improved outcomes. Healthcare delivery is complex and multiple factors effect patient outcomes. Multi-faceted approaches must be employed to reduce hospital acquired conditions. Further work should be done to develop, test and measure the effects of standard workflows for processes prone to human error and patient harm in this context.
VAP rate per 1,000 device days in BCA pilot units (U chart). Average VAP rate was 1.3 per 1,000 device days and reduced to 0.5 per 1,000 in October 2015. Average VAP bundle compliance was 86% and increased to 98% in September 2014, then reduced to 90% in January 2016.
Percent compliance with VAP bundle in BCA pilot units (P chart).
Central line infection rate per 1,000 device days in BCA pilot units (U chart). Average central line infection rate has remained constant at 2.9 per 1,000 device days despite an increase in insertion and maintenance bundle compliance.
Percent compliance with central line insertion bundle in critical care pilot units (P chart).
Percent compliance with central line maintenance bundle in BCA pilot units (P chart).
CA-UTI infections per 1,000 device days in BCA pilot units (U chart). Average catheter-associated urinary tract infections was 1.4 per 1,000 device days, then reduced to 0.6 per 1,000 in February 2015, despite bundle compliance remaining constant at 90%
Percent compliance with urinary catheter insertion bundle in BCA pilot units (P chart).
Pressure ulcer count in BCA general ward and critical care pilot units (C chart). The average count of pressure ulcers was 13.8 and reduced to 5.7 in January 2015. Percent of ‘at risk’ patients receiving pressure ulcer prevention increased as did achievement of multi-disciplinary rounds.
Percent of ‘at risk’ patients receiving the full pressure ulcer prevention bundle in BCA pilot units (P chart).
Percent achievement of multi-disciplinary rounds in general ward pilot units (P chart).
Percent of patients developing surgical site infections in BCA perioperative pilot units (P chart). Average percent of surgical patients contracting a surgical site infection was an average of 1% and reduced to 0.3% in July 2016. Percent of elective surgeries with complete pre-surgical briefings increased from 95% to 98% in January 2016. Other surgical interventions were also tested and implemented.
Percent of elective surgeries with complete pre-surgical briefing (P chart).