Patient Safety and Quality

Statewide collaborative effort to improve patient safety in intensive care units greatly enhanced unit safety culture

A collaborative quality improvement (QI) project, the Keystone Intensive Care Unit (ICU) Project, implemented in ICUs in Michigan hospitals, substantially enhanced ICU safety culture in that State, according to a new study. Of 99 ICUs, 72 participated in baseline (2004) and followup (2005) data. These ICUs had to assemble a QI team, and ensure that the ICU physician and nurse would commit 20 percent of their time to the project. Each team committed to implementing specific evidence-based patient safety interventions to reduce catheter-related blood stream infections (CRBSIs) and ventilator-associated pneumonia (VAP) among patients on artificial ventilation. Also, each ICU was to improve teamwork climate scores by at least 10 points on a 100-point scale or maintain a score of at least 60 percent of ICU caregivers reporting good teamwork.

Peter J. Pronovost, M.D., Ph.D., F.C.C.M., of Johns Hopkins University, and colleagues at the Michigan Health & Hospital Association found that teamwork climate varied significantly among ICUs at baseline from 16 to 92 percent of caregivers in an ICU reporting good teamwork climate. Good teamwork was reported by 17 percent of ICUs in 2004, but rose to 46 percent in 2005. All teamwork climate scores were significantly higher in the ICUs that increased 10 points. Nurse input, conflict resolution, and nurse-physician teamwork scores were significantly lower in ICUs that decreased by 10 points.

In the 44 ICUs that collected data on use of several evidence-based interventions in ventilated patients, adherence to the interventions ranged from a mean of 25 percent for maintaining glucose at 110 mg/dL or less to 89 percent for stress ulcer prophylaxis. Use of the antiseptic chlorhexadine, routinely available in ICU central line kits, increased from 20 percent at project launch to 60 percent after a letter was mailed to ICU leaders.

The study was funded in part by the Agency for Healthcare Research and Quality (HS14246). More details are in "Improving patient safety in intensive care units in Michigan," by Dr. Pronovost, Sean M. Berenholtz, M.D., M.H.S., Christine Goeschel, R.N., M.P.A., M.P.S., and others, in the Journal of Critical Care 23, pp. 207-221, 2008.

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