A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures

A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures. Krimsky, W., S., Mroz, I., B., McIlwaine, J., K., Surgenor, S., D., Christian, D., Corwin, H., L., Houston, D., Robison, C., & Malayaman, N. Quality and Safety in Health Care, 18(1):74-80, 2009.

Website abstract bibtex

Background: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. Objective: The purpose of this study was threefold: (1) to increase implementation rates of known, evidencebased interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an "ICU-specific" value compass. Design: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide "real-time" feedback for error correction. Setting and participants: In the before and after study, two groups of 40 consecutive patients admitted to DHMC's Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. Main outcome measures: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. Results: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-topoint variation as well as a substantial narrowing of the control limits indicating improved process control.

@article{
 title = {A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures},
 type = {article},
 year = {2009},
 pages = {74-80},
 volume = {18},
 websites = {http://www.scopus.com/inward/record.url?eid=2-s2.0-61849150415&partnerID=40&md5=f65fafe76e17268084a1f010433609ca},
 city = {Affiliation: Critical Care Medicine, Franklin Square Hospital, Baltimore, MD, United States; Affiliation: Critical Care Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Affiliation: Franklin Square Ho},
 id = {62fcf80d-d27c-3803-ac23-692d0ec9ecea},
 created = {2016-08-20T16:53:34.000Z},
 file_attached = {false},
 profile_id = {217ced55-4c79-38dc-838b-4b5ea8df5597},
 group_id = {408d37d9-5f1b-3398-a9f5-5c1a487116d4},
 last_modified = {2017-03-14T09:54:45.334Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 notes = {Cited By :21},
 folder_uuids = {292020b5-e8f2-49ce-8df5-0a6072d570db},
 private_publication = {false},
 abstract = {Background: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. Objective: The purpose of this study was threefold: (1) to increase implementation rates of known, evidencebased interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an "ICU-specific" value compass. Design: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide "real-time" feedback for error correction. Setting and participants: In the before and after study, two groups of 40 consecutive patients admitted to DHMC's Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. Main outcome measures: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. Results: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-topoint variation as well as a substantial narrowing of the control limits indicating improved process control.},
 bibtype = {article},
 author = {Krimsky, W S and Mroz, I B and McIlwaine, J K and Surgenor, S D and Christian, D and Corwin, H L and Houston, D and Robison, C and Malayaman, N},
 journal = {Quality and Safety in Health Care},
 number = {1}
}

Downloads: 0

{"_id":"RJfc7GywEzYAdsEkf","bibbaseid":"krimsky-mroz-mcilwaine-surgenor-christian-corwin-houston-robison-etal-amodelforincreasingpatientsafetyintheintensivecareunitincreasingtheimplementationratesofprovensafetymeasures-2009","downloads":0,"creationDate":"2017-11-23T19:05:19.215Z","title":"A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures","author_short":["Krimsky, W., S.","Mroz, I., B.","McIlwaine, J., K.","Surgenor, S., D.","Christian, D.","Corwin, H., L.","Houston, D.","Robison, C.","Malayaman, N."],"year":2009,"bibtype":"article","biburl":null,"bibdata":{"title":"A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures","type":"article","year":"2009","pages":"74-80","volume":"18","websites":"http://www.scopus.com/inward/record.url?eid=2-s2.0-61849150415&partnerID=40&md5=f65fafe76e17268084a1f010433609ca","city":"Affiliation: Critical Care Medicine, Franklin Square Hospital, Baltimore, MD, United States; Affiliation: Critical Care Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Affiliation: Franklin Square Ho","id":"62fcf80d-d27c-3803-ac23-692d0ec9ecea","created":"2016-08-20T16:53:34.000Z","file_attached":false,"profile_id":"217ced55-4c79-38dc-838b-4b5ea8df5597","group_id":"408d37d9-5f1b-3398-a9f5-5c1a487116d4","last_modified":"2017-03-14T09:54:45.334Z","read":false,"starred":false,"authored":false,"confirmed":"true","hidden":false,"source_type":"JOUR","notes":"Cited By :21","folder_uuids":"292020b5-e8f2-49ce-8df5-0a6072d570db","private_publication":false,"abstract":"Background: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. Objective: The purpose of this study was threefold: (1) to increase implementation rates of known, evidencebased interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an \"ICU-specific\" value compass. Design: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide \"real-time\" feedback for error correction. Setting and participants: In the before and after study, two groups of 40 consecutive patients admitted to DHMC's Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. Main outcome measures: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. Results: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-topoint variation as well as a substantial narrowing of the control limits indicating improved process control.","bibtype":"article","author":"Krimsky, W S and Mroz, I B and McIlwaine, J K and Surgenor, S D and Christian, D and Corwin, H L and Houston, D and Robison, C and Malayaman, N","journal":"Quality and Safety in Health Care","number":"1","bibtex":"@article{\n title = {A model for increasing patient safety in the intensive care unit: Increasing the implementation rates of proven safety measures},\n type = {article},\n year = {2009},\n pages = {74-80},\n volume = {18},\n websites = {http://www.scopus.com/inward/record.url?eid=2-s2.0-61849150415&partnerID=40&md5=f65fafe76e17268084a1f010433609ca},\n city = {Affiliation: Critical Care Medicine, Franklin Square Hospital, Baltimore, MD, United States; Affiliation: Critical Care Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Affiliation: Franklin Square Ho},\n id = {62fcf80d-d27c-3803-ac23-692d0ec9ecea},\n created = {2016-08-20T16:53:34.000Z},\n file_attached = {false},\n profile_id = {217ced55-4c79-38dc-838b-4b5ea8df5597},\n group_id = {408d37d9-5f1b-3398-a9f5-5c1a487116d4},\n last_modified = {2017-03-14T09:54:45.334Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n notes = {Cited By :21},\n folder_uuids = {292020b5-e8f2-49ce-8df5-0a6072d570db},\n private_publication = {false},\n abstract = {Background: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. Objective: The purpose of this study was threefold: (1) to increase implementation rates of known, evidencebased interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an \"ICU-specific\" value compass. Design: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide \"real-time\" feedback for error correction. Setting and participants: In the before and after study, two groups of 40 consecutive patients admitted to DHMC's Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. Main outcome measures: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. Results: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-topoint variation as well as a substantial narrowing of the control limits indicating improved process control.},\n bibtype = {article},\n author = {Krimsky, W S and Mroz, I B and McIlwaine, J K and Surgenor, S D and Christian, D and Corwin, H L and Houston, D and Robison, C and Malayaman, N},\n journal = {Quality and Safety in Health Care},\n number = {1}\n}","author_short":["Krimsky, W., S.","Mroz, I., B.","McIlwaine, J., K.","Surgenor, S., D.","Christian, D.","Corwin, H., L.","Houston, D.","Robison, C.","Malayaman, N."],"urls":{"Website":"http://www.scopus.com/inward/record.url?eid=2-s2.0-61849150415&partnerID=40&md5=f65fafe76e17268084a1f010433609ca"},"bibbaseid":"krimsky-mroz-mcilwaine-surgenor-christian-corwin-houston-robison-etal-amodelforincreasingpatientsafetyintheintensivecareunitincreasingtheimplementationratesofprovensafetymeasures-2009","role":"author","downloads":0},"search_terms":["model","increasing","patient","safety","intensive","care","unit","increasing","implementation","rates","proven","safety","measures","krimsky","mroz","mcilwaine","surgenor","christian","corwin","houston","robison","malayaman"],"keywords":[],"authorIDs":[]}