Results and lessons from a hospital-wide initiative incentivised by delivery system reform to improve infection prevention and sepsis care

BMJ Open Quality

article

Pranavi Sreeramoju¹  Karla Voy-Hatter²  Calvin White²  Rosechelle Ruggiero¹  Carlos Girod¹  Joseph Minei³  Karen Garvey⁴  Judith Herrington⁵  Abu Minhajuddin⁶  Christopher Madden⁷  Robert Haley¹  Fred Cerise⁸ 

[1] Department of Internal Medicine , UT Southwestern Medical Center;Department of Infection Prevention , Parkland Health and Hospital System;Department of Surgery, Burn and Critical Care , UT Southwestern Medical Center;Department of Patient Safety and Risk , Parkland Health and Hospital System;Division of Nursing , Parkland Health and Hospital System;Department of Clinical Sciences , UT Southwestern Medical Center;Department of Neurological Surgery , UT Southwestern Medical Center;Health System Administration , Parkland Health and Hospital System

关键词: patient safety;    healthcare quality improvement;    nosocomial infections;    health policy;    infection control;   

DOI  :  10.1136/bmjoq-2020-001189

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background An academic safety-net hospital leveraged the federally funded state Delivery System Reform Incentive Payment programme to implement a hospital-wide initiative to reduce healthcare-associated infections (HAIs) and improve sepsis care.Methods The study period was from 2013 to 2017. The setting is a 770-bed urban hospital with six intensive care units and a large emergency department. Key interventions implemented were (1) awareness campaign and clinician engagement, (2) implementation of HAI and sepsis bundles, (3) education of clinical personnel using standardised curriculum on bundles, (4) training of key managers, leaders and personnel in quality improvement methods, and (5) electronic medical record-based clinical decision support. Throughout the 5-year period, staff received frequent, clear, visible and consistent messages from leadership regarding the importance of their participation in this initiative, performing hand hygiene and preventing potential regulatory failures. Several process measures including bundle compliance, hand hygiene and culture of safety were monitored. The primary outcomes were rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and sepsis mortality.Results From 2013 to 2017, the hospital-wide rates of HAI reduced: CLABSI from 1.6 to 0.8 per 1000 catheter-days (Poisson regression estimate: −0.19; 95% CI −0.29 to −0.09; p=0.0002), CAUTI from 4.7 to 1.3 per 1000 catheter-days (−0.34; −0.43 to −0.26; p<0.0001) and SSI after 18 types of procedures from 3.4% to 1.3% (−0.29; −0.34 to −0.24; p<0.0001). Mortality of patients presenting to emergency department with sepsis reduced from 9.4% to 2.9% (−0.42; −0.49 to −0.36; p<0.0001). Adherence to bundles of care and hand hygiene and the hospital culture of patient safety improved. Results were sustained through 2019.Conclusion A hospital-wide initiative incentivised by the Delivery System Reform Incentive Payment programme succeeded in reducing HAI and sepsis mortality over 5 years in a sustainable manner.

【 授权许可】

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