Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit.
OBJECTIVE
Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.


METHODS
A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers.


METHODS
Adult medical intensive care unit (MICU).


METHODS
Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff.


METHODS
An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs.


RESULTS
The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low.


CONCLUSIONS
Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time.
Wall
R J
RJ
Veterans Affairs National Quality Scholars Program, Tennessee Valley Healthcare System, Nashville, TN, USA. brickw@u.washington.edu
Ely
E W
EW
Elasy
T A
TA
Dittus
R S
RS
Foss
J
J
Wilkerson
K S
KS
Speroff
T
T
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000517:prevention & control*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D018805:Sepsis / Q000517:prevention & control*; D013997:Time Factors