title: Standardizing central line safety: lessons learned for physician leaders.
abstract: A comprehensive central venous catheter (CVC) safety program reduces mechanical and infectious complications and requires an integrated multidisciplinary effort. A multistate health care system implemented a discovery and diffusion project addressing CVC insertion, maintenance, and removal. Process and outcome measures were collected before and after the intervention. The project was completed in 12 months. It was associated with statistically significant improvement in 6 process measures and reduction in the rate of ICU central line-associated bloodstream infection (from 1.16 to 0.80 infections/1000 catheter days; incidence rate ratio = 0.69; 95% confidence interval = 0.51, 0.93). A comprehensive CVC standardization project increased compliance with several established best practices, was associated with improved outcomes, produced a refined definition of discovery and diffusion project components, and identified several discrete leadership principles that can be applied to future clinical improvement initiatives.
authors.affiliation: 1Mayo Clinic, Phoenix, AZ.
authors.forename: Jeff T
authors.initials: JT
authors.lastname: Mueller
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wright
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Fedraw
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brown
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thompson
authors.forename: Randall
authors.initials: R
authors.lastname: Flick
authors.forename: Maria Teresa A
authors.initials: MT
authors.lastname: Seville
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards; D062905:Central Venous Catheters / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D007857:Leadership; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic; D016730:Program Development / Q000379:methods
keywords: best practices; central lines; clinical practice guidelines; health care delivery; leading change