title: Role of communication content and frequency in enabling evidence-based practices.
abstract: Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a "change implementation failure." A prospective study was conducted in 2 intensive care units (ICUs), a medical ICU (MICU) and a pediatric ICU (PICU), within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. The study sought to promote CLB implementation in both units through periodic quality improvement (QI) interventions over a 52-week period. Simultaneously, it examined (1) the content and frequency of communication related to CLB through weekly "communication logs" completed by physicians, nurses, and managers, and (2) outcomes, that is, CLB adherence rates through weekly medical record reviews. The aim of the study was 2-fold: (1) to examine associations between QI interventions and communication content and frequency at the unit level, and (2) to examine associations between communication content and frequency and outcomes at the unit level. The periodic QI interventions were expected to increase CLB adherence and reduce CRBSIs through their influence on communication content and frequency. A total of 2638 instances of communication were analyzed. Both units demonstrated a statistically significant increase in "proactive" communications-that is, communication intended to reduce infection risk between physicians and nurses over time. Proactive communications increased by 68% in the MICU (P < .05) and 61% in the PICU (P < .05). During the same timeframe, both units increased CLB adherence to 100%. Both units also demonstrated statistically significant declines in (1) catheter days: 34% decline in the MICU (P < .05) and 30% in the PICU (P < .05); and (2) CRBSI rates: 63% decline in the MICU (P < .05) and 100% in the PICU (P < .10). Direct costs savings from reduced CRBSIs in 1 year were estimated to be at least $840 000. Periodic QI interventions were effective in reframing interprofessional communication dynamics and enabling practice change. The prospective design provides insights into communication content and frequency associated with collective learning and culture change. The study identifies evidence-based management strategies for positive practice change at the unit level.
authors.affiliation: Department of Health, Management and Informatics, Georgia Regents University, Augusta (Dr Rangachari and Ms Hall and Mr Roy); Department of Medicine, Medical College of Georgia, Georgia Regents University, Augusta (Drs Madaio and Rissing); Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York (Dr Rethemeyer); and Institute for Advancement of Healthcare, School of Medicine-Greenville, University of South Carolina, Columbia (Dr Wagner).
authors.forename: Pavani
authors.initials: P
authors.lastname: Rangachari
authors.forename: Michael
authors.initials: M
authors.lastname: Madaio
authors.forename: R Karl
authors.initials: RK
authors.lastname: Rethemeyer
authors.forename: Peggy
authors.initials: P
authors.lastname: Wagner
authors.forename: Lauren
authors.initials: L
authors.lastname: Hall
authors.forename: Siddharth
authors.initials: S
authors.lastname: Roy
authors.forename: Peter
authors.initials: P
authors.lastname: Rissing
mesh_terms: D000046:Academic Medical Centers; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D018570:Risk Assessment; D012380:Role; D014481:United States