title: Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard.
abstract: BACKGROUND
  The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.
  
  
  OBJECTIVE
  To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center.
  
  
  METHODS
  In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.
  
  
  RESULTS
  The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64-3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14-0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, -0.32).
  
  
  CONCLUSIONS
  A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
authors.affiliation: 1Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
authors.affiliation: 3Hospital Administration,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Devin
authors.initials: D
authors.lastname: Carr
authors.affiliation: 4Department of Anesthesiology,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: C Lee
authors.initials: CL
authors.lastname: Parmley
authors.affiliation: 5Quality,Safety, andRisk Prevention,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Martin
authors.affiliation: 6Department of Trauma,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gray
authors.affiliation: 7Department of Respiratory Care,Vanderbilt University Medical Center,Nashville,Tennessee.
authors.forename: Anna
authors.initials: A
authors.lastname: Ambrose
authors.affiliation: 8Department of Biomedical Informatics,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: Jack
authors.initials: J
authors.lastname: Starmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000592:standards*; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D055815:Young Adult