Orchestrated Testing.
Health care quality improvement collaboratives implement care bundles to target critical parts of a complex system to improve a specific health outcome. The quantitative impact of each component of the care bundle is often unknown. Orchestrated testing (OT) is an application of planned experimentation that allows simultaneous examination of multiple practices (bundle elements) to determine which intervention or combination of interventions affects the outcome. The purpose of this article is to describe the process needed to design and implement OT methodology for improvement collaboratives. Examples from a multicenter collaborative to reduce central line-associated bloodstream infections highlight the practical application of this approach. The key components for implementation of OT are the following: (1) define current practice and evidence, (2) develop a factorial matrix and calculate power, (3) formulate structure for engagement, (4) analyze results, and (5) replicate findings.
1 Children's Mercy-Kansas City, MO.|2 University of Missouri-Kansas City School of Medicine, MO.
Eugenia K
EK
Pallotto
3 Children's Hospital of Philadelphia, PA.|4 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
John
J
Chuo
5 Children's Healthcare of Atlanta at Egleston, Atlanta, GA.|6 Emory University School of Medicine, Atlanta, GA.
Anthony J
AJ
Piazza
7 Associates in Process Improvement, Austin, TX.
Lloyd
L
Provost
8 Children's Hospital Colorado, Aurora, CO.|9 University of Colorado School of Medicine, Aurora, CO.
Theresa R
TR
Grover
10 St Louis Children's Hospital and Goldfarb School of Nursing at Barnes-Jewish College, St Louis, MO.
Joan R
JR
Smith
11 Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.
Teresa
T
Mingrone
8 Children's Hospital Colorado, Aurora, CO.
Susan
S
Moran
12 Children's Hospital Association, Overland Park, KS.
Lorna
L
Morelli
12 Children's Hospital Association, Overland Park, KS.
Isabella
I
Zaniletti
11 Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.|13 University of Pittsburgh School of Medicine, Pittsburgh, PA.
Beverly
B
Brozanski
D055499:Catheter-Related Infections / Q000517:prevention & control*; D062905:Central Venous Catheters; D003299:Cooperative Behavior; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration* / Q000592:standards; D064872:Patient Care Bundles / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards
orchestrated testing; patient safety; planned experimentation; quality improvement; statistical process control