Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction.

Abstract

BACKGROUND:

We have previously demonstrated that the use of a daily "Quality Rounds Checklist" (QRC) can increase compliance with evidence-based prophylactic measures and decrease complications in a busy trauma intensive care unit (ICU) over a 3-month period. This study was designed to determine the sustainability of QRC use over 1 year and examine the relationship between compliance and outcome improvement.

METHODS:

A prospective before-after design was used to examine the effectiveness of the QRC tool in documenting compliance with 16 prophylactic measures for ventilator-associated pneumonia (VAP), deep venous thrombosis, pulmonary embolism, catheter-related bloodstream infection, and other ICU complications. The QRC was implemented on a daily basis for a 1-year period by the ICU fellow on duty. Monthly compliance rates were assessed by a multidisciplinary team for development of strategies for real-time improvement. Compliance and outcomes were captured over 1 year of QRC use.

RESULTS:

QRC use was associated with a sustained improvement of VAP bundle and other compliance measures over a year of use. After multivariable analysis adjusting for age (> 55), injury mechanism, Glasgow Coma Scale score (≤ 8), and Injury Severity Score (> 20), the rate of VAP was significantly lower after QRC use, with an adjusted mean difference of -6.65 (per 1,000 device days; 95% confidence interval, -9.27 to -4.04; p = 0.008). During the year of QRC use, 3% of patients developed a VAP if all four daily bundle measures were met for the duration of ICU stay versus 14% in those with partial compliance (p = 0.04). The overall VAP rate with full compliance was 5.29 versus 9.23 (per 1,000 device days) with partial compliance. Compared with the previous year, a 24% decrease in the number of pneumonias was recorded for the year of QRC use, representing an estimated cost savings of approximately $400,000.

CONCLUSION:

The use of a QRC facilitates sustainable improvement in compliance rates for clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of the QRC, requiring just a few minutes per patient to complete, equates to cost-effective improvement in patient outcomes.

• Authors: Joseph Dubose, Pedro G R Teixeira, Kenji Inaba, Lydia Lam, Peep Talving, Brad Putty, David Plurad, Donald J Green, Demetrios Demetriades, Howard Belzberg
• Journal: The Journal of trauma (J Trauma) Vol. 69 Issue 4 Pg. 855-60 (Oct 2010) ISSN: 1529-8809 [Electronic] United States
• PMID: 20032792 (Publication Type: Journal Article)

Topics

• Academic Medical Centers
• Adolescent
• Adult
• Aged
• California
• Checklist
• Cross Infection (mortality, prevention & control)
• Evidence-Based Medicine (standards)
• Female
• Guideline Adherence (standards)
• Hospital Mortality
• Humans
• Intensive Care Units (standards)
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated (mortality, prevention & control)
• Prospective Studies
• Quality Assurance, Health Care (standards)
• Quality Indicators, Health Care (standards)
• Wounds and Injuries (mortality, therapy)
• Young Adult