Thomas R Talbot1, Devin Carr2, C Lee Parmley3, Barbara J Martin4, Barbara Gray5, Anna Ambrose6, Jack Starmer7. 1. 1Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee. 2. 3Hospital Administration,Vanderbilt University Medical Center,Nashville,Tennessee. 3. 4Department of Anesthesiology,Vanderbilt University School of Medicine,Nashville,Tennessee. 4. 5Quality,Safety, andRisk Prevention,Vanderbilt University Medical Center,Nashville,Tennessee. 5. 6Department of Trauma,Vanderbilt University School of Medicine,Nashville,Tennessee. 6. 7Department of Respiratory Care,Vanderbilt University Medical Center,Nashville,Tennessee. 7. 8Department of Biomedical Informatics,Vanderbilt University School of Medicine,Nashville,Tennessee.
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). CONCLUSION: 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.
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). CONCLUSION: 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: Duraid Younan; Sarah J Delozier; John Adamski; Andrew Loudon; Aisha Violette; Jeffrey Ustin; Glen Tinkoff; Matthew L Moorman; Nathaniel McQuay Journal: World J Surg Date: 2020-04 Impact factor: 3.352
Authors: C Landelle; V Nocquet Boyer; M Abbas; E Genevois; N Abidi; S Naimo; R Raulais; L Bouchoud; F Boroli; H Terrisse; J-L Bosson; S Harbarth; J Pugin Journal: Intensive Care Med Date: 2018-10-21 Impact factor: 17.440