Using evidence and process improvement strategies to enhance healthcare outcomes for the critically ill: A pilot project

BACKGROUND Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice. OBJECTIVES To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection inpatients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest. METHODS The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that "fit" with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information. RESULTS During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients' care resulted in estimated cost savings of $1.0 million to $2.3 million. CONCLUSIONS Early, consistent communication about the project rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.