The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide

Abstract

Background: Implementing bundles of best practices has been shown to provide patients with recommended care and reduce medical errors. Rhode Island's (RI) hospital leaders, quality organisations and insurers discussed the results of a quality improvement initiative in Michigan, the Keystone project, and explored the possibility of replicating these results statewide in RI.

Design: Hospital executives and intensive care unit (ICU) staff, RI's quality organisations, RI Quality Institute, Quality Partners of RI, and Hospital Association of RI and consultants from Johns Hopkins University, worked together to implement evidence-based interventions and change safety culture in RI's ICUs.

Objectives: The authors describe the RI ICU Collaborative, funded by insurers and hospitals, and report on statewide central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates between 1 January 2006 and 30 June 2008.

Subjects: All adult ICU patients in RI.

Measures: CLABSI and VAP rates.

Results: 100% of 23 ICUs in 11 hospitals participated in the RI ICU Collaborative. The statewide mean CLABSI rate decreased 74% from 3.73 (median 1.95) infections per 1000 catheter days to 0.97 (median 0) in quarter (Q) 2 (March-June) 2008 (p = 0.0032). The VAP rate fell 15% from 3.44 (median 0.58) to 2.92 VAPs (median 0) per 1000 ventilator days in Q2, 2008.

Conclusion: The RI ICU Collaborative, a statewide quality improvement initiative, served as the platform by which multifaceted interventions were associated with reductions in CLABSI and VAP rates, and an increase in the use of evidence-based interventions. Completing Phase II, the RI ICU Collaborative continues to sustain these statewide reductions.