Using a virtual breakthrough series collaborative to reduce postoperative respiratory failure in 16 Veterans Health Administration hospitals

Jt Comm J Qual Patient Saf. 2014 Jan;40(1):11-20. doi: 10.1016/s1553-7250(14)40002-3.


Background: The Institute for Healthcare Improvement (IHI) Virtual Breakthrough Series (VBTS) process was used in an eight-month (June 2011-January 2012) quality improvement (QI) project to improve care related to reducing postoperative respiratory failure. The VBTS collaborative drew on Patient Safety Indicator 11: Postoperative Respiratory Failure Rate to guide changes in care at the bedside.

Methods: Sixteen Veterans Health Administration hospitals, each representing a regional Veterans Integrated Service Network, participated in the QI project. During the prework phase (initial two months), hospitals formed multidisciplinary teams, selected measures related to their goals, and collected baseline data. The six-month action phase included group conference calls in which the faculty presented clinical background on the topic, discussed evidence-based processes of care, and/or presented content regarding reducing postoperative respiratory failure. During a final, six-month continuous improvement and spread phase, teams were to continue implementing changes as part of their usual processes.

Results: The six most commonly reported interventions to reduce postoperative respiratory failure focused on improving incentive spirometer use, documenting implementation of targeted interventions, oral care, standardized orders, early ambulation, and provider education. A few teams reported reduced ICU readmissions for respiratory failure.

Conclusions: The VBTS collaborative helped teams implement process changes to help reduce postoperative respiratory complications. Teams reported initial success at implementing site-specific improvements using real-time data. The VBTS model shows promise for knowledge sharing and efficient multifacility improvement efforts, although long-term sustainability and testing in these and other settings need to be examined.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Communication
  • Continuity of Patient Care / organization & administration
  • Cooperative Behavior
  • Documentation
  • Hospitals, Veterans*
  • Humans
  • Models, Organizational
  • Patient Care Team / organization & administration*
  • Patient Readmission
  • Postoperative Complications / prevention & control*
  • Quality Improvement / organization & administration*
  • Respiratory Insufficiency / prevention & control*
  • Spirometry