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Reducing preventable harm: observations on minimizing bloodstream infections

Peter J. Pronovost (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA) (Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA) (Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA)
Sally J. Weaver (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA)
Sean M. Berenholtz (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA) (Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA) (Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA)
Lisa H. Lubomski (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA)
Lisa L. Maragakis (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA)
Jill A. Marsteller (Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA) (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA)
Julius Cuong Pham (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA) (Queens Medical Center, Honolulu, Hawaii, USA)
Melinda D. Sawyer (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA)
David A. Thompson (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA) (Johns Hopkins School of Nursing, Division of Acute and Chronic Care, Johns Hopkins University, Baltimore, Maryland, USA)
Kristina Weeks (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA)
Michael A. Rosen (Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA) (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA) (Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 20 March 2017

727

Abstract

Purpose

The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.

Design/methodology/approach

An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.

Findings

The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.

Practical implications

This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.

Originality/value

Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

Keywords

Acknowledgements

The authors appreciate Professor Mary Dixon-Woods scholarship upon which this manuscript builds and her thoughtful review of this manuscript. The authors thank Christine G. Holzmueller for her review and assistance in editing the manuscript. All of the authors contributed equally to the work described in this manuscript. Dr Rosen drafted the initial manuscript and the remaining authors contributed important intellectual content during the revision process of the manuscript. Anyone who meets the criteria for authorship has been included.

Competing interests: Dr Pronovost reports receiving grant or contract support from the Agency for Healthcare Research and Quality, the Gordon and Betty Moore Foundation (research related to patient safety and quality of care), the National Institutes of Health (acute lung injury research), and the American Medical Association Inc. (improve blood pressure control); honoraria from various healthcare organizations for speaking on patient safety and quality (the Leigh Bureau manages these engagements); book royalties from the Penguin Group for his book Safe Patients, Smart Hospitals; and stock and fees to serve as a Director for Cantel Medical. Dr Pronovost is a Founder of Patient Doctor Technologies, a startup company that seeks to enhance the partnership between patients and clinicians with an application called Doctella. Dr Maragakis reports receiving grant or contract support from the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality (research related to infection prevention); the Assistant Secretary for Preparedness and Response (biocontainment and emergency preparedness); Versus Inc. (hand hygiene research) and Clorox Inc. (environmental disinfection research). Dr Thompson reports receiving a subcontract from the Johns Hopkins Applied Physics Laboratory for a CUSP-CLABSI intervention with the US Navy. Weeks reports receiving honoraria for speaking and teaching to various hospital associations, and fellowship from The Commonwealth Fund to be the Australian-American Health Policy Fellow (2015-2016). The Armstrong Institute for Patient Safety and Quality is selling training and consulting services related to patient safety and quality, including programs on the Comprehensive Unit-based Safety Program. The following authors report no conflicts: Dr Weaver, Dr Berenholtz, Dr Lubomski, Dr Marsteller, Sawyer, and Dr Rosen.

Citation

Pronovost, P.J., Weaver, S.J., Berenholtz, S.M., Lubomski, L.H., Maragakis, L.L., Marsteller, J.A., Pham, J.C., Sawyer, M.D., Thompson, D.A., Weeks, K. and Rosen, M.A. (2017), "Reducing preventable harm: observations on minimizing bloodstream infections", Journal of Health Organization and Management, Vol. 31 No. 1, pp. 2-9. https://doi.org/10.1108/JHOM-10-2016-0197

Publisher

:

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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