Theme Issue EditorialImproving patient safety in intensive care units in Michigan☆
Introduction
The need to improve quality and safety in health care is imperative. However, evidence is scarce regarding how to successfully improve [1], [2], [3]. The Institute of Medicine (IOM) created a compelling case for patient safety in its To Err is Human report [4]. However, consensus on patient safety goals, priorities, methods, and measures for safety initiatives is slow to emerge [4]. Although the IOM followed-up with a strategy for health system redesign in Crossing the Quality Chasm, evidence of improvement is still limited [5], [6], [7]. Assessing and improving safety culture is a safety strategy recommended by the IOM and National Quality Forum [8], [4].
The mission of the Keystone Center for Patient Safety and Quality, founded by the Michigan Health and Hospital Association (MHA), is to translate evidence into clinical practice. After researching the literature and attending patient safety conferences, the Keystone executive director (C.G.) approached the director of the Quality and Safety Research Group at the Johns Hopkins University (P.J.P.) to discuss collaboration on a grant to improve patient safety. In this article, we describe the design and lessons learned from implementing a large-scale patient safety collaborative and the impact of the comprehensive unit-based safety program (CUSP) on teamwork climate in intensive care units (ICUs) throughout the state of Michigan, United States.
Section snippets
Study design
This project, called the Keystone ICU Project, was based on a collaborative model [9], [10] between the Quality and Safety Research Group, the MHA-Keystone Center for Patient Safety and Quality, and participating Michigan hospitals. An improvement collaborative involves participation of multiple health care organizations in a structured program aimed at improving an aspect of clinical care. It involves group meetings and conference calls to learn about best practices, share experiences, and
Results
At the project launch in October 2003, 108 ICUs representing 77 hospitals agreed to participate; 5 of 77 hospitals were out of state but part of a health care system with corporate headquarters in Michigan. In January of 2005, a 2-week enrollment window was provided for new hospitals or ICUs to join the project. There were 5 new Michigan hospitals with 19 ICUs that joined, bringing the total number of participants to 82 hospitals and 134 ICUs; data for the 19 ICUs are not reported here
Discussion
The Keystone ICU Project is the first rigorous effort to improve ICU quality and safety, which has been implemented throughout an entire state. In this study, baseline performance of evidence-based practices known to improve care for mechanically ventilated patients were inconsistently applied across ICUs reporting data. Unfortunately, we encountered a large degree of missing baseline data, which prompted a more detailed data quality control plan [16] and a discussion with the ICU teams. We
Acknowledgments
The authors would like to acknowledge the tremendous efforts of the ICU teams in Michigan (list of participating hospitals in Appendix 1). Their leadership and courage in this innovative effort reflect an unrelenting passion and dedication to improve quality and safety for their patients. We continue to be inspired by their example. We also thank Christen Fullwood from the Quality and Safety Research Group for her coordination of research efforts related to the SAQ affiliated. We also
References (54)
- et al.
Characteristics of successful quality improvement teams: lessons from five collaborative projects in the VHA
Jt Comm J Qual Saf
(2004) - et al.
Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia
J Qual Patient Saf
(2005) - et al.
Improving care for the ventilated patient
Jt Comm J Qual Saf
(2004) - et al.
Improving communication in the ICU using daily goals
J Crit Care
(2003) - et al.
Senior executive adopt-a-work unit: a model for safety improvement
Jt Comm J Qual Saf
(2004) - et al.
A practical tool to learn from defects in patient care
Jt Comm J Qual Saf
(2006) - et al.
A morning briefing: setting the stage for a clinically and operationally good day
J Qual Patient Saf
(2005) - et al.
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial
Lancet
(1999) - et al.
Prevention of venous thromboembolism
Chest
(2004) - et al.
OR briefings and wrong-site surgery
J Am Coll Surg
(2007)
Applying multilevel confirmatory factor analysis techniques to the study of leadership
Leadersh Q
Do quality improvement organizations improve the quality of hospital care for Medicare beneficiaries?
JAMA
Quality of care in U.S. hospitals as reflected by standardized measures, 2002-2004
N Engl J Med
Care in U.S. hospitals—the Hospital Quality Alliance program
N Engl J Med
Crossing the quality chasm: a new health system for the 21st century
Five years after to err is human: what have we learned?
JAMA
The end of the beginning: patient safety five years after “To Err Is Human”
Health Aff (Millwood) Supp Web Exclusives
Safe practices for better healthcare: 2006 update
Quality collaboratives: lessons from research
Qual Saf Health Care
Prevention of intravascular catheter-related infections
Ann Intern Med
Diffusion of innovations in service organizations: systematic review and recommendations
Milbank Q
Making psychological theory useful for implementing evidence based practice: a consensus approach
Qual Saf Health Care
Changing clinical behaviour by making guidelines specific
BMJ
Changing provider behavior: an overview of systematic reviews of interventions
Med Care
Eliminating catheter-related bloodstream infections in the intensive care unit
Crit Care Med
How will we know patients are safer? An organization-wide approach to measuring and improving patient safety
Crit Care Med
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This project was funded by an Agency for Healthcare Research and Quality (grant 1UC1HS14246) and the Michigan Health and Hospital Association.
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Listed in Appendix 1.