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Effects of a multifaceted quality improvement intervention in reducing mortality and bloodstream infection in ICUs: insights from the QUALITI initiative


Our objective was to evaluate if the implementation of a multifaceted intervention program for quality improvement in ICUs of nonacademic hospitals would decrease mortality and the catheter-related bloodstream infection rate (CRBSI).


A clinical practice improvement program involving 17 Brazilian ICUs of nonacademic public hospitals located far from major economic centers under coordination of a not-for-profit private hospital with the support of Brazilian Ministry of Health. We implemented the following interventions: (1) hospital visits to assess the facilities, human resources and processes; (2) workshop with hospital directors and ICU coordinators to elaborate improvement proposals based on the initial visit findings; (3) multidisciplinary videoconference lectures every 3 weeks about critical care medicine assistance and quality issues; (4) website containing project educational material, videoconference recordings, and an evidence-based practice course; (5) subscription of an electronic clinical information resource for all participating hospitals (UpToDate®); (6) 3-day workshop to share the coordinating institution quality improvement practices with directors and ICU coordinators from the 17 participant institutions; (7) 3-day nursing visits from the coordinating hospital to perform advice on care practice; (8) basic life support courses, 56 vacancies per hospital, and fundamentals of critical care support, 30 vacancies; and (9) implementation of a web-based system to collect ICU and hospital mortality, SAPS3, standardized-mortality ratio (SMR) and CRBSI after June 2011. We assessed variation of SMR and CRBSI on time using weighted linear regression, and variation of mortality on time using generalized-estimating equations.


The results are presented in Table 1.

Table 1 (abstract P65)


A multifaceted intervention program applied to a network of ICUs in nonacademic public hospitals reduced mortality.

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Correspondence to AB Cavalcanti.

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Cavalcanti, A., Othero, J., Mouro, J. et al. Effects of a multifaceted quality improvement intervention in reducing mortality and bloodstream infection in ICUs: insights from the QUALITI initiative. Crit Care 16, P65 (2012).

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  • Quality Improvement
  • Improvement Program
  • Private Hospital
  • Bloodstream Infection
  • Improvement Intervention