Three years experience of a quality improvement programme

Introduction

As part of a safer patient initiative under the auspices of the Institute of Health improvement (IHI), Boston, we took part in a 2-year project to improve the safety and quality of care in adult intensive care.

Methods

Between October 2006 and October 2008 the IHI coached and advised our institution on mechanisms to improve quality of care. The aim was to develop systems of healthcare that were reliable at least 95% of the time. The changes to be introduced - central line bundle, ventilator bundle, hand hygiene, daily patient goals - were led by a small multidisciplinary team chaired by a hospital executive (finance director) who met every 2 weeks for 2 years for short meetings (~1/2 hour). Our aim was to reduce nosocomial infection and mortality.

Results

It took ~12 months to introduce reliable process in all areas. Hand hygiene improved from ~70% compliance to consistently >95%. MRSA acquisition on the ICU reduced from about 10% of patients prior to October 2006 to 0.3%. VAP was reduced (Figure 1). The average unadjusted mortality was reduced year on year despite similar mean APACHE II and ICNARC scores (Figure 2).

Figure 1

Ventilator-associated pneumonias per 1,000 ventilator-days. C03: Musgrove Park Hospital, Taunton and Somerset NHS Trust. CCO1 - VAP rate.

Figure 2

Intensive care mortality between 2006 and 2009.

Conclusions

Reliable evidence-based processes for patient care can significantly reduce nosocomial infection and mortality. The use of executive nonmedical hospital personnel experienced in the mechanisms of introducing change may be beneficial.