Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan.

Unlabelled: The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation.

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.

Purpose: Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination.

Materials And Methods: We administered a survey at the 2016 MHA Keystone Center ICU workshop.

Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures.

BACKGROUND Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared. METHODS A total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use.

Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.

Background: There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance.

Methods: This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings.

Results: 16 797 of 23 853 administered surveys were returned (70.

ICU team composition and its association with ABCDE implementation in a quality collaborative.

Purpose: Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation.

Materials & Methods: We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility.

Protocol-Based Resuscitation Bundle to Improve Outcomes in Septic Shock Patients: Evaluation of the Michigan Health and Hospital Association Keystone Sepsis Collaborative.

Objectives: To evaluate the impact of a multi-ICU quality improvement collaborative implementing a protocol-based resuscitation bundle to treat septic shock patients.

Design: A difference-in-differences analysis compared patient outcomes in hospitals participating in the Michigan Health & Hospital Association Keystone Sepsis collaborative (n = 37) with noncollaborative hospitals (n = 50) pre- (2010-2011) and postimplementation (2012-2013). Collaborative hospitals were also stratified as high (n = 19) and low (n = 18) adherence based on their overall bundle adherence.

A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care.

Background: Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors--appropriate catheter use, aseptic insertion, and proper maintenance--and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI.

Methods: The national Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs.

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives.

Background: The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections-central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety.

Objective: Examine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates.

Methods: We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives.

ABCDE, but in that order? A cross-sectional survey of Michigan intensive care unit sedation, delirium, and early mobility practices.

Rationale: A bundled approach to intensive care unit (ICU) care known as "Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility" (ABCDE) has been proposed, with evidence supporting individual interventions as well as the bundle as a whole. Few data exist on the bundle's implementation and efficacy in community practice.

Objectives: To evaluate self-reported rates of implementation of ABCDE components and their association with outcomes in a state-wide quality improvement collaborative.

Sustaining Reductions in Central Line-Associated Bloodstream Infections in Michigan Intensive Care Units: A 10-Year Analysis.

This article describes the interventions that sustained low central line-associated bloodstream infection (CLABSI) rates in the Michigan Keystone ICU Project. This analysis included data from March 2004 to December 2013 for 121 intensive care units (ICUs) in 73 hospitals. The Keystone Project was a cohort collaborative with an improvement team in each ICU.

Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.

Preventing catheter-associated urinary tract infection (CAUTI) remains a significant challenge for US hospitals. The "On the CUSP: Stop CAUTI" initiative represents the single largest national effort (involving >950 hospitals) to mitigate urinary catheter risk. The program brings together key organizations to assist state hospital associations and hospitals by providing education and coaching support, addressing both the technical aspects of preventing CAUTI and CAUTI-specific socio-adaptive challenges.

Issues of survivorship are rarely addressed during intensive care unit stays. Baseline results from a statewide quality improvement collaborative.

Unlabelled: RATIONALE/OBJECTIVE: In the context of increasing survivorship from critical illness, many studies have documented persistent sequelae among survivors. However, few evidence-based therapies exist for these problems. Support groups have proven efficacy in other populations, but little is known about their use after an intensive care unit (ICU) stay.

Eliminating central line-associated bloodstream infections: a national patient safety imperative.

Background: Several studies demonstrating that central line-associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.

Methods: We conducted a collaborative cohort study to evaluate the impact of the national "On the CUSP: Stop BSI" program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network.

Diverse attitudes to and understandings of spontaneous awakening trials: results from a statewide quality improvement collaborative*.

Objectives: Spontaneous awakening trials (SATs) improve outcomes in mechanically ventilated patients, but implementation remains erratic. We examined variation in reported practice, prevalence of attitudes and fears regarding spontaneous awakening trials, and organizational practices associated with routine implementation of spontaneous awakening trials in an ICU quality improvement collaborative.

Design: Written survey.

Preventing catheter-associated urinary tract infection in the United States: a national comparative study.

Importance: Despite the national goal to reduce catheter-associated urinary tract infection (CAUTI) by 25% by 2013, limited data exist describing prevention practices for CAUTI in US hospitals and none associate national practice use to CAUTI-specific standardized infection ratios (SIRs).

Objectives: To identify practices currently used to prevent CAUTI and to compare use and SIRs for a national sample of US hospitals with hospitals in the state of Michigan, which launched a CAUTI prevention initiative in 2007 ("Keystone Bladder Bundle Initiative").

Design And Setting: In 2009, we surveyed infection preventionists at a sample of US hospitals and all Michigan hospitals.

Developing and pilot testing practical measures of preanalytic surgical specimen identification defects.

Accurate patient identification is a National Patient Safety Goal. Misidentification of surgical specimens is associated with increased morbidity, mortality, and costs of care. The authors developed 12 practical, process-based, standardized measures of surgical specimen identification defects during the preanalytic phase of pathology testing (from the operating room to the surgical pathology laboratory) that could be used to quantify the occurrence of these defects.

Improving intensive care unit quality using collaborative networks.

Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario.

Using the Opportunity Estimator tool to improve engagement in a quality and safety intervention.

Teams throughout the United States participating in a program to reduce central line-associated bloodstream infections (CLABSIs) are using the Opportunity Estimator. This web-based tool translates CLABSI-related data into "opportunity estimates" of the patient lives and money that could be saved by reducing these infections.

Michigan Health & Hospital Association Keystone Obstetrics: a statewide collaborative for perinatal patient safety in Michigan.

Background: Preventable harm to mothers and infants during labor and birth is a significant patient safety and professional liability issue. A Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality Obstetric Collaborative Project involved perinatal teams from 15 Michigan hospitals during an 11-month period in 2009. The purpose of the project was to promote safe care practices during labor and birth using the Comprehensive Unit-based Safety Program (CUSP).

Reducing inappropriate urinary catheter use: a statewide effort.

Background: Indwelling urinary catheters may lead to both infectious and noninfectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use.

Methods: Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention promoting adherence to appropriate urinary catheter indications.

Gender based differences in acute stroke care in Michigan hospitals.

Background: We sought to examine whether gender-based differences in acute stroke care occur in both Joint Commission (JC) certified and noncertified hospitals.

Methods: 602 charts of patients with ischemic stroke were reviewed from five JC certified and five noncertified hospitals for gender differences in the prehospital factors, emergency department evaluation, in-hospital stroke care, discharge outcome and use of secondary prevention measures.

Results: More women arrived via ambulance (63.

Are racial disparities in stroke care still prevalent in certified stroke centers?

Racial differences in stroke risk and risk factor prevalence are well established. The present study explored racial differences in the delivery of care to patients with acute stroke between Joint Commission (JC)-certified hospitals and noncertified hospitals. A retrospective chart review was conducted in patients sustaining ischemic stroke admitted to 5 JC-certified centers and 5 noncertified hospitals.

Eradicating central line-associated bloodstream infections statewide: the Hawaii experience.

The authors' goal was to determine if a national intensive care unit (ICU) collaborative to reduce central line-associated bloodstream infections (CLABSIs) would succeed in Hawaii. The intervention period (July 2009 to December 2010) included a comprehensive unit-based safety program; a multifaceted approach to CLABSI prevention; and monitoring of infections. The primary outcome was CLABSI rate.

The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs.

Health care-associated infections affect an estimated 5% of hospitalized patients and represent one of the leading causes of illness and death in the United States. This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.