Institutional members access full text with Ovid®

Share this article on:

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

Rawat, Nishi MD1,2; Yang, Ting PhD, MHS1,2; Ali, Kisha J. MS1,2; Catanzaro, Mary RN3; Cohen, Mariah D. BA1,2; Farley, Donna O. MPH, PhD1,2; Lubomski, Lisa H. PhD1,2; Thompson, David A. DNSc, MS1,2; Winters, Bradford D. MD, PhD1,2; Cosgrove, Sara E. MD, MS1,4,5; Klompas, Michael MD, MPH6,7; Speck, Kathleen A. MPH1,2; Berenholtz, Sean M. MD, MHS1,2,8

doi: 10.1097/CCM.0000000000002463
Clinical Investigations

Objectives: Ventilator-associated events are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the National Institute of Health and Agency for Healthcare Research and Quality funded a two-state collaborative to reduce ventilator-associated events. We describe the collaborative’s impact on ventilator-associated event rates in 56 ICUs.

Design: Longitudinal quasi-experimental study.

Setting: Fifty-six ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015.

Interventions: We organized a multifaceted intervention to improve adherence with evidence-based practices, unit teamwork, and safety culture. Evidence-based interventions promoted by the collaborative included head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care, and daily spontaneous awakening and breathing trials. Each unit established a multidisciplinary quality improvement team. We coached teams to establish comprehensive unit-based safety programs through monthly teleconferences. Data were collected on rounds using a common tool and entered into a Web-based portal.

Measurements and Results: ICUs reported 69,417 ventilated patient-days of intervention compliance observations and 1,022 unit-months of ventilator-associated event data. Compliance with all evidence-based interventions improved over the course of the collaborative. The quarterly mean ventilator-associated event rate significantly decreased from 7.34 to 4.58 cases per 1,000 ventilator-days after 24 months of implementation (p = 0.007). During the same time period, infection-related ventilator-associated complication and possible and probable ventilator-associated pneumonia rates decreased from 3.15 to 1.56 and 1.41 to 0.31 cases per 1,000 ventilator-days (p = 0.018, p = 0.012), respectively.

Conclusions: A multifaceted intervention was associated with improved compliance with evidence-based interventions and decreases in ventilator-associated event, infection-related ventilator-associated complication, and probable ventilator-associated pneumonia. Our study is the largest to date affirming that best practices can prevent ventilator-associated events.

1Armstrong Institute, Johns Hopkins School of Medicine, Baltimore, MD.

2Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

3The Hospital and Healthsystem Association of Pennsylvania, Harrisburg, PA.

4Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.

5Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

6Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA.

7Department of Medicine, Brigham and Women’s Hospital, Boston, MA.

8Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

This work was performed at Johns Hopkins University School of Medicine.

Drs. Rawat and Yang contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Agency for Healthcare Research and Quality (HHSA29032002T) and National Heart, Lung and Blood Institute (1R01HL105903).

Dr. Rawat’s institution received funding from Agency for Healthcare Research and Quality (AHRQ) (HHSA29032002T) and National Institute of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) (1R01HL105903), received support for article research from the NIH and AHRQ, and disclosed paying CECity for being a vendor. Dr. Yang’s institution received funding from AHRQ, the NIH, Patient-Centered Outcomes Research Institute, and the Moore Foundation, and she received support for article research from the NIH; she disclosed work for hire. Ms. Ali received support for article research from the NIH. Ms. Cohen’s institution received funding from AHRQ and the NIH/NHLBI, and she received support for article research from the NIH and AHRQ. Dr. Farley received funding from Armstrong Institute, Johns Hopkins Medical School (independent consultant on the Armstrong research team). Dr. Lubomski’s institution received funding from AHRQ, NIH/NHLBI, and the American Medical Association, and she received support for article research from the NIH. Dr. Thompson’s institution received funding from AHRQ. Dr. Winters’s institution received funding from AHRQ. Dr. Cosgrove received support for article research from the NIH and AHRQ. Dr. Klompas’s institution received funding from AHRQ and the CDC. Dr. Speck’s institution received funding from AHRQ and the NIH/NHLBI, and she received support for article research from the NIH and AHRQ. Dr. Berenholtz’s institution received funding from AHRQ and the NIH/NHLBI, and he received support for article research from the NIH. Dr. Catanzaro has disclosed that she does not have any potential conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

For information regarding this article, E-mail: nrawat1@jhmi.edu

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.