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BACKGROUND: Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as "change implementation failure." PURPOSE: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap. METHODS: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly "communication logs" completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews. FINDINGS: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in "proactive" communications-that is, communications intended to reduce infection risk-between physicians and nurses over time. Further analysis revealed that, during the early phase of the study, "champions" emerged within each unit to initiate process improvements. PRACTICE IMPLICATIONS: The study helps identify evidence-based management strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation. [ABSTRACT FROM AUTHOR]

Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a "change implementation failure." A prospective study was conducted in 2 intensive care units (ICUs), a medical ICU (MICU) and a pediatric ICU (PICU), within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. The study sought to promote CLB implementation in both units through periodic quality improvement (QI) interventions over a 52-week period. Simultaneously, it examined (1) the content and frequency of communication related to CLB through weekly "communication logs" completed by physicians, nurses, and managers, and (2) outcomes, that is, CLB adherence rates through weekly medical record reviews. The aim of the study was 2-fold: (1) to examine associations between QI interventions and communication content and frequency at the unit level, and (2) to examine associations between communication content and frequency and outcomes at the unit level. The periodic QI interventions were expected to increase CLB adherence and reduce CRBSIs through their influence on communication content and frequency. A total of 2638 instances of communication were analyzed. Both units demonstrated a statistically significant increase in "proactive" communications--that is, communication intended to reduce infection risk between physicians and nurses over time. Proactive communications increased by 68% in the MICU (P < .05) and 61% in the PICU (P < .05). During the same timeframe, both units increased CLB adherence to 100%. Both units also demonstrated statistically significant declines in (1) catheter days: 34% decline in the MICU (P < .05) and 30% in the PICU (P < .05); and (2) CRBSI rates: 63% decline in the MICU (P < .05) and 100% in the PICU (P < .10). Direct costs savings from reduced CRBSIs in 1 year were estimated to be at least $840 000. Periodic QI interventions were effective in refraining interprofessional communication dynamics and enabling practice change. The prospective design provides insights into communication content and frequency associated with collective learning and culture change. The study identifies evidence-based management strategies for positive practice change at the unit level. [ABSTRACT FROM AUTHOR]

In fall 2016, a two-year grant was secured from AHRQ, to pilot a mobile Social Knowledge Networking (SKN) system on Electronic Health Record (EHR) Medication Reconciliation (MedRec), to enable Augusta University (AU) Health System, to progress from "limited-use" of EHR-MedRec technology, to "meaningful-use." The rationale is that an SKN system would enable knowledge exchange on practice issues related to EHR-MedRec, across diverse provider subgroups and settings-of-care, which, in turn, is expected to increase provider engagement, promote inter-professional learning of best-practices, and provide a foundation for practice change (e.g., Meaningful Use of EHR-MedRec technology). Over a one-year period, 50 SKN Users (physicians, nurses, and pharmacists from outpatient-and-inpatient-medicine services), participated in discussing issues-related-to-EHR-MedRec, moderated by 5 SKN Moderators (senior administrators). This paper describes the health system's experiences with this pilot initiative; and discusses lessons learned, in regard to the potential of a mobile SKN system to enable Meaningful Use of EHR-MedRec technology., (©2019 AMIA - All rights reserved.)