Abstract

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.” Theoretical literature has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in healthcare organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing this gap could identify evidence-based management strategies for practice change. Our study sought to both evaluate the theoretical literature and address the gap. A prospective study was conducted in two ICUs within an academic health center; both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down communication interventions were conducted over 52 weeks, to promote CLB adherence in both units. Simultaneously, the study examined: 1) the content and frequency of communication related to CLB through weekly “communication logs” completed by unit physicians, nurses, and managers; and 2) unit outcomes, i.e., CLB adherence rates. Both units demonstrated increased adherence to CLB, and significant, sustained declines in CRBSIs and catheter days (i.e., central line use). Results indicate that the interventions cumulatively, had a significant negative (desired) impact on catheter days. Data from “communication logs” suggest that “change champions” emerged early to initiate process improvements in both units. Findings help validate the theoretical literature, and identify evidence-based management strategies for successful practice change at the unit level.

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