Successful Quality Improvement Project Research Articles

Improving Inpatient Colonoscopy Bowel Preparation: A Successful Quality Improvement Project.

Inadequate inpatient bowel preparation can lead to repeat procedures, prolonged hospital stays, and increased financial burden. In this quality improvement project, the authors developed an electronic medical record (EMR)-based order set with precise instructions and anticipatory guidance for inpatient bowel preparation before colonoscopy. The current study is a nonrandomized intervention study. The authors compared 2 groups: an intervention group using a newly developed, consensus-based, standardized EMR bowel preparation order set and a control group using previously existing EMR bowel preparation orders. Bowel preparation outcomes were followed over the course of 16 months. The aim was to improve inpatient colonoscopy bowel preparation, as evaluated by the Boston Bowel Preparation Scale, procedure delays, and length of hospital stay. We additionally evaluated the groups' demographics and patient-level factors. A total of 459 inpatient colonoscopies were evaluated over a 16-month period. The intervention group consisted of 227 inpatient colonoscopies, while the control group consisted of 232. The intervention group showed superior Boston Bowel Preparation Scale score and decreased length of hospital stay. The number of adequate bowel preparations increased in the intervention group when compared to the control group from 77% to 86%. The creation of an EMR-based order set is a low-cost and sustainable action that can be easily implemented throughout a hospital system.

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

BackgroundPublic–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.MethodsWe searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.ResultsWe identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change.ConclusionsMany of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.

A quality improvement project to establish accuracy in completing Early Warning Score chart and appropriate clinical response depending on the score in acute care wards at Asiri Surgical Hospital

Failure or delay in recognition of acutely deteriorating patients in acute care ward setting leads to preventable morbidity, cardiac arrest, and death. Assessment and responding to Early Warning Score (EWS) adapted from National Early Warning Score 2 is implemented at Asiri Surgical Hospital to capture these patients early and escalate their care appropriately. Though a colour-coded EWS chart and a hospital policy are available, gaps in accurate recording, monitoring, and triggering were reported. Thus, a quality improvement project was conducted with the aim of establishing more than 80% accuracy in completing the EWS chart and appropriate clinical response to EWS score in acute care wards at Asiri Surgical Hospital by August 2022.A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focusing on correct documentation and calculation of EWS score and appropriate monitoring and escalation of care. Key drivers for hindering the pathway were identified and addressed. Over the course of the project, correct recording improved from 81.25% to 99.4%, accurate calculation of total EWS score had improved from 79% to 88%, patients who received recommended monitoring as triggered by EWS score improved from 78.8% to 84.6% and escalation of care when EWS score is 5 or more improved from 70.9% to 91.7%.A step improvement in the clinical response to a deteriorating patient in the acute care ward setting at Asiri Surgical Hospital was attained by the successful quality improvement project involving the frontline care providers.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum.

Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.

Successful quality improvement project to increase hydroxyurea prescriptions for children with sickle cell anaemia

Hydroxyurea (HU) is an effective but underused disease-modifying therapy for patients with sickle cell anaemia (SCA). EMBRACE SCD, a sickle cell disease treatment demonstration project, aimed to improve access to...

Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project.

Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.

Moving Toward a Safer Health Care Facility: Improving Patient Identification at a Public Hospital in Saudi Arabia.

Patient misidentification errors continue to represent a significant risk to patients, health care staff, and hospitals. The study's purpose was to present a successful quality improvement project implemented in a public hospital in Saudi Arabia. The project focused on increasing staff's compliance with and awareness of the hospital's patient identification policy to thus reducing the number of patient misidentification-related incidents. Through a quality improvement project, we employed FOCUS PDSA to address the issue of patient misidentification at outpatient departments. A total of 640 staff members participated in the educational program including physicians, nurses, receptionists, radiologists, physiotherapists, and laboratory staff. Collected data included measures of compliance and awareness levels as well as patient misidentification incidents, before and after the project. Statistical analysis was conducted to measure significant differences in the study indicators before and after the project. Results from the post-project assessment revealed that the project was successful in achieving its objectives. The overall compliance rate and awareness level increased from 59% to 78% and from 75% to 90%, respectively. Improvement in the levels of compliance and awareness was statistically significant. The average number of patient misidentification errors also reduced after the project's implementation with an average of 3 errors per month. The mean difference of patient misidentification errors before and after the project was significant ( P < .01). This project demonstrated how quality improvement projects can be used to address a critical issue such as patient misidentification. The project furthers efforts made by national and international agencies to improve patient safety. It also highlights the importance of continuous education and training to ensure compliance with patient identification policies that ultimately contributes to a safer hospital environment.

Establishing a Diagnostic Autism Assessment Clinic in a Primary Healthcare Setting to Reduce Waiting Times, Increase Efficiencies and to Improve the Patient Journey and Clinical Outcomes

AimsTo establish a multidisciplinary diagnostic autism assessment clinic in primary healthcare so as to reduce lengthening waiting lists for specialist hospital based services, to increase efficiencies and improve the patient journey and clinical outcome. Timely diagnosis and early access to community based early intervention services optimizes outcomes.MethodsWaiting time for specialist hospital based services were increasing in number. Analysis of the data revealed that 42.9% of all referrals were autism related and 75.5% of these referrals were for autism assessments in under six-year-olds. Bottlenecks were found in the current system. In collaboration with primary healthcare colleagues, a new pathway was developed with paediatricians, social workers and primary healthcare physicians completing a comprehensive initial assessment including conducting a Childhood Autism Rating Scale (CARS). Each of the three hospital based child psychiatrists then ran a diagnostic autism clinic in the primary healthcare setting once a month (so three clinics in total) to review the initial assessment, meet the child and family/carers and then to confirm the diagnosis and write a medical report for community based services as appropriate. Follow-up care remained in primary healthcare unless there was diagnostic uncertainty, significant behavioural difficulties or comorbidities requiring medication. The project timeline started with one and gradually increased to four diagnostic assessments in each clinic, that is, twelve per month.Results57 diagnostic assessments were completed in first eight month period. Waiting times for diagnostic assessments in under six-year-olds were reduced from two to four months to only one to two weeks. Medical reports were issued within five working days. Under six-year-olds and their parents no longer had to attend busy, less child friendly hospital settings but rather were able to attend a purpose build early intervention centre within the primary healthcare setting.ConclusionIn conclusion, this is an example of a successful quality improvement project embracing the efficiencies of integrated models of care between primary, secondary and tertiary services. Critical success factors included strong leadership support, compelling rationale and purpose, clear clinical pathways and clear roles and responsibilities. It was presented as part of the hospital wide quality meetings in November 2021.

Pain Management Program in Cardiology: A Template for Application of Normalization Process Theory and Social Marketing to Implement a Change in Practice Quality Improvement.

Quality improvement plays a major role in healthcare, and numerous approaches have been developed to implement changes. However, the reasons for success or failure of the methods applied often remains obscure. Normalization process theory, recently developed in sociology, provides a flexible framework upon which to construct quality improvement. We sought to determine if examination of a successful quality improvement project, using normalization process theory and social marketing, provided insight into implementation. We performed a retrospective analysis of the steps taken to implement a pain management program in an electrophysiology clinic. We mapped these steps, and the corresponding social marketing tools used, to elements of normalization process theory. The combination of mapping implementation steps and marketing approaches to the theory provided insight into the quality-improvement process. Specifically, examination of the steps in the context of normalization process theory highlighted barriers to implementation at individual, group, and organizational levels. Importantly, the mapping also highlighted how facilitators were able to overcome the barriers with marketing techniques. Furthermore, integration with social marketing revealed how promotion of tangibility of benefits aided communication and how process co-creation between stakeholders enhanced value. Our implementation of a pain-management program was successful in a challenging environment composed of several stakeholder groups with entrenched initial positions. Therefore, we propose that the behavior change elements of normalization process theory combined with social marketing provide a flexible framework to initiate quality improvement.

Successful Quality Improvement Projects to Maximize Prescription Rates and Acceptance of Hydroxyurea Among Patients with Sickle Cell Anemia

Background: “Education and Mentoring to Bring Access to Care for SCD (EMBRACE SCD)”–U1EMC31108-- is a multicenter study sponsored by HRSA in the US southeastern region, which focuses on extending knowledge about sickle cell disease (SCD) to hematology and primary care providers and to improve the care of children and adults with SCD. In Florida we aimed to improve access by increasing prescription (RX) rates of hydroxyurea (HU), by at least 10% from baseline in patients with sickle cell anemia.Methods: Three SCD centers, assisted by three community-based organizations and with the support of two pediatricians with expertise in quality improvement (QI), were engaged in this QI project. The SCD centers are the University of Miami (UM), Salah Foundation at Broward Health and Johns Hopkins All Children's Hospital (JH). Data were abstracted locally and entered into REDCap by a central data manager. Run charts were created to assess data improvement. UM also assessed barriers using a parent/caregiver questionnaire administered at least 6 months after offering HU with the purpose of improving patient education and desire to take HU.Results: Beginning in June 2019 until June 2021, center clinicians concentrated in identifying all patients who were eligible for HU (namely, children 9 months and older with hemoglobin SS and hemoglobin SB 0thalassemia who were not on chronic transfusions). As a group, 50.2% (N=263) of patients were on hydroxyurea at entry (range 35.4-62.4 % among the sites) from a total of 524 eligible patients. The main organizing activities which allowed for higher percent were having a center patient database (done March 2019), educating all providers in the centers about the importance of HU as disease-modifying therapy, having a unified protocol for the education of parents and/or patients about HU benefits, and using visual aids (pictures) of erythrocytes pre and post HU treatment. The QI consultants met virtually with the Florida EMBRACE team monthly beginning June 2020 to increase engagement and interest in participating in this QI activity. We implemented a data collection sheet to track medical records every month to determine whether we were capturing all eligible patients. As depicted in the run chart, we surpassed the QI goal by ending with 64.8% (N=343) prescription rate (range 48.0-85.0 %) from a total of 529 eligible patients.From the 76 barrier assessment questionnaires given at UM, we identified 12 (15.8%) refusals. Seven of 12 refused because of fear of taking “chemotherapy”, one because of fear of side effects, and four because their children's disease was considered mild. With further education, we decreased the refusals from 12 to 9.Conclusion: A unified approach to a QI project was successful among several centers in Florida, increasing the prescription rate of hydroxyurea by 14.6% among patients with sickle cell anemia.Acknowledgment: We acknowledge HRSA and region principal investigators for EMBRACE SCD Drs. Ify Osunkwo, Julie Kanter and John J. Strouse for their support in this work. [Display omitted] DisclosuresAlvarez: Forma Therapeutics: Membership on an entity's Board of Directors or advisory committees; GBT: Membership on an entity's Board of Directors or advisory committees. Clay: Novartis: Honoraria; GBT: Membership on an entity's Board of Directors or advisory committees.

Registration of catheter-related complications in adverse events reporting systems: a major underestimation of the real complication practice.

Reporting and learning from preventable adverse events is crucial to improve patient safety. Although physicians should file and analyse adverse events by law in The Netherlands, it is unknown if these reporting systems are sufficiently used in clinical practice. This study is a substudy of the multicenter RICAT trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in medical wards in seven hospitals, in which we screened 5696 patients and documented 803 catheter-related complications. We also checked the adverse events reporting systems of these patients and found that only 13 (1.6%) of 803 catheter-related complications were registered. Of the infectious complications only five (10.9%) of 46 catheter-associated bloodstream infections and urinary tract infections were registered. We conclude that the reported complications were a major underestimation of the real complication practice in medical wards in The Netherlands.The RICAT trial is registered at Netherlands Trial Register, trial NL5438.

Lean Six Sigma Methodology and the Future of Quality Improvement Education in Anesthesiology.

Lean Six Sigma Methodology and the Future of Quality Improvement Education in Anesthesiology.

Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program.

Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change. An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation. Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation. LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition. The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change. Lean Six Sigma can increase the effectiveness of an EBQI program.

765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care

Abstract Introduction A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway. Method The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI) Results 150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days. Conclusions Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.

Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

BackgroundThere is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects. MethodsEight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions. ResultsCourse evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice. ConclusionsThe course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.

Improving cardiovascular outcomes by using team-supported, EHR-leveraged, active management: Disseminating a successful quality improvement project

BackgroundUncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered support and patient-generated data from home BP monitors and virtual BP visits to manage BP. ObjectiveThe purpose of this project is to augment the current approach to addressing uncontrolled BP so that existing clinical staff can reach a larger patient population. MethodsOur project will address uncontrolled BP by leveraging team-based care, the Veteran's Health Administration Electronic Health Record, and patient-centered medical home data to address patient, provider, and system barriers to cardiovascular disease (CVD) preventive care. We will implement this project in cardiovascular disease practices in three rural Veterans Health Administration clinics. We will evaluate implementation processes as well as patient-level (e.g., clinical outcomes, referrals to specialty services) outcomes in a one-arm, pre-post design. DiscussionThis manuscript describes our process in expanding the implementation of a successful project to improve BP control in high-risk, rural Veterans. Findings from our study will inform an understanding of both implementation and clinical effectiveness outcomes of a potentially scalable BP intervention in rural, community-based clinics. Appropriate management of Veterans with uncontrolled BP can reduce morbidity and mortality related to CVD. In turn, improvements in BP, can lead to improved quality metrics and potentially decrease costs for a healthcare system.

6. MEET THE TEAM: PAIRING VERBAL INTRODUCTIONS AND VISUAL HANDOUTS TO IMPROVE FAMILY KNOWLEDGE OF THEIR CARE TEAM

Background Hospitalized families often have poor knowledge of care team members which can negatively impact communication. Our institution lacked a standard process to introduce the multilevel learner team to families. Baseline data showed few families had knowledge of team members. We sought to create a standardized approach to introductions during patient and family centered rounds (PFCR) to improve family knowledge of their team. Aim Statement Increase the percent of families interviewed through our rounds coach program with knowledge of their team members to 75% over one year Interventions We conducted a quality improvement (QI) project with multiple plan-do-study-act cycles. We created a “Meet the Team” form (MTTF) outlining team member names, photos, and role explanations for the team (nurses, students, residents, fellows, faculty), b) process mapped and refined the steps of MTTF distribution, c) assessed family preferences for frequency and type of introductions via structured interviews by a trained rounds coach d) implemented a series of interventions to sustain the process including fostering introduction use culture change and data tracking/sharing. Measures The outcome measure was the percent of families interviewed by a rounds coach successfully identifying a team member. The process measure was the percent of PFCR that included introductions. The balancing measure was rounds length. We used statistical process control charts to track the impact of interventions. Results Focused interviews of 141 parents revealed 73% preferred verbal introductions on the first day of PRCR and if new members joined the team; 100% preferred paper over electronic MTTF. For the outcome measure, there was an increase in the percent of families who could identify team members from 10% to 78%. The process measure of the rate of PFCR that included introductions showed special cause variation, increasing from 40% to 80% of PFCR events (Figure 1). The balancing measure of rounds length held steady at ∼11 minutes/patient. Conclusions and Next Steps We performed a successful QI project that substantially increased the frequency of team introductions and increased family knowledge of team members with no change in rounds length. Next steps include evaluating the impact of increased team member knowledge on areas of family experience and understanding of care plans.

How many urinalysis and urine cultures are necessary?

BackgroundUrinalysis and urine culture are two of the most commonly ordered tests. A positive urine test in asymptomatic patients often leads to overtreatment. Antimicrobials for asymptomatic bacteriuria is one of the most common unnecessary treatments. We aimed to explore the current ordering patterns of urinalysis and cultures. MethodsThis is a substudy of the multicentre RICAT-trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in seven hospitals in the Netherlands. Adult patients with a (central or peripheral) venous or urinary catheter admitted to internal medicine and non-surgical subspecialty wards were eligible for inclusion. Data were collected every other week during baseline (seven months) and intervention periods (seven months). The primary outcome was the proportion of urine cultures performed following a negative urinalysis, i.e. dipstick and/or microscopic analysis, within 24 h. ResultsBetween September 2016 and April 2018, we included 3748 patients, of which 3111 (83%) were admitted from the emergency department. Urinalysis and/or urine cultures were obtained in 2610 (70%) of 3748 patients. 626 (23.7%) of 2636 urine cultures and 1351 (55.8%) of 2419 microscopic analysis were unnecessary performed after a negative urinalysis. Cancelling urine testing orders after a negative dipstick would have saved almost € 19.500 during the study period in these seven hospitals. ConclusionUnnecessary urine testing is frequent in non-surgical patients in the Netherlands. We need to take action to reduce unnecessary urinalysis and cultures, and thereby probably reduce overtreatment of asymptomatic bacteriuria.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Developing an Infection Prevention Position for a Multi-Center Hospital-based Dialysis System

<h3>Background</h3> There exists in most dialysis centers opportunities for improvement, including infection control practices, work practice safety, medication safety, regulatory compliance, training, and cost reduction. Although IP's are experts in HAI prevention, implementation science and problem-solving, it is typical for dialysis centers to have only limited access to an infection preventionist (IP). This hospital-based dialysis system created a .8 FTE IP dialysis staff position to support existing quality improvement efforts and address compliance and infection control issues. <h3>Methods</h3> 2 IPs are responsible for this health system's infection prevention program, including 4 outpatient hemodialysis centers, 1 inpatient hemodialysis center and a home peritoneal dialysis program. Prior to September 2018, the dialysis centers' monthly audits, compliance and quality improvement issues were the responsibility of the centers' supervisors and manager. Based on an increase in NHSN positive blood culture events and observed infection control and compliance issues, the health system identified the need for additional IP support for dialysis. A .8 FTE IP position was created within dialysis with job responsibilities in the area of both infection control and compliance. <h3>Results</h3> Positive blood culture events dropped 42%, from 12 in 2018 to 7 (as of December 2019). Compliance with the contact time during dialysis catheter hub disinfection improved from 8% to a sustained 100%. Likewise, compliance with skin antisepsis contact time improved from 40% to a sustained 100%. The IP was a major contributor to over 25 successful quality improvement projects which focused on safety, infection prevention, regulatory compliance and cost reduction. <h3>Conclusions</h3> The addition of an IP to the dialysis staff can contribute to best practices, safety, infection prevention, regulatory compliance, and reduced costs. Collaboration with the health system's IP's, dialysis staff and leadership is essential for success.