Benefit of TeamSTEPPS Rounding Improvement Project on Infection-Related Monitoring
Jack C He, MD, Dept of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine; Joseph Golob Jr M.D., MetroHealth Medical Center; Kate Clancy, Case Western Reserve University School of Medicine; David Schechtman, Case Western Reserve University School of Medicine; Jeffrey Claridge, MetroHealth Medical Center Case Western Reserve
Background:TeamSTEPPS was developed to improve teamwork and patient safety, and was shown to benefit patient care in complex clinical settings including intensive care units. Our two trauma/surgical intensive care units received TeamSTEPPS training, but only Unit 1 participated in a TeamSTEPPS Rounding Improvement Project (TRIP). Our goal was to assess any unintended benefit to infection-related monitoring and prevention from TRIP.
Hypothesis:TRIP implementation in intensive care units would be associated with better monitoring, resulting in improved antibiotic and invasive line/tube stewardship.
Methods:Between September and November, 2014, trained observers prospectively collected data on rounds in both units. Unit personnel were blinded to the data collection process. Monitoring variables obtained for each patient encounter include: review of invasive line/tube presence (endotracheal tube, central line, and urinary catheter), and review of antibiotic indication and course. For patients on antibiotic and had invasive line/tube, we conducted a retrospective review for treatment variables such as: antibiotic duration and cessation accuracy, inappropriate antibiotics days (time difference between actual and planned stop date), and invasive line/tube duration.
Results:416 patient encounters were observed. The use of invasive line/tube was reviewed on rounds significantly more in Unit 1 than Unit 2 (83% vs 51%, p <0.005). In the 135 encounters with patients on antibiotics, review of antibiotic indication, stop date, day into course, and all three components occurred significantly more in Unit 1. Based on the 65 different antibiotic courses encompassed by the 135 encounters, antibiotic duration, cessation accuracy, and inappropriate antibiotic days were not significantly different between the units. From the same 135 encounters, 125 had invasive line/tube placement. Significantly more discussion of line/tube presence occurred in Unit 1, but the duration of their presence was not significantly different (Table 1).
Conclusions:TRIP was associated with an unintended, increased monitoring of antibiotics and invasive line/tube usage. Nevertheless, this did not translate into significant, immediate treatment differences.