Delivering Real Time Data: How Quality Management Web-Based Technology Can Change Clinical Behavior and Practice at the Bedside

Objective: To increase clinician involvement in improving and standardizing clinical practices, and implementing best practices, through the design and implementation of quality management web-based technology.

Methods: The Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign to prevent central line infections was prioritized as a quality initiative by the North Shore-LIJ Health System. In order to implement recommended changes in care and to persuade busy clinicians of the importance of accomplishing these tasks, the Krasnoff Quality Management Institute developed web-based databases hospital-specific data entry/reporting. The technology enabled clinicians to enter concurrent data into a site-specific database and provided immediate review of aggregate data through reports. This methodology influenced ICU clinicians in 15 hospitals with open ICU units, some with intensivists and with various complexity of care. The clinicians implemented best practices to reduce central line infection rates through implementation of the evidence-based IHI central line bundle (i.e., maximal barrier precautions, central line site selection, chlorhexidine skin preparation, and hand hygiene). The immediate feedback to clinicians created a shift from reaction to prevention.

Results: Quarterly IHI related data for process indicators were obtained from October 2005 to December 2007 (N=4090). Trends analyses were performed on best practice compliance and bundle compliance of these indicators. Statistically significant improvements in compliance within all components of the central line bundle were seen during this time period (p<.01). Bundle compliance of these indicators increased from 82.1% (Q4 2005) to 98.9% (Q4 2007).

Conclusions: Education on quality measures and the web-based tool influenced clinician behavior in implementing best practices. The immediate feedback of the web entries illuminated the difference between physician perception of compliance and actual compliance.