(1241) Successful Execution of an Objective and Key Result Framework to Reduce ICU CLABSI and CAUTI Rates

Monday, January 22, 2024

9:00 AM – 10:00 AM MT

Location: Connections Central - RST 02

First Author(s)

Nicholas Kelly (he/him/his)

n/a
Aurora

Co-Author(s)

BS

Breandan Sullivan, MD

Associate Professor of Anesthesiology and Critical Care, CTICU Director
University of Colorado, United States
Benjamin K. Scott, MD (he/him/his)

Associate Professor of Anesthesiology and Critical Care
University of Colorado
Aurora, CO
FW

Franklin Wright, MD

Associate Professor of Surgery, STICU Co-Director
University of Colorado Anschutz Medical Campus, United States
AW

Arek Wiktor, MD

Associate Professor of Surgery, Director of the UCH Burn and Frostbite Center
University of Colorado, United States
MM

Mark Mikkelsen, MD, MSCE, FCCM

Professor of Pulmonary Medicine and Critical Care, Associate Chief Medical Officer
University of Colorado Hospital, United States
MM

Mandy Moorer, MSN, RN, NPD-BC, CCRN-K

Director of Patient Services- Critical Care
UC Health, United States
SV

Shannon Vernon, RN

Clinical Quality Specialist
UC Health, United States
JB

Jason Brainard, MD, FCCM

Anesthesiology Section Chief of Critical Care, Medical Director of Surgical Critical Care
University of Colorado School of Medicine, United States

Introduction: Hospital-acquired infections, including central-line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) represent opportunities to prevent iatrogenic injury, reduce costs, and improve outcomes. Development of a CLABSI has been demonstrated to increase costs by $32,000 and risk of mortality by 2.27 fold1 and intensive care units (ICU) patients with CAUTIs have been shown to increase costs by up to $1000.2 To improve rates of CLABSIs and CAUTIs, the University of Colorado Hospital (UCH) surgical ICUs implemented a quality improvement framework to reduce the incidence of CLABSIs and CAUTIs.

Methods: The UCH surgical ICUs implemented a new Objective and Key Result (OKR) structure for ICU quality improvement starting in July 2022. OKRs are a goal-setting framework that helps to focus and align efforts and track progress toward the objective.3 For this project, the objective was a reduction in ICU CLABSI and CAUTI rates, and key results included: incorporating in-depth CLABSI and CAUTI reviews into monthly leadership meetings, communicating opportunities for improvement to frontline teams, and renewed utilization of a daily rounding checklist, including discussion of necessity for indwelling central lines and foleys. The SIR (standardized infection rate) was compared before and after the intervention.

Results: All key results were enacted and achieved between July and December of 2022. The annual SIR was compared for the July-June 2022 and 2023 academic years. The three subspecialty surgical ICUs (Surgical-Trauma ICU (STICU), Cardiothoracic ICU (CTICU), Burn ICU (BICU)) decreased their CLABSI rates from academic year 2022 to 2023. The overall CLABSI SIR decreased from 1.17 to 0.80 and the incidence was reduced from 11 to 8. The ICUs decreased their overall CAUTI rate during this same timeframe. The CAUTI SIR decreased from 0.52 to 0.46, and the incidence was reduced from 7 to 6.

Conclusions: An Objective and Key Result (OKR) quality improvement framework was successfully implemented in the UCH STICU, CTICU, and BICU, leading to a reduction in the overall SIR and total number of CLABSIs and CAUTIs. For the next academic year, OKRs will be updated to include additional key results with a goal of further reduction in hospital-acquired infections.