Quality Assurance and Performance Improvement
Background : Transmission-based precautions are used for selecting patients with specific diseases or pathogens to protect other patients and healthcare providers. Emergency Departments (ED) are the first line of defense to prevent entry of pathogens into the healthcare setting but are fast paced and quick turnaround departments. Despite well documented outbreaks occurring in this setting, in general, transmission - based precautions have been less frequently implemented in these units. Noting this issue, in the spring of 2016 the institution’s Infection Control (IC) department partnered with ED leadership to promote improved use of transmission-based precautions.
Methods : IC assessed the appropriate use of isolation signs posted as per written isolation orders between February 2016 through September 2018 and introduced progressive process improvements through education of the ED staff by IC and attention to standard work for surveillance. Near-real time feedback was given for compliance and non–compliance to individual providers and summary results were provided monthly to the ED leadership. Unusual observations were photographed and shared real-time with ED leadership.
Results : Over the study period there were 753 total observations,and the percent of patients without appropriate signage decreased from 53% in the first year to 29% for the period from September 2017 through September 2018 (p-value < 0.001). Additional observed benefits of our intervention included: increased staff engagement in the use of isolation precautions and the elimination in the use of hand written signs.
Conclusions : A collaborative quality improvement initiative between the IC and ED leadership led to a marked improvement in the appropriate use of transmission-based isolation signage. A culture of accountability coupled with a supportive relationship established between the departments helped drive culture change. More work efforts are now underway focusing on confirming that isolation precautions are ordered when appropriate, and to assess the time required to institute precautions.