(1363) Use of an Interdisciplinary Rounding Model to Optimize Bundled External Ventricular Drain (EVD) Care

Introduction: Bundles of care based are used extensively in critical care settings to reduce complications associated with invasive devices. External ventricular drains (EVD) are used for evaluation and management of patients with severe acquired brain injury, but an evidence-based EVD bundle of care has not been established. However, clinical guidelines emphasize the benefit of local EVD care bundle use to improve outcomes. This quality improvement project chronicles the impact of a weekly interdisciplinary (IDT) EVD rounding model to finesse a local EVD care bundle to dramatically sustain reduction in the EVD-related ventriculitis, while optimizing resource utilization.

Methods: Interprofessional EVD rounds are conducted for 30-minutes weekly and attended by Neurosurgery, nursing, quality and infection prevention on all EVD patients in an academic Level 1 trauma center setting. Rounds include monitoring local EVD bundle of care elements, education of patient and families, providing meaningful staff recognition, entering EVD quality metrics using a handheld phone application to provide quality metric feedback to clinicians and documentation of an EVD IDT note to communicate individualized EVD patient care recommendations in the electronic medical record. Over the 4-year project implementation, new evidence reviews are conducted with systematic local EVD unbundling to sustain improvements while enhancing resource utilization.

Results: The baseline EVD-related ventriculitis rate was 24.7/1000 EVD line days. Systematic unbundling of the original local EVD care bundle resulted in a sustained reduction in EVD-related ventriculitis rate of 2.97/1000 EVD line days, with no EVD-related infections for the last 12-months. Systematically local EVD bundle optimization has contributed to reduction in clinician delivery of care time and cost associated with supply use while augmenting individualized patient care.

Conclusions: Use of an innovative weekly IDT rounding model to optimize local bundled EVD care transformed the local interprofessional culture of care contributing to sustained quality of care improvements with reduction in delivery of care resource use. This IDT rounding model may have applicability to other device-related quality initiatives and warrants further investigation.