VHA National Center for Patient Safety

A virtual breakthrough series allows VA teams, often with members in different geographic locations, to meet by phone or video conference, rather than face-to-face. Such a series allows for effective sharing of ideas while avoiding travel expenses and staff time lost in travel.

Despite the power of modern medicine and the introduction of complex technologies, medicines and treatments, hospital-acquired conditions continue to develop in patients.

To combat these and similar preventable conditions, NCPS adapted the Institute of Medicine’s (IHI) breakthrough series model, originally developed in 1995, into a “virtual” collaborative founded on evidence-based guidelines.

“We have had success leading virtual collaboratives using the IHI model in the past, particularly with fall prevention,” said Julia Neily, M.S., M.P.H., R.N., associate director, NCPS Field Office. “Comparing baseline to follow-up, the overall fall rate decreased 40 percent for 31 teams participating in a recent series, indicating a major improvement.”

A breakthrough series is based on simple, straight-forward goals developed by asking:

• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that will result in improvement?

A virtual breakthrough series allows VA teams, often with members in different geographic locations, to meet by phone or video conference, rather than face-to-face. Such a series allows for effective sharing of ideas while avoiding travel expenses and staff time lost in travel.

“The teams focus on improving patient outcomes by systematically implementing evidence-based practice at the bedside,” said Beth King, R.N., B.S.N., M.A., C.C.M. “For this series, hospital units are focusing on either catheter-associated urinary tract infections or hospital-acquired pressure ulcers. This is not a stand-alone effort, it is intended to complement the many other VA activities that are working to reduce or eliminate hospital-acquired conditions.”

Each virtual breakthrough series combines condition-specific subject matter experts with clinical and NCPS implementation coaches who, together, help hospital unit teams select, test and implement changes.

Successful collaboratives are based on a number of principles associated with a Culture of Safety, including: leadership’s commitment to change, data-driven decision-making, evidence-based practice, developing a “learning culture,”  and improving communication and teamwork.

“The key is to focus on small, gradual changes using the Plan-Do-Study-Act model of continuous cycles of improvement,” said Kristen Miller, Dr. P.H., NCPS patient safety fellow. “We encourage the teams to start by making one change with one patient and then evaluate what they’ve learned.”

NCPS’ virtual model includes coaching calls to facilitate dialogue, providing opportunities to innovate, collaborate, and share best practices between often significantly different units. The teams report initial successes by implementing site-specific improvements using real-time data. 

“The sharing between teams implementing changes is exciting,” said King, “It allows staff with differing levels of expertise from both large and small hospitals to contribute to one another.”

The model continues to show promise for future knowledge-sharing and efficient multi-facility improvement collaboratives.

Learn More 

Stories on virtual breakthrough series that have appeared in TIPS, our bimonthly newsletter:

• Reducing Falls at VA Boston Healthcare System (March/April 2014)
• Working together to Keep Veterans Safe (Nov/Dec 2013)
• The “Butler Tornados” Take on Falls Prevention (Nov/Dec 2013)

Note

The information provided in Ms. Neily’s quote is based on a mean aggregated fall rate decreased from baseline to follow-up: 5.8 to 3.5 falls/1,000 bed days of care; T-test (p=0.0003). Baseline was January-May 2012; follow-up was January-May 2013.

Questions? Email: NCPS@va.gov