A Baseline STUDY of COMMUNICATION Networks RELATED to EVIDENCE-BASED INFECTION PREVENTION Practices IN AN ICU

Theoretical Background and research questions/hypothesis: Recent hospital infection prevention success stories have suggested that “peer-to-peer” communication network structures, where different professional subgroups (like physicians and nurses) directly communicate with each other regarding practice changes, with minimal interference from authority, may be most effective for improving performance on evidence-based practices. This argument however, is inconsistent with theoretical literature which suggests that “top-down” communication network structures, where changes to work practices are initiated by those with authority, may be more effective for tacit knowledge exchange, learning and improvement in healthcare organizations. These inconsistencies suggest a gap in understanding which communication network structures are more effective for infection prevention, i.e., which are associated with higher compliance on evidence-based practices and lower infection rates. This study seeks to gain a baseline understanding of the: 1) “communication network structure;” 2) “content of communication” and 3) “outcomes” in a medical ICU experiencing higher-than-expected central line blood stream infection (CLBSI) rates. The “communication network structure” refers to the direction and frequency of communication on evidence-based CLBSI prevention practices across various professional subgroups and hierarchical levels in the MICU, including medical faculty, nurses, residents, medical students, unit managers and hospital administrators. The “content of communication” refers to the type of knowledge (i.e., tacit vs. explicit knowledge) exchanged on CLBSI practices. “Outcomes” include 1) compliance with CLBSI prevention practices and 2) CLBSI rates in the unit.

Methods: Data on “communication network structure” and “content of communication” are collected using “communication logs,” completed weekly for four weeks, by a random sample of participants in each professional subgroup and hierarchical level in the MICU. “Outcomes” in the MICU are collected through weekly chart review. Data analysis includes social network analysis (SNA) and content analysis.

Results: The study finds a sparse communication network structure with minimal interaction across subgroups and levels on CLBSI prevention practices. It also finds that primarily explicit knowledge on general infection topics is being exchanged across subgroups (as against tacit knowledge on specific CLBSI practices). Unit outcomes are poor with the “central line bundle score” at 0% for each of the four weeks and the CLBSI rate at the fourth (highest quartile) based on comparative data from the National Healthcare Safety Network (NHSN). 

Conclusions: Results indicate that the baseline communication network structure (related to infection prevention practices) in a poorly performing ICU is substantially different from the “effective communication network structure” suggested in the theoretical literature.

Implications for research and/or practice: This study represents an original attempt at developing methods for measuring communication network structures related to evidence-based practices at the unit level. It lays the groundwork for a comprehensive study directed towards testing hypotheses related to effective communication network structures for hospital infection prevention. The study provides insight into strategies for operationalizing improvement in the context of evidence-based practices. Such insight is critical from the perspective of “evidence-based healthcare management.” The Institute of Medicine (IOM) has stressed the importance of evidence based medicine going hand in hand with evidence-based management. As such addressing the gap in the literature may be critical to reducing the burden of hospital-acquired infections.