Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach

BACKGROUND The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root‐cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE Our short‐term goal was a 50% reduction of both CVC‐associated and all‐cause IAP rates within 18 months, with long‐term goals of sustained reduction. DESIGN Observational study. SETTING Academic tertiary care hospital. PATIENTS Consecutive inpatients from 2006 to 2014. INTERVENTION Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services. MEASUREMENTS: CVC‐associated IAP, all‐cause IAP rate. RESULTS We achieved both a short‐term (years 2006 to 2008) and long‐term (years 2006 to 2008–2014) reduction in our CVC‐associated and all‐cause IAP rates. Our short‐term reduction in our CVC‐associated IAP was 53% (P = 0.088), and our long‐term reduction was 85% (P