Dissertation
A hybrid implementation and improvement framework to drive innovation in critical access hospitals
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Sepsis has a devastating impact on the U.S. population (Rhee et al., 2017). Timeliness in sepsis recognition and intervention is crucial as mortality increases by eight percent for each hour in treatment delay (Kumar et al., 2006). The Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) is a standard to improve long-term mortality (Townsend et al., 2022). In critical access hospitals (CAH), several barriers to sepsis quality improvement exist, including staffing shortages and leaders fulfilling multiple roles (Gale, 2023; Gonzales, 2018; Hoppe & Clukey, 2021; Lemont et al., 2023; Nelson-Brantley et al., 2018; Seright & Winters, 2015). Purpose: The primary purpose of this project is to understand and target local barriers and facilitators to implementation and sustaining sepsis best practices in CAH. The secondary aims are to improve SEP-1 compliance and sepsis mortality. Methods: Following a focus group, a hybrid quality improvement and implementation science design was used. Provider champions were identified and implementation of a nurse-driven sepsis bundle was initiated. Findings: Barriers were identified upon discussion of nurse-driven protocol related to physician hesitancy with protocol use, nursing scope, and antibiotic stewardship. Nursing leaders adapted and created individualized, sustainable sepsis interventions at each site. As a result, sepsis bundle compliance improved and sepsis mortality stayed at 0% or decreased from baseline data. Discussion: Despite initial barriers, nursing leaders adapted styles and strategies to each context to promote clinically significant results. Nursing leaders must align implementation science with quality improvement science and integrate leadership strategies into the project. Additionally, nurse-driven protocols are an opportunity to reduce variability in under-resourced CAH, provided there is adequate structural support and appropriate physician buy-in. A Hybrid Implementation and Improvement Framework to Drive Innovation in Critical Access Hospitals has been recommended.
Details
- Title: Subtitle
- A hybrid implementation and improvement framework to drive innovation in critical access hospitals
- Creators
- Abby Rail - University of Iowa
- Contributors
- M Lindell Joseph (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Health Systems/Administration
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Abby Rail
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841034602771
Metrics
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