Contextual Factors Affecting Implementation of In-hospital Pediatric CPR Quality Improvement Interventions in a Resuscitation Collaborative

Abstract

Introduction: Pediatric quality improvement (QI) collaboratives are multisite clinical networks that support cooperative learning. Our goal is to identify the contextual facilitators and barriers to implementing QI resuscitation interventions within a multicenter resuscitation collaborative.

Methods: A mixed-methods evaluation of the contextual facilitators and barriers to implementation of a resuscitation QI bundle. We administered a quantitative questionnaire, the Model for Understanding Success in Quality (MUSIQ), to the Pediatric Resuscitation Quality (pediRES-Q) Collaborative. Its primary goal is to optimize the care of children who experience in-hospital cardiac arrest through a resuscitation QI bundle. We also conducted semistructured phone interviews with site primary investigators adapted from the Consolidated Framework for Implementation Research qualitative interview guide.

Results: All 13 actively participating US sites completed the MUSIQ questionnaire. Total MUSIQ scores ranged from 86.0 to 140.5 (median of 118.7, interquartile range 103.6-124.5). Evaluation of the QI team subsection noted a mean score of 5.5 for low implementers and 6.1 for high implementers (P = 0.02). We conducted 8 interviews with the local QI team leadership. Contextual facilitators included a unified institutional approach to QI, a fail forward climate, leadership support, strong microculture, knowledge of other organizations, and prioritization of goals. Contextual barriers included low team tenure, no specific allocation of resources, lack of formalized QI training, and lack of support and buy-in by leaders and staff.

Conclusions: Using mixed methods, we identified an association between the local QI team's strength and the successful implementation of the QI interventions.

Fig. 1.

Comparison of median Total MUSIQ score for high (2–3 interventions) and low (0–1 intervention) implementers. Median score for low implementers was 112.6 and for high implementers was 123.6. For low implementers, 86.0 = min, 103.6 = 25th percentile, 112.6 = median, 119.6 = 75th percentile, and 124.2 = max. For high implementers, 87.6 = min, 119.6 = 25th percentile, 123.6 = median, 131.8 = 75th quartile, and 140.5 = max. The blue box indicates a score of 120–168 determined to have a reasonable chance of success, and the green box indicates a total score of 80–119, indicating possible contextual barriers.