Winning the Fight to Save Lives
Few situations make us feel more helpless and afraid than seeing a loved one hooked up to tubes and machines in Intensive Care. Equally frightening is the fact that the same machines, which save lives, can also contribute to serious complications. Fifteen percent of patients in the U.S. who depend on mechanical ventilators to help them breathe will develop a serious complication. Ventilator-associated pneumonia is the leading killer among all hospital-acquired infections, causing an estimated 26,000 deaths each year.
Hospitals across the nation have been trying to address the problem of secondary infections in Intensive Care for some time. If you or someone you love is one of the 15,500 people each year who find themselves in an Intensive Care Unit in Rhode Island—we would like you to know what we are doing to help turn the tide on this devastating problem and improve the safety of intensive care in our state.
The good news is that techniques recently identified as most effective for reducing secondary infections in the ICU are low-tech, simple in concept, and produce remarkable results.
By concentrating on five evidence-based areas of intervention as many as 167,819 deaths can be prevented nationally and we can significantly reduce costs incurred by patient complications in ICU’s. Actions, such as raising the head of the bed to an angle of 30-45 degrees and making sure patients are weaned off ventilators as quickly as possible, can cut deadly infection rates dramatically.
Sharing this knowledge is important but not enough. Hospitals in Michigan, Maryland, and New Jersey and Rhode Island are finding that they can attain more consistent results, enhance communications and staffing, and turn simple techniques into lifesaving daily procedures by forming ICU improvement collaboratives. Of the 108 Intensive Care Units participating in the Michigan pilot program, about one third reduced ventilator associated pneumonia and catheter-related blood stream infections to zero. Learn more about the Michigan study.
Making Rhode Island’s ICU’s safer—faster
In 2004, Congressman Kennedy challenged Rhode Islanders to ask—how can we help our hospitals apply this evidence-based knowledge and produce significant results as rapidly as possible? We knew that, while some of our hospitals were performing very well, a collaborative ICU improvement program could provide all our hospitals with guidance from leading experts, train them in the science of safety and modern improvement techniques, and allow them to share best practices, but who was going to find the funds and organize this kind of effort? This was the perfect role for the Rhode Island Quality Institute. We provide the forum to secure funding for the project, and our board members, Quality Partners of Rhode Island and the Hospital Association of Rhode Island provide project management by monitoring progress and maintaining momentum for the state’s collaborative ICU improvement efforts.
Our goal is to help the Rhode Island ICU Improvement Collaborative adopt the techniques already yielding dramatic improvements in ICUs across the country.
To speed up the rate of learning we have entered into an agreement with John Hopkins University. Now every hospital in Rhode Island’s ICU Improvement Collaborative can benefit from working closely with Johns Hopkins and Rhode Island’s own national experts, as well as access tools and resources for planning, implementation, evaluation and networking with other ICU’s.
Chalk up our state’s 100% participation rate to the efforts of Quality Partners of Rhode Island, the Hospital Association of Rhode Island, and Rhode Island’s hospital leaders. Project leaders from Quality Partners of Rhode Island and the Hospital Association visited every hospital in the state to evaluate their existing quality programs and encourage them to join the effort.
The Rhode Island Collaborative applies a rapid-cycle improvement model that follows material developed in other states to facilitate peer-to-peer ICU team sharing strategies. This model has been successfully used in ICU projects and other hospital quality improvement efforts in Rhode Island. In addition to reducing cases of secondary infection, the collaborative aims to improve overall efficiency, reduce costs, change culture, improve staffing, and improve patient, family, and staff satisfaction.
Saving Lives—Curbing Costs
Case Study
A teaching hospital’s sharp focus on preventing infection has resulted in significant savings in both lives and financial costs.* The hospital estimated that patients diagnosed with ventilated associated pneumonia averaged a 34-day stay, with a net loss to the hospital of $24,435 after reimbursement and patients diagnosed with central line associated bloodstream infection averaged a 28-day stay, at an operating loss of $26,839.
For an investment of about $35,000 in improvement procedures, the hospital’s ventilated associated pneumonia rate dropped by 83 percent and its central line associated bloodstream infection rate fell by 87 percent during just one year. By reducing the rate of infection the hospital also reduced the rate of patient stay and associated expenses. (Institute for Healthcare Improvement) We look forward to reporting similar statistics in Rhode Island as our pilot program matures.
*Case study courtesy of Allegheny General, a 580-bed hospital in Pittsburgh, Pennsylvania.
Reductions in length of stay, complications from ventilator-associated pneumonia and catheter-related blood stream infection while in the ICU translate into significant cost savings to the health care system. We would like to thank Blue Cross and Blue Shield of Rhode Island which has donated $609,000, and United Healthcare of RI, which has donated $261,000 to fund the coordination of the Rhode Island ICU collaborative for two years. This funding goes towards project management, data collection and surveys, oversight by national experts, and sharing of best practices. Rhode Island hospitals have agreed to absorb internal costs, which total approximately $2,596,000 for staffing the pilot program for our 22 Intensive Care Units.
Rhode Island could save over $6 million annually by preventing ventilator-associated pneumonia. (Estimated cost savings based on data from RI hospitals and John Hopkins University)
Support the Effort and Sustain Front Line Gains
How do we continue to improve intensive care and protect the lives of our most vulnerable?
We need to fund the Rhode Island ICU Improvement Collaborative after the pilot phase. The Rhode Island Quality Institute is investigating potential funding sources. Those who support this effort will make health care safer and more effective and help hospitals achieve the best possible outcomes for all patients.
