This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law. Clinical Performance and 100k Lives Campaign Peter J. Plantes, MD Vice President Clinical Performance (972) 830-0322 [email protected]Version 8.HV
Clinical Performance and 100k Lives Campaign. Version 8.HV. Peter J. Plantes, MD Vice President Clinical Performance (972) 830-0322 [email protected]. What We Do. Improve members’ clinical and economic performance. VHA Member Networks Accelerate Members’ Competitive Advantage. - PowerPoint PPT Presentation
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This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
There are approximately 5.3 CR-BSIs per 1,000 catheter days in the ICU
Central Line “Bundle”
o Hand Hygiene
o Maximal Barrier Precautions
o Chlorhexidine Skin Antisepsis
o Appropriate Catheter Site Administration and Care
o No Routine Replacement
IHI Intervention Call – March 30, 2pm EST
Statistics - Source: www.ihi.org
11This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Prevention of Surgical Site Infections: Stats
SSIs account for 14-16% of hospital acquired
infections.
Among surgical patients,
SSIs account for 40% of hospital acquired
infections.
Surgical patients who develop SSIs are twice as
likely to die.
SSI is a component of
VHA’s Transformation of the OR
Source: www.ihi.org
12This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Prevention of Surgical Site Infections
Measures
o Antibiotic Selection
o Antibiotic Start
o Antibiotic Discontinuance
o Appropriate Hair Removal
o Peri-operative Glucose Control
IHI Intervention Call – March 23, 2pm EST
13This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Prevention of Ventilator Associated Pneumonia
VAP occurs in 15% of mechanically ventilated patients;
Mortality rate of patients who develop VAP is 46%
“Ventilator Bundle”
o HOB Elevation of 30 Degrees
o Daily Sedation Vacations
o Daily Assessment of Readiness to Extubate
o PUD prophylaxis
o DVT prophylaxis
IHI Intervention Call-March 30, 2pm EST
14This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
VHA executive leadership pledges commitment to the 100k lives
Campaign – communicated to senior management team. (December
’04)
CEO Communiqué, January 2005
“VHA has established a significant clinical agenda for 2005”
VHA will “…disseminate powerful improvement tools, with
supporting expertise, throughout the American health care
system.”
“VHA will serve as a coach and data repository for member
organizations that wish to join the 100,000 lives Campaign.”
‘100k lives Campaign’ - VHA Commitment
15This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Actions:
1. Recruit VHA members and assist in program enrollment
2. Connect VHA participating hospitals to facilitate dialogue
and monitor progress
3. Collect VHA hospital performance data and forward to IHI
4. Support the implementation of the six clinical interventions
via VHA programs Transformation of the ICU
Transformation of the OR
Cardiovascular Bundle
Rapid Response Teams
‘100k lives Campaign’ – VHA’s Actions
16This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Structure for Participation
Hospital Level – the basic element of
campaign
Network Level – systems or associations or
collections of facilities
Node Level – a sponsoring organization for a
network (example – VHA “super-node”)
IHI Field Operations Level
17This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
VHA Area Offices - A Key Differentiator
Central
Pennsylvania
Central Atlantic
East Coast
Empire State
Georgia
Gulf States
Metro Michigan Mid-America
Mountain States
New England Northeast
Oklahoma/Arkansas
Southeast SouthwestUpper
MidwestWest Coast
18This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Delivery Vision
NATIONAL
AreaOffice
AreaOffice
AreaOffice
AreaOffice
AreaOffice
VHA Area Offices - A Key Differentiator
18 “nodes” of action tied together as the
VHA “super-node” in the 100k lives Campaign.
Results:Results: 1/3rd of the 2000+ hospitals enrolled are
VHA
The VHA potential…..18 Area Offices providing
local/regional collaboration supported by a small
national team and national data management
resources.
19This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
20This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
COLLECT: Real Time Data Entry of Clinical Metrics and Indicators
21This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
COLLECT: Real Time Reporting & Benchmarking of Clinical Metrics and Indicators
Automatically Export Data intoMicrosoft Excel with one click.
Review your Hospital’s results on various Topics
Compare your results against Customized peer groups and National Averages in a real time environment.
22This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Executive Style Dashboards and scorecards available to track your progress on various Clinical Performance
Initiatives.
23This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
IHI Interventions vs. VHA offering
Deploy Rapid Response Teams
RRT Program offering
Deliver Reliable, Evidenced
Based Care for Acute
Myocardial Infarction
CV Bundle Program offering
Prevent Adverse Drug Events (ADEs) –
Medication Reconciliation
Included domain in all Programs
Prevent Central Line Infections
TICU domain
Prevent Surgical Site Infections
Surg/TOR Program offering
Prevent Ventilator-Associated
Pneumonia
TICU domain
VHA offering vs. IHI Interventions
RRT Program offering(VHA-SE collaboration)
Deploy Rapid Response Teams
Prevent ADEs- Med Reconciliation
CV Bundle Program offering
Deliver Reliable, Evidenced
Based Care for Acute
Myocardial Infarction
Prevent ADEs- Med Reconciliation
Surg / Transformation of the OR (TOR)
Prevent Surgical Site Infections
Prevent ADEs- Med Reconciliation
Transformation of the ICU
(TICU)
Prevent Central Line Infections
Prevent Ventilator-Associated
Pneumonia
Prevent ADEs- Med Reconciliation
100k lives Clinical Performance – Program match
24This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Transformation of the ICU
Content Links to the “100k
lives Campaign”:
o Ventilator Associated
Pneumonia (VAP)
o Central Venous Line Infections
(BSI)
o Rapid Response Teams (RRT)
o Medication Reconciliation
Program Components:
o Nationally prominent subject matter experts
o Two face-to-face meetings annually
o Monthly coaching calls
o Measurement tool and database (ICU-CM)
o Content calls
o Short assessment
o Secured space in CKM for “tools”
(order sets, presentations, patient education
materials, etc.)
o Listserv
25This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
VHA’s TICU Clinical and Economic Impact
ICU COST SAVINGS/REVENUE ENHANCEMENT
TICU Impact: Average Length of StayAnd Vent Days Decreased
12.910.8
4.94.3
0.02.04.06.08.0
10.012.014.0
Average LOS Average Vent Days
BaselinePost
Da
ys
36% reduction
TICU Impact: Sepsis Reduction
Cost savings from reduced ICU LOS •Moving from an ICU inpatient [$2,674] to a non-ICU inpatient bed [$891] = $1,783 X 8 days = $14,264 cost savings per patient•Per patient savings ($14,264) x Average Hospital ICU Census (892) = $12,723,488 savings per hospital
Cost savings from reduced Vent Days •Base costs per patient ($2,115/day) x 6.5 day reduction = Average savings of $13,745 per patient
Cost savings from Sepsis reduction (Implied) and revenue enhancement•Median margin expense of severe sepsis patients ($10,623) is partially avoided by either reductions in LOS and/or reductions in incidence of sepsis itself•Reduction in excessive expenses, including supply costs and cost per case•Revenue enhancement opportunity of open ICU beds(Note: exact contribution cannot be calculated)
26This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly
prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.
Mortality Rate (Percent) Sepsis Population: On ICU AdmissionReporting Period: November 2003 to December 2004
Total number of ICUs in group participated in reporting: 19
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prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.