Linking Quality Improvement and Infection Prevention Manoj Jain, MD, MPH Medical Director, QSource 19 February, 2009
Jan 12, 2016
Linking Quality Improvement andInfection Prevention
Manoj Jain, MD, MPH
Medical Director, QSource
19 February, 2009
Objectives
Personal Journey in ID Personal Journey with QI What is QI? What are Quality Measures? Methods of QI – PDSA/Lean/Six Sigma Applying PDSA Cycle
Goals for Quality Improvement
Know Your Quality Indicators
• Rate of VAP
• Rate of UTI
• Rate of BSI
• Rate of SSI
• Rate of MRSA incidence
Outcome Measures inInfection Prevention
• Rate for hand washing compliance
• Antibiotic in a timely manner (within 1 hour) to reduce SCIP
• VAP bundle followed?
• Catheter days
Process Measures inInfection Prevention
Surgical Care ImprovementProject Performance Measures - Process
• Surgical infection prevention– Antibiotics
Administration within one hourbefore incision
Use of antimicrobialrecommended in guideline
Discontinuation within24 hours of surgery end
– Glucose control in cardiac surgery patients– Proper hair removal– Normothermia in colorectal surgery patients
• Measure the rates
• Educate others on how to reduce the rates, i.e., hand hygiene, prophylaxis antibiotics
• Encourage others to do interventions – hope the strategy works
• Result – rates remains the same.
Infection Preventionist’s Job
• If an outbreak occurs, then take action!!!
• In fact – the present rates are an outbreak
• We never had the tools to intervene
Infection Preventionist’s Job
• Goal is reducing infections
• Strategy is QI
• Tool is PDSA cycle
• Reducing infections is the Goal
• VAP and BSI are the outcome measures
• Hand Hygiene and bundles(checklist is the process measure)
What is QI? PDSA?
PDSA: The Wheel of Improvement
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
4 Elements of Change
• Multidisciplinary Teams– Staff ownership
• Flow Meetings– Administrative support
• Bundles– Evidence based medicine
• Culture of Change– Horizontal decision-making
Wheels in Motion:Continuous Quality Improvement
IMPACT: Patient OutcomesCan Improve
The overall surgical infection rate fell 27%, from 2.28% (215 infections among 9435 surgical cases) in the first 3 months to 1.65% (158 infections
among 9584 cases) between the first and the last 3 reporting months.Dellinger EP, et al. Am J Surg.2005;190:9–15.
Adverse Events Per ICU Day*
0
5
10
15
20
25
30
10/1/2002 12/30/2002 3/30/2003 6/28/2003 9/26/2003 12/25/2003 3/24/2004
Multidisciplinary Rounds
Hand Hygiene Protocol
Vent Bundles
ICU Medical DirectorCentral Line Bundles
UTI Bundles
* A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)
Nosocomial Infection RatesFY 2001-FY 2004 YTD
ICU ALOS Per Episode
Average Cost Per ICU Episode
$3,406$2,874 $2,626
$0$500
$1,000$1,500$2,000$2,500$3,000$3,500$4,000
FY 2002 FY 2003 FY 2004 YTD
15.6% Decrease 8.6% Decrease
Public Reporting
• Public Reporting of Quality Data• CMS – Hospital/NH/Dialysis• AHRQ – State Data• Health Grades
Manoj Jain, MD, MPH
Medical Director, QSource
Thank You!
This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-04
Linking Quality Improvement andInfection Prevention