Hospital improvements and successes
- Allegheny hospital project (Pittsburgh, PA)
- Health Partners' Regions Hospital (St. Paul, MN)
- Owensboro Medical Health System (Owensboro, KY)
- Swedish Medical Center (Seattle, WA)
- Overlake Hospital Medical Center (Bellevue, WA)
- University of Rochester/Strong Health (Rochester, NY)
Allegheny hospital project (Pittsburgh, PA)
At Allegheny General Hospital, a 580-bed teaching hospital in Pittsburgh, PA, a sharp focus on preventing infection initiated in 2004 has resulted in significant savings in both categories. Allegheny General led by Richard Shannon, M.D., implemented the interventions in IHI's 100,000 Lives Campaign to prevent ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLI) in two ICUs. The results were dramatic. Between 2004 and 2005:
- The VAP rate dropped by 83 percent.
- The CLI rate fell by 87 percent.
Allegheny General estimates that patients diagnosed with VAP average a 34-day stay, with a net loss to the hospital of $24,435 after reimbursement; patients diagnosed with CLI average a 28-day stay, at an operating loss of $26,839. For an investment of about $35,000 in improvement work, Dr. Shannon estimates that the hospital experienced a $2 million improvement.
By standardizing procedures and investigating every single infection within 24 hours, Allegheny cut the annual number of infections from 49 to three and reduced related deaths from 19 to one. Shannon had similar success in reducing ventilator-associated pneumonia from 45 to eight.
- "Allegheny General Hospital: Lower Infection Rates Have Lowered Costs" (article from IHI 2006 progress report) (.doc) (21 KB)
Health Partners' Regions Hospital (St. Paul, MN)
Health Partners' Regions Hospital has been focused on both the ventilator-associated pneumonia and central line-associated bundling initiatives since 1998. To facilitate consistent use of the bundles, Regions co-sponsored a team to fast-track interventions that was found to dramatically improve compliance with the ventilator and central line bundles – finding that effective teamwork was key.
Results included:
- An example of one of Regions' successful interventions was to place a red sticker on an IV line if placed under less-than-sterile conditions to indicate that it needs to be removed, and a green sticker on IV lines that are placed in the emergency department using maximum sterile barriers.
- Compliance with the elements of the ventilator bundle and central line bundle in the critical care units at Regions Hospital currently ranges from 67 to 100 percent.
- Data show that the use of bundles is associated with reductions in infections. For example, VAP rates in the Surgical ICU in 1997 were 29/1,000 ventilator days; in 2004, that rate had dropped to just under 18/1,000 ventilator days. Similar declines have been seen in the Medical ICU and Burn Center.
- Catheter-related bloodstream infections (CR-BSIs) have also dropped between 2002 and 2005 in rates per 100 device days, from 8.2 to 0 in the medical ICU and 9.5 to 0 in the Burn Center.
- Article: "Pursuing Perfection: Report from HealthPartners' Regions Hospital on Reducing Hospital-Acquired Infection: Ventilator-Associated Pneumonia and Catheter-Related Bloodstream Infection" (.doc) (52 KB)
- Health Partners report (.doc) (184 KB)
Owensboro Medical Health System (Owensboro, KY)
Owensboro Medical Health System exceeded its goal of decreasing its VAP rate by 50 percent over an 18-month period and achieved a zero VAP rate for eight consecutive months in the ICU. Significant, sustained improvements, however, took time, patience, and a long-term commitment to this project.
- Article: "Reducing Ventilator-Associated Pneumonia" (.doc) (184 KB)
Swedish Medical Center (Seattle, WA)
Swedish Hospital Medical Center, a 1,300-bed institution on three campuses in the greater Seattle area, used to average two or three VAPs per month in its 80-bed intensive care units (ICUs). After instituting the IHI collaborative in 2004, VAPs at Swedish dropped sharply. Between October 2004 and September 2005, the hospital had just five VAPs. Based on CDC estimates that the average VAP adds $40,000 to the cost of care, Swedish avoided spending $720,000.
The hospital also:
- Decreased VAP rates from a range of 3 percent to 5 percent, to 1.1 percent.
- Averaged 23 VAPs per year (system-wide) for the two years prior to working with IHI.
- In 2005, had five VAPs (system-wide) – a 74 percent reduction in VAPs.
- Article: "Swedish Medical Center Reduces Mortality Rate by Nineteen Percent" (.doc) (27 KB)
Overlake Hospital Medical Center (Bellevue, WA)
Overlake Hospital Medical Center said it reduced its ventilator-associated pneumonia (VAPs) by 80 percent and central line-associated bloodstream infections (CLABSI) by 74 percent, avoiding "needless harm" to 39 patients. Savings were an estimated $1.8 million over 12 months (October 2004 to September 2005).
- Article: "Overlake quickly adopts safety recommendations: Lives are saved" (.doc) (32 KB)
University of Rochester/Strong Health (Rochester, NY)
The medical intensive care unit at the University of Rochester-Strong Health reported having only three cases of ventilator-associated pneumonia in two years (from 2004 to 2005). A similar significant reduction in VAP rates and days between occurrences was reported in the surgical and cardiovascular intensive care units.
- Article: "Reducing Complications from Ventilators and Central Lines in the ICU at Strong Health" (.doc) (141 KB)