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Regional and state initiatives

The Greater New York Hospital Association - United Hospital Fund Collaborative

The Greater New York Hospital Association (GNYHA) and United Hospital Fund (UHF) embarked upon a Quality Improvement Collaborative in 2005 supporting the use of proven infection control practices in ICUs to improve the quality of care and patient safety. Thirty-eight hospitals throughout the Greater New York region participated in a CLABS Collaborative with the primary goal of reducing central line associated bloodstream CLABS) infections in intensive care units. In less than two years their CLABS rate dropped nearly 70 percent from 5 to 1.62 CLABS per 1,000 ICU patient days, with some hospitals reporting no infections for 9-12 months. A Web site called Joint Effort New York (Jeny), which is administered through IPRO, serves as the Collaborative's information-sharing resource center, with documents, sample tools, educational programs and best practices at http://jeny.ipro.org/clabs/

Johns Hopkins Center for Innovation
in Quality Patient Care

The Johns Hopkins Center for Innovation in Quality Patient Care was created in 2002 to facilitate patient-centered revamping of healthcare delivery systems at Johns Hopkins Medicine. Supporting a grassroots model of improvement, the center helps coordinate the efforts of interdisciplinary teams of physicians, nurses and managers to gather data, evaluate changes, and recommend and implement best practices. The center is led by Dr. Peter Pronovost, medical director and a leading safety expert. Pronovost and his Hopkins colleagues are known for their groundbreaking research in ICUs to improve safety culture among staff and in particular, their research on the new technique of "bundling" of evidence-based practices. A set or "bundle" of specific evidence-based practices is being used to reduce catheter-related bloodstream infections, ventilator-associated pneumonia and sepsis. Their research began in 1998 in a surgical intensive care unit (ICU) and resulted in near elimination of catheter-associated bloodstream infections by 2002. It was estimated that these interventions prevented eight patient deaths and eliminated $1.8 million in additional costs per year in the study ICU teams.

Sample tools, resources, successes from their initiatives, case studies and processes used are available on the Johns Hopkins Web site. Resources include implementing a Daily Goals Sheet to improve communication in the ICU, as well as details on how they achieved reductions in bloodstream infections.

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Maryland Patient Safety Center

The Maryland Health Care Commission (MHCC) on June 18, 2004, announced the selection of the Maryland Hospital Association (MHA) and the Delmarva Foundation (Delmarva) to jointly develop and run the new Maryland Patient Safety Center. The two organizations provide funding for the patient safety center through 2007.

In November 2004, the Maryland Patient Safety Center launched the first in a series of Safety Culture Collaboratives. More than 300 people from 50 Maryland hospital ICUs committed to a common goal of dramatically improving results for all intensive care unit patients. Throughout the next 12 months, these teams met regularly to share and learn from each other the best practices to improve patient outcomes. The aim was to achieve the following goals:

As reported in 2005, this collaborative effort showed evidence of success. The Maryland hospital ICU teams had reduced ventilator-associated pneumonia by 19 percent in just eight months. Teams working on reducing blood stream infections have seen a 36 percent reduction over this time period.

The Emergency Department (ED) Collaborative involved twenty-nine multi-disciplinary teams representing over half of the hospitals in the state working towards ensuring that the sickest ED patients get the care they need quickly, in a timely manner with the smallest possible exposure to preventable healthcare associated harm. Teams have begun to implement a series of change strategies that have been recommended in the scientific literature or reported as successful by other hospitals. These strategies are included in the Improvement Guide.

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Michigan Keystone ICU project

The Michigan Health and Hospital Association's (MHA) Keystone Center for Patient Safety and Quality was created in March 2003 with some funding from the Agency for Healthcare Research and Quality (AHRQ). MHA Keystone brings together hospitals, national experts and best practice evidence to improve patient safety by addressing the quality of healthcare delivery at the bedside. One of Keystone's most ambitious collaboratives, the Keystone ICU (KICU), exists through an ongoing and innovative partnership with patient safety experts at Johns Hopkins University. As of June 2005:

The final results of the 18 month study involving 103 ICUs were published in the New England Journal of Medicine (NEJM) in December, 2006. The NEJM reported that 103 Michigan intensive care units (ICUs) reduced catheter-related bloodstream infection to zero at three months. Up to 66 percent sustained the zero rates during the 18-month study period.

A study at one Michigan hospital implemented a reminder system that was found to reduce, by seven percent, the amount of time an indwelling urinary catheter is in place, a step that could help stem infections among the 25 percent of hospital patients who have urinary catheters in place at any given time.

The Michigan Hospital Association's toolkit consists of a series of recommendations based on current research and best practices. It was developed by a nine-member volunteer workgroup of health professionals experienced in leading ICUs and improving patient safety and quality of care.

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New Jersey Hospital Association ICU collaborative

The New Jersey Hospital Association (NJHA) ICU collaborative, an initiative of the NJHA Quality Institute, was initiated in June 2004. Twenty-four hospitals and health systems encompassing more than 30 facilities were involved in the initial phase of the project, which uses a collaborative model to report data, reinvent processes and share best practices in ICU care. Expert faculty members Dr. Peter Pronovost of Johns Hopkins University and Dr. Thomas Rainey, chairman of the Institute for Healthcare Improvement's ICU initiative, lead the effort. It is based on a successful model used in IHI's 100,000 Lives Campaign. As reported in June 2005, results based on data reports from all participating hospitals show that:

The New Jersey Hospital Association ICU Collaborative focuses on several dimensions of care, including culture of patient safety, ventilator-associated pneumonia and catheter-related blood stream infections. Collaborators analyze evidence-based practices to update ICU protocols and introduce patient safety improvements, utilize workshops, surveys, and conference calls to facilitate communication and determine best practices.

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Pittsburgh Regional Health Initiative (PRHI)

The Pittsburgh Regional Health Initiative (PRHI) is different from other initiatives that routinely convene experts in various healthcare areas to generate discussion and the sharing of ideas. The unique elements include:

According to a CDC report based on the Pittsburgh initiative, the participants have reduced bloodstream infections associated with the use of intravenous catheters by 63 percent during the past four years. The overall incidence of catheter-related bloodstream infections has dropped from 4.3 to 1.6 bloodstream infections per 1,000 catheter days. Participating hospitals began a strict enforcement of safety guidelines in 2001 and the strict implementation of a set of practices known to reduce the risk of infections during catheter insertion. The bundle included the use of large sterile barriers, gowns, gloves, masks, and head coverings; application of appropriate skin antiseptics; insertion of the catheter in the neck versus the groin area; and completion of a checklist verifying that all infection control procedures were followed. All were used correctly with empowerment of nurses to intervene when protocols were not followed to assure compliance.

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