Thursday, September 20, 2007

Teamwork wins against VAP


Back in March, I gave an update on our efforts to eliminate ventilator associated pneumonia in our ICUs. This requires implementing a five-part "bundle" of steps every day with every patient. You measure compliance in this program by the percentage of time you do all five steps. There is no partial credit.

An additional item is to perform dental hygiene on patients every four hours. The bugs that can cause pneumonia often originate in the mouth.

The goal is to reduce the number of cases of VAP, which statistically have a 30% mortality rate.

We report on this item on our company website, but I wanted to give you a secret advanced preview. The charts above show our improvement with the bundle and with dental hygiene.

I don't want to brag too much -- well, actually I do! -- because these results are spectacular. They are the result of terrific teamwork among several departments of nurses, doctors, and other health care professionals. Our best estimate is that the reduction in VAP from these efforts is amounting to about 320 cases per year at BIDMC. While it is risky to extrapolate to relatively small numbers by applying broad statistics, if the 30% mortality figure is applied to this number of cases, it means that our folks saved 96 lives per year.

For those interested in costs, a case of VAP is estimated to increase hospital costs by about $40,000 per patient. Once again, applying this broad average figure to our specific number of avoided cases (320) means cost savings to the hospital of about $12 million. Hmm, saving lives and saving money by teamwork and rigorous attention to detail. Any lessons here?

4 comments:

Anonymous said...

Wow, something happened in Dec. 06 (not that you weren't improving before; it just jumped up then.) New leader, new idea, any correlation?

I LOVE those words "rigorous attention to detail." Seems like that has been lost in medicine, and everywhere else these days. Congrats on your obvious success, Paul.

Barry Carol said...

My employer's business is in the heavy manufacturing sector of the economy. When our current CEO assumed his position several years ago, he embraced workplace safety as one of his top priorities. He pounds on it constantly, incorporates it into managers' goals, and goes out of his way to praise (and reward) successes and fully investigate adverse incidents to better understand how our work processes can be improved in the future. The point is that leadership from the top is extremely important and makes a positive difference. Congratulations on your success and keep up the good work.

Patient Dave (deBronkart) said...

What I see here is the benefit of "getting past a culture of blame and fault-finding," as you've said.

If the people who produced this result had instead expected to get punished for reporting errors, we wouldn't have this to celebrate.

Thank you for your role in keeping BIDMC alive, and your role in supporting the teams who produced this results.

Paul Levy said...

anon 8:33 -- Actually the work started just a few months before that. You can see the uptick.

dave -- EXACTLY right!

barry -- Thanks very much. We have great people here who really want to make this work.