tag:blogger.com,1999:blog-32053362.post3235805987509140362..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Progress in the ICUsPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-32053362.post-55957539311641478022010-02-02T14:21:41.748-05:002010-02-02T14:21:41.748-05:00Stefani - we have been using checklist-driven care...Stefani - we have been using checklist-driven care for at least a decade, now integrated into our critical care information and doumentation system (which all of the ICU docs write our notes in), so we did not change to a different checklist based on Pronovost's work. Ours turns out to be very similar.<br /><br />Anon 1:46 -- completely agree that the conventional metric (pneumonias per 1,000 ventilator days) accounts inappropriately for the phenomenon that you've described here. We have also seen a drop in our ventilator days, which ironically (because of the mathematical construction of the metric) can cause your rate to go up! On the research side, we are doing work (funded by the Robert Wood Johnson Foundation) trying to better quantify this issue using a mix of real data and stochastic simulation.<br /><br />- michael, one of the ICU docs at BIDMCMichaelnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-29275998186074059782010-02-02T13:46:46.589-05:002010-02-02T13:46:46.589-05:00Intersting that you posted the VAP data. We just ...Intersting that you posted the VAP data. We just took a look at the 2009 VAP data at our hospital. Our infection rate is very low (which we are proud of) but what was more interesting was the dramatic decrease in the number of device days. While the total number of vent patients was about the same we saw our days on a vent drop by 40% from the previous year. We posted this on our intranet and shared it with the medical staff.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-19430581630805908032010-02-02T09:55:05.987-05:002010-02-02T09:55:05.987-05:00Just wondering if the ICU is also using the Pronov...Just wondering if the ICU is also using the Pronovost checklist and, if so, if your outcomes jive with those in Michigan?Stefanihttp://www.phoenixmed.netnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-48418689487419940002010-01-31T16:55:07.963-05:002010-01-31T16:55:07.963-05:00Great work, both with regards to the reduction and...Great work, both with regards to the reduction and the transparency. I'm currently completing my MHA and patient safety and quality improvement is one of my passions. I was wondering if you would be willing to share more on this reduction. I would be interested in learning about some of the interventions that were undertaken to promote this change.Kevin Bnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-58013409555959668652010-01-30T14:58:48.677-05:002010-01-30T14:58:48.677-05:00I'd like to learn more about the processes tha...I'd like to learn more about the processes that lead to these reductions. great work!Unknownhttps://www.blogger.com/profile/00547930874629599344noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1514893238424039922010-01-30T00:54:33.521-05:002010-01-30T00:54:33.521-05:00Bravo! It's a shame that when a horrible compl...Bravo! It's a shame that when a horrible complication is avoided, no one notices because the achievement is a nonevent. <br /><br />Huzzah for nonevents!Aaronnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-11187179976894270792010-01-29T21:31:25.978-05:002010-01-29T21:31:25.978-05:00This is really really good - maybe even better tha...This is really really good - maybe even better than you think, if severity adjusted...76 Degrees in San Diegohttps://www.blogger.com/profile/14358630186174729315noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-48879019408291924582010-01-29T17:40:18.925-05:002010-01-29T17:40:18.925-05:00Whether or not global payment ensues, the hospital...Whether or not global payment ensues, the hospital which is most efficient and patient centered will be well positioned, particularly given Keith's observation concerning CMS withholding payment for an increasing list of "never events."<br />So you are doing the right thing in lots of ways. Congrats!<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-66336708609698414312010-01-29T14:00:33.162-05:002010-01-29T14:00:33.162-05:00I am curious whether you have an ethics committee ...I am curious whether you have an ethics committee or ethics consultant that could have helped with decreasing the length of stay in you ICU. Do you have any way of tracking the impact the consultant or committee had on the length of stay in the ICU? If so, how did you measure it?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46946786113697330552010-01-29T13:25:29.266-05:002010-01-29T13:25:29.266-05:00Paul,
I applaud your efforts to improve quality, ...Paul,<br /><br />I applaud your efforts to improve quality, but lets be frank; most of these cases I suspect are under Meidicare, which pays your hospital on a DRG basis, so shorter lengths of stay result in decreased use of resources and increased net profit.<br /><br />Secondly, Medicare is giving close scrutiny to these indicators and will be using them shortly in a punitive manner in its attempt to limit payment for shoddy care. This is driving more hospitals to collect this data (which I believe they have to under current Medicare rules) and nobody wants to be on the lower end of the quality care scale when this data is released.<br /><br />Third, I would hope you are using this data as your bargaining chip with the commercial carriers when negotiating contracts. Hopefully they are willing to pay more to steer patients to hospitals with good quality data instead of the biggest health care system with the best name recognition (can we say Partners?).Keithnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80828148109383359382010-01-29T10:50:45.161-05:002010-01-29T10:50:45.161-05:00It is worth highlighting that the keystone of thes...It is worth highlighting that the keystone of these interventions was the reflexive impulse developed by leaders to put the patient at the center of work. These improvements happened in a context of greater participation of families and patients, and fresh ways of thinking about possibilities rather than only constraints. It is a model worth sharing.Anonymousnoreply@blogger.com