Tuesday, January 23, 2007

Why can't we do that?

A recent note from our chief operating officer to several of our clinical chiefs:

I came across the NEJM from 12/28/06 and the article and editorial on catheter-associated blood stream infections done in Michigan (my medical school alma mater!)

In that study of 108 ICU’s in Michigan, the institution of a set of evidence-based interventions reduced the median rates of infection per 1000 catheter days from 2.7 to 0 and the mean rates from 7.7 to 1.4. These impressive gains were held through 18 months of follow-up. If more than half of these ICU’s can virtually eliminate these infections, it seems that we should be able to do so as well. We had 2 months in the last year when we achieved this goal, but the last two months showed a sizable bump. Are we doing everything possible to eliminate these on a sustainable basis? What will we do differently going forward to hold the ‘zero rate’ for every month?

For the record, here are the numbers for BIDMC, updated from my posting of December 17, below.

Month ----- Infection Rate
Oct 05 ----- 1.67
Nov 05 ----- 1.28
Dec 05 ----- 2.43
Jan 06 ----- 3.07
Feb 06 ----- 1.40
Mar 06 ----- 1.07
Apr 06 ----- 0.00
May 06 ----- 0.59
Jun 06 ----- 1.15
Jul 06 ----- 0.57
Aug 06 ----- 3.03
Sep 06 ----- 2.50
Oct 06 ----- 0.00
Nov 06 ----- 2.38
Dec 06 ----- 1.87

We are serious about this and, like Michigan, we will share any lessons learned with others in the medical community. Recall that we engaged in an intensive training and improvement program in this arena, and the result we want is tantalizingly within reach. Nonetheless, as noted by our COO, we are not yet "best in class," which is our goal.

Here is what we are doing for now: Every single infection is now viewed as a sentinel event, for which we conduct a root cause analysis and from which we learn how to do better. Stay tuned to see how we progress over the coming months.


Anonymous said...

I understand that process, protocol and a culture of safety are all important factors in driving infection rates toward (and eventually to) zero. I wonder, however, if there is any correlation between best in class and mediocre infection rates and staffing ratios. Or, are there well accepted staffing ratios (especially for nurses) for various parts of the hospital that everyone accepts and follows?

Anonymous said...

Kudos to you for sharing the good and not so good months, Paul! This is the spirit of true quality improvement and transparency. I look forward to reading about your quest for sustained progress!

Anonymous said...

To BC,

This is not related to staffing ratios. These infection rates are occurring in ICUs, where the nurse-to-patient ratio is 1:2 or 1:1. It has to do with people following well established protocols to avoid infections.

And to Nancy,


Anonymous said...

I agree!I am an ICU RN and people need to be aware of the infections, but also look at each case individually. Protocols (that are followed), new equipment, great staffing & training, as well as experitise in execution do not always make for "PERFECT" numbers all of the time. People, i.e. the public, insurance carriers and politicians, need to look at "the big picture" and each case again as an individual, as well as doing thorough and accurate research. We are all up for the challenge!!