clinical performance and 100k lives campaign

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Clinical Performance and 100k Lives Campaign

Peter J. Plantes, MDVice President

Clinical Performance

(972) [email protected]

Version 8.HV

2This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly

prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law.

What We Do

Improve

members’

clinical and

economic

performance



VHA Member Networks Accelerate Members’ Competitive Advantage

VHA MEMBER NETWORKS

>> Clinical & OperationalImprovement

SHAREDCHALLENGE

>> Shared Resources

>> Shared Performance Targets

>> Shared Accountability

>> Shared Funding

WORKING TOGETHER

>> Outcomes:•Clinical•Operational•Financial•Market•Safety

COLLECTIVE ACHIEVEMEN

T



A national movement originates to SAVE lives…

VHA Area Offices collaborate under one plan to inform, support and measure the members effort to SAVE lives…

VHA members rally, working together in networks to SAVE lives…

VHA members implement clinical care improvements that have been proven to promote health and prevent avoidable deaths…

VHA members lead the industry in measured clinical performance and are noted for their significant contribution to the SAVE lives campaign…

VHA recognizes members who have achieved a significant, measurable contribution to this effort.

Picture this…..



IHI’s ‘100k lives Campaign’ Overview

Announced by Don Berwick at 2004 IHI meeting…Save 100,000 lives by June 14, 2006… ‘100k lives Campaign’

“Some is Not a Number. Soon is Not a Time.”“Some is Not a Number. Soon is Not a Time.”(December 14(December 14thth, 2004), 2004)

Six Interventions: Deploy Rapid Response Teams

Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction

Prevent Adverse Drug Events (ADEs) – Medication Reconciliation

Prevent Central Line Infections

Prevent Surgical Site Infections

Prevent Ventilator-Associated Pneumonia



Rapid Response Teams: Statistics

Only 17% of patients who experience an arrest survive until

discharge.

Cardiac arrests occur in 1 in 200 hospital admissions

Most patients who arrest show clinical signs of deterioration

within the 8 hour period preceding the event

Chance of survival is greater if the arrest occurs in the ICU

settingSource: www.ihi.org



Rapid Response Teams

May be summoned by anyone in the hospital to

preclude a cardiac arrest or other adverse event

Development of criteria is a key

Sites that have implemented RRTs have reported

reductions in cardiac arrests, sepsis, stroke, acute

renal failure and deaths, as well as reduced LOS and

ICU admissions

Primarily a nurse driven function



Evidence Based Care for AMI

Early Administration of Aspirin

Aspirin at Discharge

Early Administration of Beta Blocker

Beta Blocker at Discharge

ACEI/ARBs at Discharge for LVSD

Smoking Cessation Advice/counseling

Timely Reperfusion



Prevention of Adverse Drug Events Through Medication Reconciliation

High priority for JCAHO and IOM

Approximately 1,200 hospital deaths per year were

due to an adverse drug events.

** 46 percent of all medication errors occur at

transition points

Medication reconciliation needs to occur at

admission, discharge, and at any point following

transitions in care locations




Attributable mortality – 18%; estimated deaths annually – 14,000 to 28,000

There are approximately 5.3 CR-BSIs per 1,000 catheter days in the ICU

Central Line “Bundle”

o Hand Hygiene

o Maximal Barrier Precautions

o Chlorhexidine Skin Antisepsis

o Appropriate Catheter Site Administration and Care

o No Routine Replacement

IHI Intervention Call – March 30, 2pm EST

Statistics - Source: www.ihi.org



Prevention of Surgical Site Infections: Stats

SSIs account for 14-16% of hospital acquired

infections.

Among surgical patients,

SSIs account for 40% of hospital acquired

infections.

Surgical patients who develop SSIs are twice as

likely to die.

SSI is a component of

VHA’s Transformation of the OR

Source: www.ihi.org



Prevention of Surgical Site Infections

Measures

o Antibiotic Selection

o Antibiotic Start

o Antibiotic Discontinuance

o Appropriate Hair Removal

o Peri-operative Glucose Control

IHI Intervention Call – March 23, 2pm EST



Prevention of Ventilator Associated Pneumonia

VAP occurs in 15% of mechanically ventilated patients;

Mortality rate of patients who develop VAP is 46%

“Ventilator Bundle”

o HOB Elevation of 30 Degrees

o Daily Sedation Vacations

o Daily Assessment of Readiness to Extubate

o PUD prophylaxis

o DVT prophylaxis

IHI Intervention Call-March 30, 2pm EST



VHA executive leadership pledges commitment to the 100k lives

Campaign – communicated to senior management team. (December

’04)

CEO Communiqué, January 2005

“VHA has established a significant clinical agenda for 2005”

VHA will “…disseminate powerful improvement tools, with

supporting expertise, throughout the American health care

system.”

“VHA will serve as a coach and data repository for member

organizations that wish to join the 100,000 lives Campaign.”

‘100k lives Campaign’ - VHA Commitment



Actions:

1. Recruit VHA members and assist in program enrollment

2. Connect VHA participating hospitals to facilitate dialogue

and monitor progress

3. Collect VHA hospital performance data and forward to IHI

4. Support the implementation of the six clinical interventions

via VHA programs Transformation of the ICU

Transformation of the OR

Cardiovascular Bundle

Rapid Response Teams

‘100k lives Campaign’ – VHA’s Actions



Structure for Participation

Hospital Level – the basic element of

campaign

Network Level – systems or associations or

collections of facilities

Node Level – a sponsoring organization for a

network (example – VHA “super-node”)

IHI Field Operations Level



VHA Area Offices - A Key Differentiator

Central

Pennsylvania

Central Atlantic

East Coast

Empire State

Georgia

Gulf States

Metro Michigan Mid-America

Mountain States

New England Northeast

Oklahoma/Arkansas

Southeast SouthwestUpper

MidwestWest Coast



Delivery Vision

NATIONAL

AreaOffice

AreaOffice

AreaOffice

AreaOffice

AreaOffice

VHA Area Offices - A Key Differentiator

18 “nodes” of action tied together as the

VHA “super-node” in the 100k lives Campaign.

Results:Results: 1/3rd of the 2000+ hospitals enrolled are

VHA

The VHA potential…..18 Area Offices providing

local/regional collaboration supported by a small

national team and national data management

resources.



COLLECT: Real Time Data Entry of Clinical Metrics and Indicators



COLLECT: Real Time Reporting & Benchmarking of Clinical Metrics and Indicators

Automatically Export Data intoMicrosoft Excel with one click.

Review your Hospital’s results on various Topics

Compare your results against Customized peer groups and National Averages in a real time environment.



Executive Style Dashboards and scorecards available to track your progress on various Clinical Performance

Initiatives.



IHI Interventions vs. VHA offering

Deploy Rapid Response Teams

RRT Program offering

Deliver Reliable, Evidenced

Based Care for Acute

Myocardial Infarction

CV Bundle Program offering

Prevent Adverse Drug Events (ADEs) –

Medication Reconciliation

Included domain in all Programs


TICU domain


Surg/TOR Program offering

Prevent Ventilator-Associated

Pneumonia

TICU domain

VHA offering vs. IHI Interventions

RRT Program offering(VHA-SE collaboration)

Deploy Rapid Response Teams

Prevent ADEs- Med Reconciliation

CV Bundle Program offering

Deliver Reliable, Evidenced

Based Care for Acute

Myocardial Infarction


Surg / Transformation of the OR (TOR)



Transformation of the ICU

(TICU)


Prevent Ventilator-Associated

Pneumonia


100k lives Clinical Performance – Program match



Transformation of the ICU

Content Links to the “100k

lives Campaign”:

o Ventilator Associated

Pneumonia (VAP)

o Central Venous Line Infections

(BSI)

o Rapid Response Teams (RRT)

o Medication Reconciliation

Program Components:

o Nationally prominent subject matter experts

o Two face-to-face meetings annually

o Monthly coaching calls

o Measurement tool and database (ICU-CM)

o Content calls

o Short assessment

o Secured space in CKM for “tools”

(order sets, presentations, patient education

materials, etc.)

o Listserv



VHA’s TICU Clinical and Economic Impact

ICU COST SAVINGS/REVENUE ENHANCEMENT

TICU Impact: Average Length of StayAnd Vent Days Decreased

12.910.8

4.94.3

0.02.04.06.08.0

10.012.014.0

Average LOS Average Vent Days

BaselinePost

Da

ys

36% reduction

TICU Impact: Sepsis Reduction

Cost savings from reduced ICU LOS •Moving from an ICU inpatient [$2,674] to a non-ICU inpatient bed [$891] = $1,783 X 8 days = $14,264 cost savings per patient•Per patient savings ($14,264) x Average Hospital ICU Census (892) = $12,723,488 savings per hospital

Cost savings from reduced Vent Days •Base costs per patient ($2,115/day) x 6.5 day reduction = Average savings of $13,745 per patient

Cost savings from Sepsis reduction (Implied) and revenue enhancement•Median margin expense of severe sepsis patients ($10,623) is partially avoided by either reductions in LOS and/or reductions in incidence of sepsis itself•Reduction in excessive expenses, including supply costs and cost per case•Revenue enhancement opportunity of open ICU beds(Note: exact contribution cannot be calculated)



Mortality Rate (Percent) Sepsis Population: On ICU AdmissionReporting Period: November 2003 to December 2004

Total number of ICUs in group participated in reporting: 19



Catch the Vision !

Ensure your hospital is enrolled –

you are already doing some of the

work!!

clinical performance and 100k lives campaign

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