peter pronovost, md john r. combes, md
DESCRIPTION
Using Collaboratives to Reduce Central Line-Associated Bloodstream Infections (CLABSI): A National Implementation Program. Peter Pronovost, MD John R. Combes, MD. Overview. Context and National Leadership State Level Consortia Sustainability Q&A. National Context and Leadership. - PowerPoint PPT PresentationTRANSCRIPT
Using Collaboratives to Using Collaboratives to Reduce Central Line-Reduce Central Line-
Associated Bloodstream Associated Bloodstream Infections (CLABSI):Infections (CLABSI):
A National Implementation ProgramA National Implementation Program
Peter Pronovost, MD
John R. Combes, MD
OverviewOverview
• Context and National Leadership
• State Level Consortia
• Sustainability
• Q&A
National ContextNational Contextand Leadershipand Leadership
HHS Steering Committee for the HHS Steering Committee for the Prevention of HAIPrevention of HAI
• Charge: Develop an Action Plan to reduce, prevent, and ultimately eliminate HAIs
• Plan will:– Establish national goals for reducing HAIs– Include short- and long-term benchmarks– Outline opportunities for collaboration with
external stakeholders– Coordinate and leverage HHS resources to
accelerate and maximize impact
Steering Committee Steering Committee Working Group StructureWorking Group Structure
HHS SteeringCommittee
for thePrevention
of HAI
Prevention and
Implementation
Lead:CDC
Research
Lead:AHRQ
InformationSystemsand
Technology
Co-Leads:OS/ ONC & CDC
Incentives andOversight
Co-Leads:CMS
Outreachand
Messaging
Lead:OS/ OPHS
HHS SteeringCommittee
for thePrevention
of HAI
Prevention and
Implementation
Lead:CDC
Research
Lead:AHRQ
InformationSystemsand
Technology
Co-Leads:OS/ ONC & CDC
Incentives andOversight
Co-Leads:CMS
Outreachand
Messaging
Lead:OS/ OPHS
HHS Action PlanHHS Action Plan
• Initial version issued in January 2009
• Public comment received in February 2009
• Revision finalized in June 2009
• HHS Action Plan Websitehttp://www.hhs.gov/ophs/initiatives/hai
Tier One PrioritiesTier One PrioritiesHAI Priority Areas
• Catheter-Associated Urinary Tract Infection
• Central Line-Associated Blood Stream Infection
• Surgical Site Infection• Ventilator-Associated
Pneumonia• MRSA• Clostridium difficile
Implementation Focus• Hospitals
*Tier Two will address
other types ofhealthcare facilities
AHA’s Hospitals in Pursuit of AHA’s Hospitals in Pursuit of ExcellenceExcellence
• Reduce Surgical Infections and Complications
• Reduce Central Line-associated Blood Stream Infections (CLABSI)
• Reduce methicillin-resistant Staphylococcus aureus (MRSA)
• Reduce clostridium difficile infections (c diff)
• Reduce ventilator-associated pneumonia (VAP)
• Reduce catheter-associated urinary tract infections
• Reduce adverse drug events from high-hazard medications (e.g., anticoagulants, narcotics, opiates, insulin, sedatives)
• Reduce pressure ulcers
State ConsortiaState Consortia
Project OrganizationProject Organization
• Statewide effort coordinated by State Hospital Association including QIOs and State DOHs
• Collaborative model • Standardized data collection tools and evidence• Local ICU modification of implementing
interventions• Implementing interventions outside the ICU
Participating StatesParticipating States
• 10 states with at least 10 hospitals in 2008-2011California North Carolina
Colorado Ohio
Florida Pennsylvania
Massachusetts Texas
Nebraska Washington
CUSP EXPANSIONCUSP EXPANSION
• All hospitals within the states are eligible
• The following states are in the expansion:Alabama, Alaska, Arizona, Delaware, District of Columbia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Montana, Nevada, North Dakota, Puerto Rico, South Dakota, Utah, Vermont, Virginia, Wyoming
JHU Funded State ProjectsJHU Funded State Projects• Arkansas Hospital Association• Connecticut Hospital
Association• Georgia Hospital Association• Healthcare Association of
Hawaii• Illinois Hospital Association• Indiana Hospital Association• Minnesota Hospital
Association• Missouri Hospital Association• New Hampshire Hospital
Association • New Jersey Hospital
Association• New Mexico Hospital
Association
• Healthcare Association of New York State
• Oklahoma Hospital Association• Oregon Hospital Association• South Carolina Hospital
Association• Tennessee Hospital Association• West Virginia Hospital
Association• Wisconsin Hospital Association
8
State Consortia MembersState Consortia Members
• State hospital associations
• QIOs
• State health departments
May include
• Payers
• PSOs
• Government officials
• Business
State Hospital AssociationsState Hospital Associations
• Serve as project coordinator for state consortia and participating hospitals
• Facilitate conference calls and in-person meetings with HRET/JHU/MHA faculty
• Oversee collection of CLABSI and safety culture data
Role of QIOsRole of QIOs
• Part of state infrastructure—lend expertise and other resources to support initiative
• Participate in conference calls, in-person meetings
Building State Programs to Building State Programs to Prevent HAIsPrevent HAIs
• Project Description:– Create and expand state-based HAI prevention
collaboratives– Build a public health HAI workforce in states– Enhance states abilities to assess where HAIs are
occurring
• Agency Lead: CDC• Collaborating Agencies: AHRQ and CMS• Funds Source & Amount: ARRA ($40 M)• CDC HAI Recovery Act Website
http://www.cdc.gov/nhsn/ra
Consortia OrganizationConsortia Organization
• Lead Partner Role: State Hospital Association or affiliated state hospital association organization coordinating the state-wide collaborative.
• Advisor role: will support the collaborative effort with infectious disease expertise.
• Endorser role: will support the collaborative by promoting On the CUSP: Stop BSI and by providing cash or in-kind resources such as meeting space.
NC Safer ICUs: Eliminating NC Safer ICUs: Eliminating CLABSI CollaborativeCLABSI Collaborative
Organization Name
Organization Website
Description of Organization Key Contact Name / Title
Key Contact Telephone
Key Contact Email Collaborative Role
Duke Infection Control
Outreach Network (DICON)
https://dicon.mc.duke.edu
DICON is a private membership organization, established in 1997 by Duke physicians and nurses, that exists to advance efforts that improve quality of care and enhance patient safety while minimizing the costs associated with non-evidence based approaches to infection control.
Deverick Anderson, MD, MPH Assistant Professor Medicine
919-681-7483
Advisor Role Will support the collaborative effort with infectious disease expertise to provide guidance to the leadership team and collaborative hospitals.
North Carolina
Area Health Education Centers
Program (AHEC)
http://www.med.unc.edu/ahec
NC AHEC’s mission is to meet the state’s health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina.
Rebecca Knight, MSN, MBA Executive Director
336-832-7933
Endorser Role Will support the Collaborative by helping to spread the word and to support it meetings with venue (classroom) space as available.
The Carolinas Center for Medical
Excellence (CCME)
http://www2.thecarolinascenter.org
The designated Quality Improvement Organization (QIO) for NC. Holds the federal and state contracts for Quality Improvement under CMS in NC.
Jill McArdle, RN, MSPH, CPHQ, PMP Director Federal Programs
919-380-9860
Endorser Role Will support the Collaborative by helping to spread the word and will look at alignment with initiatives.
NC Center for Hospital Quality and
Patient Safety (NC
Quality Center)
http://www.ncqualitycenter.org
Created in 2004, the NC Quality Center, an initiative of the NC Hospital Association, funded by grants and donations, mission is to lead NC hospitals to become the safest and highest quality hospitals in the United States. In addition the NC Quality Center is the federally designated Patient Safety Organization (PSO) for NC.
Barb Edson, RN, MBA, MHA Director of Collaborative Learning
919-677-4121
[email protected] Lead Partner Role Lead role for NC Consortia Liaison between other NC organizations and National group. Liaison between NC hospitals and NC and national consortia.
Florida ConsortiumFlorida ConsortiumOrganization Name
Organization Website
Description of Organization Key Contact Name / Title
Key Contact Telephone
Key Contact Email Collaborative Role* (you may use your own descriptions or use the ones listed below)
Florida Hospital
Association
www.fha.org State hospital association Kim Streit/VP/Health care Research and Information
407-841-6230
[email protected] Lead Partner Role
Florida Professiona
ls in Infection Control
http://www.flpic.com/index.html
Professional Association for Florida’s Infection Control practitioners
Loretta Litz Fauerbach
352-265-0284
[email protected] Advisor Role
Florida Medical Quality
Assurance Inc.
http://www.fmqai.com
Quality improvement organization Marie Hall 813-865-3538
[email protected] Advisor Role
BlueCross BlueShield of Florida
http://www.bcbsfl.com/
One of Florida’s Largest Health Plans Brian Kiss, MD 407-833-7788
[email protected] Endorser Role
Department of Health
http://www.doh.state.fl.us/
Staff agency responsible for tracking infections
Roger Sanderson
Advisor Role
PSOFLorida Patient Safety Organization Bill Bell, FHA General Counsel
850-222-9800
[email protected] Advisor Role
Evolving Consortia RolesEvolving Consortia Roles
• SHA– Recruitment, Marketing, Convening
• QIO– Training, Field Agent
• DOH– Technical Support, Analysis, Epidemiology
SustainabilitySustainability
State Consortia & SustainabilityState Consortia & Sustainability
• State consortia key to sustainability:– Train-the-trainer education to build capacity
for future patient safety innovations, e.g., On the CUSP: Decubiti
– Evaluation component to identify lessons, including critical success factors and barriers
FLEXTRA KitFLEXTRA Kit
• A model for the development of resource materials to support instructor-delivered in service training and faculty development
• Contains:Contains:1. Instructors/Leader’s Guide
2. Camera ready materials for handouts
3. Presentation materials (PowerPoint slides & videos)
4. Evaluation instruments
• Battles JB, Sheridan MM The FLEXTRA Kit: a model for instructor
• support materials. J Biocommunication; 1989:6;3;1-13. 6
CUSP FLEXTRA KitCUSP FLEXTRA Kit• Begins with all existing content as well as new content developed as part of the project• Identifies key concepts to be illustrated through video vignettes• Work with experts in CUSP, care in each selected hospital unit, and adult learning to
develop storyboards and final scripts for the vignettes• The compilation of the video vignettes supervised by clinical experts• The embedding of the video content into DVD and CD format suitable for bundling with
other training materials• The development and editing of the instructional guides, in collaboration with experts in
both CUSP and adult learning concepts• The final bundling of all the resources into print and electronic formats that are:
– Fully in the public domain– 508 compliant– Branded as an AHRQ product, but designed to be co-branded
Emanuel,L (2009)
Core team p repare s State Coordinators to implement CUSP -CLABSI using a
Professional Development Workshop that a. familiarizes them with the project and
the materials; b. teaches them how to teach using these
materials; and c . teaches them how
to facilitate others in implementing
CUSP - CLABSI
State Coordinat or s / core team prepare hospital teams of representatives to implement CUSP -CLABSI using a Train the Trainer
method that a. familiarizes them with the project and
the mater ials; b. teaches them how to teach using these
materials; and c. teaches them how to facilitate others in
implementing CUSP - CLABSI
State coordinators team s
Hospital representatives team s
Hospital workers
12
200
20,000
Hospital representatives work with QI staff at their
hospitals to implement CUSP -CLABSI, blanketing all relevant hospital staff in the relevant
training and rolling out CUSP - CLABSI.
State Coordinators / core team provide follow up coaching calls to hospital representatives.
Core team
Conclusion
HAI Elimination CollaborationHAI Elimination CollaborationPolicy Leadership
AHRQ CDC CMS AHA
Field LeadershipJHU MHA HRET NW
Implementation Leadership
SHA DOH QIO
SummarySummary
• National Commitment
• Strong Collaboration– Federal Agencies– Provider Organizations– State Stakeholders
• Local Consortia Sustainability– Unit Based Culturally Driven Improvements
Questions