Clinical Performance and 100k Lives Campaign

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Clinical Performance and 100k Lives Campaign
Version 8.HV
Peter J. Plantes, MDVice PresidentClinical
Performance [phone]pplantes_at_vha.com
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What We Do

• Improve members clinical and economic
  performance

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VHA Member Networks Accelerate Members
Competitive Advantage
VHA MEMBER NETWORKS
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Picture this..

• 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.

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IHIs 100k lives Campaign Overview

• Announced by Don Berwick at 2004 IHI meetingSave
  100,000 lives by June 14, 2006 100k lives
  Campaign Some is Not a Number. Soon is
  Not a Time. (December 14th, 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

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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 setting
• Source www.ihi.org

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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

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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

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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

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Prevent Central Line Infections

• 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

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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 VHAs Transformation of
  the OR
• Source www.ihi.org

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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

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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

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100k lives Campaign - VHA Commitment

• 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.

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100k lives Campaign VHAs Actions

• Actions
• Recruit VHA members and assist in program
  enrollment
• Connect VHA participating hospitals to facilitate
  dialogue and monitor progress
• Collect VHA hospital performance data and forward
  to IHI
• Support the implementation of the six clinical
  interventions via VHA programs
• Transformation of the ICU
• Transformation of the OR
• Cardiovascular Bundle
• Rapid Response Teams

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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

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VHA Area Offices - A Key Differentiator
Central Atlantic
East Coast
Empire State
Central
Georgia
Gulf States
Mid- America
Metro
Michigan
Mountain States
New England
Oklahoma/ Arkansas
Northeast
Upper Midwest
West Coast
Pennsylvania
Southeast
Southwest
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VHA Area Offices - A Key Differentiator
The VHA potential..18 Area Offices providing
local/regional collaboration supported by a small
national team and national data management
resources.
Delivery Vision
Area Office
Area Office
NATIONAL
Area Office
Area Office
Area Office
MEGA-Node
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COLLECT Real Time Data Entry of Clinical
Metrics and Indicators
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COLLECT Real Time Reporting Benchmarking of
Clinical Metrics and Indicators
Compare your results against Customized peer
groups and National Averages in a real time
environment.
Review your Hospitals results on various Topics
Automatically Export Data into Microsoft Excel
with one click.
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Executive Style Dashboards and scorecards
available to track your progress on various
Clinical Performance Initiatives.
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100k lives Clinical Performance Program match

• 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
• Prevent Central Line Infections
• TICU domain
• Prevent Surgical Site Infections
• 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
• Prevent ADEs- Med Reconciliation
• Surg / Transformation of the OR (TOR)
• Prevent Surgical Site Infections
• Prevent ADEs- Med Reconciliation
• Transformation of the ICU (TICU)
• Prevent Central Line Infections
• Prevent Ventilator-Associated Pneumonia
• Prevent ADEs- Med Reconciliation

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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

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VHAs TICU Clinical and Economic Impact
TICU Impact Sepsis
Reduction
36 reduction
ICU COST SAVINGS/REVENUE ENHANCEMENT

• 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)

• 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

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Mortality Rate (Percent) Sepsis Population On
ICU AdmissionReporting Period November 2003 to
December 2004
TICU
Total number of ICUs in group participated in
reporting 19
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Catch the Vision !

• Ensure your hospital is enrolled you are
  already doing some of the work!!