Patient Safety Summit
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Transcript Patient Safety Summit
Making “Infection-Free” Happen:
Across, Down & Up; An Update
August 13, 2014
Pranavi Sreeramoju, MD, MPH
Associate Professor, Medicine-Infectious Diseases, UT Southwestern
Chief of Infection Prevention, Parkland Health and Hospital System, Dallas, TX
Email: [email protected]
+ HAI Reduction at Parkland: FY09 to FY13
-60.0%
-80.0%
-100.0%
-75.5%
-90.3%
-38.2%
-49.0%
52.8%
C.difficile
associated
diarrhea of
Hospital Onset
-40.0%
VRE Hospital
Onset BSI
-20.0%
MRSA
Hospital Onset
Bloodstream
Infections
0.0%
SSIHysterectomy
20.0%
% Change in Rate in FY2013 compared
to Baseline Rate in FY2008
0.0%
VAP - adult
ICUs
40.0%
CLABSI - ICUs
60.0%
+ HAI Reduction at Parkland: FY09 to FY13
Rate of Known HAI through IC Surveillance
CLABSI - ICUs (per 1000 catheter-days)
Ventilator Associated Pneumonia - adult ICUs (per 1000
ventilator-days)
SSI-Hysterectomy (% of procedures)
MRSA Hospital Onset Bloodstream Infections (Infection per
10,000 patient-days)
VRE Hospital Onset BSI (Infection per 10,000 patient-days)
C.difficile associated diarrhea of Hospital Onset (Infection
per 10,000 patient-days)
FY09 FY13 %Change
5.3
1.3
-75.5%
14.4
3.4
1.4
2.1
-90.3%
-38.2%
0.98
0.5
0.5
0.5
-49.0%
0.0%
3.6
5.5
52.8%
+
Project RITE: FY2013 to FY2016
‘Reduce Infections Together in Everyone’
A Texas 1115 Waiver Program for Quality Transformation at
Parkland
Executive Sponsors: Ron Laxton, RN, PhD and Chris Madden, MD,
MBA
Project Lead: Pranavi Sreeramoju, MD, MPH
Project Managers: Herron Mitchell, Nancy Baez, David Huffman,
and Joanne Muturi
+
AIM Statement (1 of 2)
Compared to FY2013 baseline rates at Parkland,
•
FY2015 and FY2016 - 20% per year reduction in
Central Line Associated Bloodstream Infection
(CLABSI) in ICUs, Wards, and outpatients
•
FY2015 and FY2016 - 20% per year reduction in
Catheter Associated Urinary Tract Infection
(CAUTI) in ICUs, and Wards
+
AIM Statement (2 of 2)
Compared to FY2013 baseline rates at Parkland,
•
FY2015 and FY2016 - 8% per year reduction in SSI
occurring after seventeen types of procedures.
•
Improve adherence to 3-hour and 6-hour Sepsis
Management Bundle for patients admitted with
Sepsis in the Emergency Department
+
Our Interventions
1.
Reduce Variation in Processes of Care and
Standardize Curriculum and Training
2.
Engage Clinicians & Stakeholders
3.
Have Bi-weekly Learning Sessions
4.
Train At Least 500 Champions in Process
Improvement Methodologies
5.
Participate in Regional Collaborative
+
Results Thus Far vs. FY13
10.0%
5.6%
0.0%
CLABSI
CAUTI
-10.0%
Rolling 12-Month
Goal by FY16
-30.0%
-50.0%
Sepsis
Mortality
-4.3%
-15.4%
-20.0% -12.4%
-40.0%
SSI
-36.0%
-36.0%
-40.5%
+
Positive Deviance Trial
+
Project Outputs
English/Spanish Flashcards - Teach
Patients How to Participate in their
Care
Hand Hygiene Video - Teach Patients
How to Perform Hand Hygiene
Infection Prevention Skills Checklist: 64
items
Name for the study
+
Outcome Data
# of Patient-days of Care
# of HAI (Primary Outcome)
Intervention Group
6-month
9-month
Baseline
Intervention
9-month FollowPeriod
Period
Up Period
9144
14841
15095
43
48
34
Control Group
6-month
9-month
9-month
Baseline
Intervention
Follow-Up
Period
Period
Period
9564
14339
14652
43
41
46
Rate of HAI per 1000 Patient-days
# of CLABSI
# of CAUTI
# of HAP
# of CDI
4.70
9
11
8
15
3.23
11
7
11
19
2.25
6
7
15
6
4.50
8
10
13
12
2.86
7
8
15
11
3.14
7
10
17
12
# of HAI associated with complications
occurring during same admission within 28
days (Secondary Outcome)
8
17
8
15
10
7
0.87
1.15
0.53
1.57
0.70
0.48
3
2
0
0
0
0
5
5
13
8
6
4
15
6
10
6
6
3
Rate of HAI associated with complications
per 1000 patient-days
# HAI associated with permanent loss of
organ or organ system
# HAI associated with transfet to higher
level of care
# HAI associated with Death
+
Summary of Positive Deviance Trial
Intervention may have accelerated reduction of HAI
Culture of Safety decline not seen in Intervention Wards
Social networks revealed that the ward manager, charge nurse,
ward clerk were predominantly the ‘go-to’ people for infection
prevention work
Staff turnover was high during study period due to
organizational situation
Look for the Publication
+
What Others can Learn from Us: 2013
Ensure that the program meets the highest of regulatory standards , e.g.,
TJC, CMS
Perceptions matter a great deal
Optimize technical solutions first
Leverage intrinsic motivation
Learn from the frontline employees and stakeholders if your challenges
are adaptive in nature
+
What Others can Learn from Us: 2014
Regulatory not done yet: Mock Surveys, Corporate Integrity Agreement,
Quality Review Organization
Perceptions still matter a great deal
Past performance will haunt (e.g., HAC reduction program due to late start
with CAUTI reduction, hemodialysis-associated CLABSI)
1115 Waiver Program is a blessing
Keep At It
Antimicrobial Stewardship
1, 2014
Patient Safety Summit
2013