GNYHA and UHF Central Line-Associated Bloodstream Infections CLABs Quality Improvement Collaborative

1. GNYHA and UHF Central Line-Associated Bloodstream Infections (CLABs) Quality Improvement Collaborative Hillary Jalon Session E1: Supporting Transparency Efforts at the Local Level Thursday, February 15, 2007, 10:30-11:45 a.m.

2. GNYHA and UHF The Greater New York Hospital Association (GNYHA) is a trade organization with members from 300+ hospitals and continuing care facilities throughout the tri-state metropolitan area The United Hospital Fund (UHF) is a health services research and philanthropic organization whose mission is to shape positive change in health care for people in New York

3. CLABs: A Significant Issue 5 million ICU patients 48% have central lines: 2.4 million patients 3% get a CLAB infection: 80,000 patients Up to 25% die: approximately 20,000 deaths Expensive: up to additional $56,000 in costs per case Public Reporting: media, state legislation

4. GNYHA/UHF CLABs Collaborative Primary Goal: Prevent CLAB infections and deaths by implementing the �Central Line Bundle� Identify and disseminate effective models and best practices throughout the region Share lessons learned from implementation experiences Provide technical assistance and coaching Originally 38 hospitals; 56 ICUs 9 additional hospitals joined in Aug. 2006 Wide variability in practice

5. What are the Interventions? Central line bundle Hand hygiene Maximal barrier precautions Chlorhexidine skin use Site of line placement Review of line necessity Checklist Hospital-wide staff education Daily goals

6. GNYHA/UHF �Bundle� for Improvement: �Expert on Call� Physician Consultant Regular Meetings and Conference Calls Site visits to hospitals Information-sharing through IPRO/JENY Web site Reports and Feedback on Data Collected

7. Senior Executive, Medical, and Nursing commitment Nurse and Physician Champions Day-to-Day Liaison/Key Contact Interdisciplinary team Standardized data collection Monthly reporting to GNYHA/UHF GNYHA/UHF �Bundle� for Improvement: (continued)

8. CLABs Collaborative Activities 3 Learning Sessions May 2005, October 2005, May 2006 Ongoing bi-weekly to monthly conference calls Web based communication IPRO/JENY Web site GNYHA and UHF Staffing Funding from UHF

9. Tracking Collaborative Performance What do we count? Central Line Days Central Line Bloodstream Infections How do we report? Baseline and Monthly Data Hospital-specific Reports with Peer Group Comparisons (teaching and non-teaching hospital rates) Algorithms and FAQ Developed for Collaborative

10. JENY: Web-Based Collaborative Support Designed and supported by IPRO to provide an online collaborative workspace All team members were pre-registered All Collaborative materials are posted on JENY IPRO staff provides technical support Participants submit information to GNYHA or UHF to post OR they post themselves

12. GNYHA/UHF CLABs Collaborative Monthly CLAB Infection Data Results

13. Other GNYHA/UHF Initiatives: 2006-2007 Rapid Response System (RRS) Collaborative One of IHI 100,000/5 Million Lives Campaign initiatives Designated groups of practitioners that identify high risk patients and respond to acute deterioration Culture of Safety Assessment and Patient Safety Leadership Problem Solving Rounds Information-sharing through JENY: http://jeny.ipro.org/rrs Critical Care Leadership Network (CCLN) Group formed to identify additional ICU improvement opportunities First activity is 24-hour Prevalence Study across GNYHA region Creation of specialized sub-committees Information-sharing using a private forum through JENY

16. Next Steps for Information-sharing through JENY Develop a �GNYHA/UHF Overall Homepage� � in progress Continue to encourage participants to use JENY Materials and best practices �Expert on Call� clinical resources Create and use new forums on JENY for ongoing GNYHA/UHF Joint Initiatives