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Clinical Performance and 100k Lives Campaign

Clinical Performance and 100k Lives Campaign. Version 8.HV. Peter J. Plantes, MD Vice President Clinical Performance (972) 830-0322 pplantes@vha.com. What We Do. Improve members’ clinical and economic performance. VHA Member Networks Accelerate Members’ Competitive Advantage.

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Clinical Performance and 100k Lives Campaign

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  1. Clinical Performance and 100k Lives Campaign Version 8.HV Peter J. Plantes, MDVice PresidentClinical Performance (972) 830-0322pplantes@vha.com

  2. What We Do Improve members’ clinical and economic performance

  3. VHA Member Networks Accelerate Members’ Competitive Advantage SHAREDCHALLENGE WORKING TOGETHER COLLECTIVE ACHIEVEMENT >> Shared Resources >> Shared Performance Targets >> Shared Accountability >> Shared Funding >> Clinical & Operational Improvement • >> Outcomes: • Clinical • Operational • Financial • Market • Safety VHA MEMBER NETWORKS

  4. 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.

  5. 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.” (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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. ‘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.”

  15. ‘100klives Campaign’ – VHA’s 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

  16. 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

  17. 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

  18. VHA Area Offices - A Key Differentiator 18 “nodes” of action tied together as the VHA “super-node”in the 100k lives Campaign.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. Delivery Vision Area Office Area Office NATIONAL Area Office Area Office Area Office MEGA-Node

  19. COLLECT: Real Time Data Entry of Clinical Metrics and Indicators

  20. 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 Hospital’s results on various Topics Automatically Export Data into Microsoft Excel with one click.

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

  22. 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 domainin 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 100k lives Clinical Performance – Program match

  23. 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 Transformation of the ICU

  24. TICU Impact: Average Length of Stay And Vent Days Decreased Baseline 12.9 14.0 Post 10.8 12.0 10.0 Days 8.0 4.9 6.0 4.3 4.0 2.0 0.0 Average LOS Average Vent Days VHA’s 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

  25. 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

  26. Catch the Vision ! • Ensure your hospital is enrolled – you are already doing some of the work!!

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