Reducing Hospital-Acquired Infections Among the Neurologically Critically Ill.

BACKGROUND: Hospital-acquired infections (HAIs) result in excess morbidity, mortality, and resource consumption. Immobilized, ventilator-dependent ICU patients are at the highest risk of HAI. METHODS: Despite broad implementation of relevant bundles, HAI incidence in our neuro ICU remained high, particularly catheter-associated urinary tract infections (CAUTIs) and ventilator-associated events (VAEs). We reviewed the administrative data and nosocomial infection markers (NIMs) for all neurology and cranial neurosurgery patients admitted to our neuro ICU between January 2011 and May 2014, identified and implemented interventions, and measured effects using National Healthcare Safety Network (NHSN)-defined CAUTIs and VAEs. Interventions included (1) reviewing Foley catheter use, including indications and alternatives, and instituting daily rounds, continuously questioning the ongoing need for a catheter; (2) re-educating neuro ICU personnel in insertion and maintenance technique, introducing a new kit that simplified and standardized sterile insertion; and (3) placing a mobile CT in the neuro ICU since our patients required repeated transports for brain imaging and since we found correlations between frequencies of these transports, and both respiratory and urinary NIMS. RESULTS: VAEs decreased 48 %, Foley use decreased 46 %, CAUTIs decreased from 11/1000 catheter days to 6.2. Overall complication rate decreased 55 %, ICU length of stay 1.5 days, and risk-adjusted mortality 11 %. CONCLUSIONS: Combining a multidisciplinary approach with rigorous analysis of objective data, we decreased total HAIs by 53 % over 18 months. Key drivers were decreased urinary catheter use and decreased patient transport from the ICU for imaging.

Community hospital participation in a pilot project for venous thromboembolism quality measures: learning, collaboration, and early improvement.

BACKGROUND: Participation in national demonstration projects by hospitals provides opportunities for learning, collaboration, and early improvement. A community teaching hospital, Overlook Hospital, part of the two-hospital Atlantic Health system, participated in a pilot project in the United States with The Joint Commission to develop quality measures for venous thromboembolism (VTE) prevention and management. THE PILOT PROJECT: The VTE project formally began in January 2005, and by January 2007, on the basis of alpha testing to assess face validity and data-collection issues, eight measures were selected for pilot testing. The hospitals tested the quality measures from January through June 2007; data collected included discharges from October 2006 through March 2007. During the pilot, Overlook achieved significant improvements in VTE prevention and management. As a result, in Summer 2007, Atlantic Health developed an organizationwide initiative to improve VTE prevention and treatment. DISCUSSION: In 2008, the Joint Commission recommended that the VTE measures become a core measure set and be aligned with the Centers for Medicare & Medicaid Services quality measures. Following successful implementation of multiple quality improvement innovations that arose from the pilot project participation, Atlantic Health sustained and expanded its efforts in 2009 to improve'performance on eight VTE quality measures. CONCLUSIONS: Participation of a broad range of hospitals, including academic medical centers and community hospitals, in a national pilot project to develop quality measures is critical to ensure that differences in environment, resources, staffing, and patient acuity are accounted for, particularly when the measures are used for public reporting.