Sunday, December 17, 2006

What Works -- Part 4 -- Central Line Infections







Month ----- Infection Rate
Oct 05 ----- 1.67
Nov 05 ----- 1.28
Dec 05 ----- 2.43
Jan 06 ----- 3.07
Feb 06 ----- 1.40
Mar 06 ----- 1.07
Apr 06 ----- 0.00
May 06 ----- 0.59
Jun 06 ----- 1.15
Jul 06 ----- 0.57
Aug 06 ----- 3.03
Sep 06 ----- 2.50
Oct 06 ----- 0.00





Anonymous said...

Congratulations. It shows that significant improvement can happen when leadership and determination come together.

My questions are: as you analyze each infection to determine the cause and how the process can be improved going forward, how does the need to promulgate the results among your people (and perhaps share your experience with other hospitals) affect malpractice litigation -- number of suits, likelihood of an award and the size of an award? Would specialized healh courts as a replacement for the jury system largely take this issue off the table in trying to learn from mistakes, publicize your findings, and spread best practices?

Anonymous said...

This is a laudable effort, and as someone involved in marketing writing, I know it's gutsy of you to post the months that have less-flattering numbers, too - especially since you're in a business where some people are all to eager to (literally and figuratively) bury their mistakes. Good for you, and I invite everyone to be as open!

It sounds like your work used some of the methods of Six Sigma quality improvement. Do you use (or study) any formal discipline like that or is it all home-grown thinking?

Anonymous said...

This is a wonderful program, Paul, and a beautifully written explanation of the complexities involved in driving and measuring change. Thank you for making what goes on in the hospital real, accessible, and transparent in a way that is easy to understand for someone with a non-clinical background. It is very clear that you and the rest of your staff at BID really care about what you all do together, and that you have created an environment that allows people to interact in this way. I really enjoy reading your blog each day!

Anonymous said...

Dear bc,

Our hospital is a member of the Risk Management Foundation, a non-profit organization that shares claims and quality information throughout the Harvard hospital system (BIDMC, MGH, the Brigham, Children's, and others). When any of us learn something worthwhile that might improve patient safety and quality, or affect malpractice claims, we share that with one another. Under RMF's auspices, we also do research on promising area of quality improvement. Also, being an academic medical center, our faculty often public articles in medical journals about progress in this arena.

So, I guess I am not sure if a specialty health court system would result in greater promulgation of this kind of material. I would welcome other folks' thoughts on that question.

Anonymous said...

Dear patient dave,

We try to borrow and learn from other disciplines, but, truthfully, a lot of this is home grown. Medicine is not an industrial process, with repetitive and somewhat uniform inputs and outputs. While there can be general rules, the patient's particular situation requires physician and nurse judgment, and so you have to leave them the discretion to override the general rules.

Also, we do not have the same people doing the same functions all the time. Many of them are trainees: A resident who is assigned to the ICU today might be seeing it for the first time, having spent time on other floors and in other disciplines before.

Six Sigma is more likely to show up in more process-oriented situations like clinical laboratories. The improvement in central line infection rates in the ICU is certainly based on documented best practices from elsewhere in the health care field -- for example, those collected by IHI -- but the actual implementation process has to be cognizant of the culture of an academic medical center.

Anonymous said...

> Six Sigma is more likely to show up
> in more process-oriented situations
> like clinical laboratories.

Got that. Besides, I'm always looking to distill the "active ingredient" in any process - I don't care that much about the literal methods.

One approach I've seen in a non-industrial situation is

- let the customer, not your opinion, decide what's a failure.

- be data-driven (not subjective)

- analyze every single failure incident to understand how it arose, address those causes, and if necessary add more measurements to keep track of improvement there too.

And it sounds like that's basically what your team did.

Anyway, pass our admiration to the people whose commitment to improvement is trumping any concern about covering their own butts. This is a new world that's very much worth creating.

Anonymous said...

congratulations on your diligent work!

this is an area that will be in the headlines more once Patients First begins to publish these rates next year (altho they plan to use catheter days not icu patient days as their denominator).

Anonymous said...

Congratulations. The example of an academic medical center showing that "zero" is possible will add will and optimism to many others. Thanks for this terrific work, and for the transparency.

--Don Berwick

pdozier said...

Nice to see such openness. You might want to visit visit They are launching disposable products for infection control for IVs while showering, bathing, and so forth as a direct respone to the CDC Guidelines. I know they are looking for trial opportunities and feedback. Cheers, and keep up the good work.