Linking Quality Improvement and Infection Prevention Manoj Jain, MD, MPH Medical Director, QSource 19 February, 2009

Objectives  Personal Journey in ID  Personal Journey with QI  What is QI?  What are Quality Measures?  Methods of QI – PDSA/Lean/Six Sigma  Applying PDSA Cycle

Goals for Quality Improvement

Know Your Quality Indicators

Rate of VAP Rate of UTI Rate of BSI Rate of SSI Rate of MRSA incidence Outcome Measures in Infection Prevention

Rate for hand washing compliance Antibiotic in a timely manner (within 1 hour) to reduce SCIP VAP bundle followed? Catheter days Process Measures in Infection Prevention

Surgical Care Improvement Project Performance Measures - Process Surgical infection prevention –Antibiotics  Administration within one hour before incision  Use of antimicrobial recommended in guideline  Discontinuation within 24 hours of surgery end –Glucose control in cardiac surgery patients –Proper hair removal –Normothermia in colorectal surgery patients

Measure the rates Educate others on how to reduce the rates, i.e., hand hygiene, prophylaxis antibiotics Encourage others to do interventions – hope the strategy works Result – rates remains the same. Infection Preventionist’s Job

If an outbreak occurs, then take action!!! In fact – the present rates are an outbreak We never had the tools to intervene Infection Preventionist’s Job

Goal is reducing infections Strategy is QI Tool is PDSA cycle Reducing infections is the Goal VAP and BSI are the outcome measures Hand Hygiene and bundles (checklist is the process measure) What is QI? PDSA?

PDSA: The Wheel of Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo

4 Elements of Change Multidisciplinary Teams – Staff ownership Flow Meetings –Administrative support Bundles –Evidence based medicine Culture of Change –Horizontal decision-making

Wheels in Motion: Continuous Quality Improvement

IMPACT: Patient Outcomes Can Improve The overall surgical infection rate fell 27%, from 2.28% (215 infections among 9435 surgical cases) in the first 3 months to 1.65% (158 infections among 9584 cases) between the first and the last 3 reporting months. Dellinger EP, et al. Am J Surg.2005;190:9–15.

Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

Nosocomial Infection Rates FY 2001-FY 2004 YTD

ICU ALOS Per Episode

Average Cost Per ICU Episode 15.6% Decrease 8.6% Decrease

Public Reporting Public Reporting of Quality Data CMS – Hospital/NH/Dialysis AHRQ – State Data Health Grades

Manoj Jain, MD, MPH Medical Director, QSource Thank You! This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN Linking Quality Improvement and Infection Prevention