1. Clinical Performance and 100k Lives Campaign
Version 8.HV
Peter J. Plantes, MD Vice President Clinical Performance (972)

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

3. VHA Member Networks Accelerate Members’ Competitive Advantage
>> Clinical & Operational
Improvement
SHARED CHALLENGE
>> Shared Resources
>> Shared Performance Targets
>> Shared Accountability
>> Shared Funding
WORKING TOGETHER
>> Outcomes:
Clinical
Operational
Financial
Market
Safety
COLLECTIVE ACHIEVEMENT
Develop visual image: Picture This…
VHA members working together to save lives
VHA members will implement clinical care improvements that have proven to promote health and prevent avoidable deaths.
400 VHA members participate in one or more VHA initiatives.
VHA members will lead the industry in clinical quality and safety and will be noted for their significant contribution to the 100K lives campaign.
VHA recognizes members who have achieved a significant measurable contribution to this effort.

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:

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:

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:

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.”
In support of the 100k campaign, VHA will:
Connect members to improve clinical performance
Leverage VHA’s network strategy
Increase members’ awareness and participation in the 100k campaign
Identify, enumerate and stay in contact with participating VHA members
Assist with data collection
Support members in the implementation of the six interventions

15. ‘100k lives Campaign’ – VHA’s 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
In support of the 100k campaign, VHA will:
Connect members to improve clinical performance
Leverage VHA’s network strategy
Increase members’ awareness and participation in the 100k campaign
Identify, enumerate and stay in contact with participating VHA members
Assist with data collection
Support members in the implementation of the six interventions

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 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

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

21. 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.

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

23. 100k lives Clinical Performance – Program match
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 domain in all Programs
Prevent Central Line Infections
TICU domain
Prevent Surgical Site Infections
Surg/TOR Program offering
Prevent Ventilator-Associated Pneumonia
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
Surg / Transformation of the OR (TOR)
Prevent Surgical Site Infections
Transformation of the ICU (TICU)
Prevent Central Line Infections
Prevent Ventilator-Associated Pneumonia

24. Transformation of the ICU
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

25. ICU COST SAVINGS/REVENUE ENHANCEMENT
VHA’s TICU Clinical and Economic Impact
TICU Impact: Average Length of Stay
And Vent Days Decreased
12.9
10.8
4.9
4.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Average LOS
Average Vent Days
Baseline
Post
Days
TICU Impact: Sepsis
Reduction
36% reduction
ICU COST SAVINGS/REVENUE ENHANCEMENT
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
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)

26. Mortality Rate (Percent) Sepsis Population: On ICU Admission Reporting Period: November 2003 to December 2004
TICU
Total number of ICUs in group participated in reporting: 19

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