Participation in national benchmarking studies improves care, reduces cost

Hospitalized patients who develop pneumonia from their use of ventilators are common at hospitals around the country, including UC Davis Medical Center, and this occurrence leads to increased mortality rates, longer hospital stays and increased costs.

However, through its participation in an alliance of nearly 100 academic health centers, the medical center reduced its incidence of ventilator-associated cases of pneumonia by 15 percent in 2005 compared to the previous year. The number of days patients were on ventilators went from 13.6 in 2004 to 11.6 in 2005. UC Davis Health System is a member of the University HealthSystem Consortium, which conducts numerous, large-scale benchmarking studies to identify opportunities for long-term improvements and cost reductions in clinical and operational areas. The health system participated in a study of ventilator-associated pneumonia that concluded last November.

The health system has implemented measures that the study found had been effective in reducing ventilator-associated pneumonia in other hospitals. Those measures are reducing the amount of time patients are on ventilators, improving treatment with antibiotics, keeping the head of the hospital bed raised and conducting more frequent oral hygiene.

The health system has ongoing participation in several other UHC benchmarking studies.

“Through our membership in the University HealthSystem Consortium, we are able to benefit from the combined experiences and knowledge of a large pool of fellow institutions that face the same challenges we do,” said Cynthia Stefani, manager of Clinical Quality Improvement and Patient Safety for the health system. “We learn about improvement strategies that have succeeded elsewhere, and share with others the initiatives that have worked well for us.”

The University HealthSystem Consortium consists of 93 full members and 136 associate members, located mainly in the United States. The UHC is intended to provide its members with a variety of resources to improve their performance in clinical, operational and financial areas. The UHC’s mission is to advance knowledge, encourage collaboration and promote change to help members succeed in their respective markets.

One of the methods used by UHC is benchmarking studies on clinical and operational topics. The UHC now has almost 60 benchmarking projects under way. Participants in benchmarking projects, in addition to receiving and contributing information about successful improvement strategies, periodically receive customized reports that illustrate their institution’s performance on key benchmarking project measures.

Following are the UHC benchmarking projects in which the health system is participating, and the individuals heading those projects at the health system:

• Antifungal Prophylaxis in Transplant MUE – Twenty institutions are participating in this Medication Use Evaluation (MUE), which is primarily focused on the prophylactic use of antifungal medications in solid organ (excluding kidney, eye, and skin) and hematopoietic stem cell transplants. Leading the project at the health system is Jeff King, clinical coordinator in the pharmacy department.

• Central Line-Associated Bloodstream Infections – In 2003, UHC conducted its third Adult ICU project and the first that examined patient-level care for ventilator-dependent patients in the intensive care setting. Significant initiatives have been introduced this year that bring the care of these patients back onto the national agenda: UHC has formed a partnership with the Institute of Healthcare Improvement (IHI) to assist in its 100K Lives campaign, an initiative to enlist hospitals across the nation to prevent avoidable deaths by implementing proven interventions. One of these interventions is the prevention of central line infections. The National Healthcare Quality Report also includes bloodstream infections associated with central vascular catheters. Karen Mondino, manager of SICU I and II, is on the steering committee for the project.

• MVP Bundle – To date, UHC has conducted four benchmarking projects examining the operational processes used in caring for mechanically ventilated patients (MVP). The most recent projects, Adult ICU 2003 and MVP Bundle 2005, examined clinical processes as well. The MVP Bundle project evaluated institutional compliance with performance measures drawn from evidence-based literature, including national guidelines from the American Association for Respiratory Care, American College of Chest Physicians, American Thoracic Society, and Centers for Disease Control, and the proposed intensive care unit (ICU) core measures from the Joint Commission on Accreditation of Healthcare Organizations. Linda Moore, manager of the Burn Unit, was on the steering committee for this project.

• Rapid Response Team – UHC supports the implementation of some form of rapid response team (RRT) in its member institutions, but there is little objective data to determine the value and understand the differences among the different models used, such as those led by a physician compared to those led by an R.N. or a respiratory therapist. An RRT – known by some as a medical emergency team – is a team of clinicians who bring critical care expertise to the patient bedside or wherever it is needed. The purpose of RRTs is to reduce the number of patients who die unnecessarily during their hospitalization. Aida Calpo, a nurse manager in Patient Care Services, and Eric Moore, a nurse administrator in Patient Care Services, have assembled a rapid response team for the health system and will be participating in an upcoming UHC survey on RRTs.

• Core Measures Networking Collaborative – In early December 2005, UHC launched the Core Measures Networking Collaborative. Previous work in Core Measures was conducted in 2003 through a benchmarking project that focused on aggregating and analyzing data on conditions such as acute myocardial infarction, heart failure and community-acquired pneumonia. The 2005 networking collaborative is designed to support academic medical centers that wish to pursue improvement projects independently while networking with other UHC members and learning from organizations that have made notable core measure improvements. Leading the health system’s work on this project are Carlie Hatt, Lynne Boehret, Debra Burgess and Beverly Smiley, nurse analysts in Clinical Quality Improvement.

• Automated Dispensing Machines – One of the initiatives of the UHC Pharmacy Council Medication Management Quality Improvement Committee in 2002 was to look at override policies for automated dispensing systems. One of the committee's primary concerns is that the growing use of automated medication dispensing machines has caused many organizations to experience problems with pharmacists reviewing medication orders before medications are dispensed and administered to patients. The committee created a task force and invited nursing participation because nurses play a role in the dispensing of medications. Survey results will be sent to project participants and selected members have been asked to provide additional information about their ADM-related strategies and improvement initiatives. John Grubbs, director of the health system’s pharmacy department, participated in the survey.

• Managing Patient Flow – UHC has conducted two benchmarking projects on managing patient flow, in 2002 and 2004. The 2004 project was followed by a successful implementation project. However, the issue remains one of the top five concerns of UHC members as reported in the 2005 UHC member satisfaction survey. To respond to this continuing need, UHC is conducting another patient flow project. This project will focus on emergency department and operating room flow and capacity management. Robert Derlet, professor of emergency medicine, is on UHC’s steering committee for the project.