Hospital Buyer

Hospitals in the Philadelphia area have made great strides in decreasing rates of bloodstream infections. Central line-associated blood stream infections are among the most common, costly and deadly complications of hospital care. Central lines are placed in a major artery or vein in the sickest patients as a way to administer medications and nutrients. Typically, 50 percent or greater Intensive Care Unit (ICU) patients have a central line in place.

Nurses from Allegheny General Hospital (part of the West Penn Allegheny Health System) have been selected to receive the American Association of Critical Care Nurses (AACN) 2007 Baxter Circle of Excellence Award for patient safety. A central line team was formed that consisted of nurses, physicians and other clinical staff. The team and other Allegheny General staff worked closely with the Pittsburgh Regional Healthcare Initiative to apply Toyota Production System principles to the central line infection problem. After extensive analysis of existing practices and all levels of work that were associated with the use and management of central lines, the team determined that:

• “There was little consistency with regards to the techniques, supplies and barrier precautions used by staff during central line insertion and dressing changes.
• Aggressive, real time case review was imperative to uncovering the causes of central line infection and taking appropriate measures to address them.”

Next, the team “established a process to immediately identify and investigate central line infections at the bedside to determine what could have been done differently. The team cultivated a ‘no blame’ atmosphere in an effort to promote creative problem solving and ownership of the project by the entire staff. Learning occurred with every infection and the team and staff realized that patient safety could be enhanced significantly and swiftly.”

The results were dramatic. In a three-month period after implementing the program, there was a 90% reduction in Medical Intensive Care Unit and Coronary Care Unit central line infections. When the program began there was a one in 25 chance that a patient in these units would get a central line infection. Currently patients have a one in 527 chance.

The following are some of the practices that were instituted at Allegheny General:

• “Changing the standard site of central line insertion from the femoral region near the groin to the subclavian region near the collarbone.
• Eliminating the practice of rewiring existing lines.
• Establishing a protocol of removing and replacing central lines of patients coming into the hospital.
• Closely examining the necessity of every central line on a daily basis and establishing standardized central line insertion and dressing kits, techniques and documentation.
• Developing an online computer training model and skills verification lab for staff training.”

Similar efforts are underway at other hospitals in the Philadelphia region including large academic medical centers such as Thomas Jefferson University Hospital and smaller hospitals such as Chester County Hospital. In addition, the Governor of Pennsylvania, Edward G. Rendell has targeted hospital-acquired infections in his 47-point plant to improve healthcare in the state.

February 22, 2007 Related topics: Legal & legislative, Quality, Safety, Errors, Cardiology