Institute for Healthcare Improvement: BTS Collaborative: Reducing Complications from Ventilators and Central Lines in the ICU

Overview

The Breakthrough Series is IHI’s collaborative improvement methodology to rapidly deploy major changes that produce breakthrough results in a specific clinical or operational area. Collaboratives last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT and non-IMPACT member organizations.

Enrollment for this program is closed. If you are interested in receiving information for the next offering of this program, please send an email to info@ihi.org.

Click here to listen to an informational call led by the faculty of this Collaborative.

The Problem

The Solution

The intensive care unit (ICU) provides highly complex medical care requiring precision, synchronization, and coordination of multiple services and personnel. Providing critical care consumes 30% of hospital expenses for just 8% of the hospital population. Currently, roughly 4.4 million Americans receive care in our ICUs annually, and it is estimated that this number will grow significantly as our population of Baby Boomers ages.

Among the most challenging aspects of this clinical setting is the necessity to avoid complications from ventilators and central lines, particularly ventilator-associated pneumonia (VAP) and catheter-related bloodstream infections.

VAP is a leading cause of morbidity and mortality in the ICU. Estimates are that VAP is associated with up to a 30% mortality rate — as high as 50% when the VAP is caused by a more virulent strain of infection.

VAP also increases length of stay in the hospital an average of 13 days, and brings an added cost per episode of $3,000 to $6,000.

Catheter-related bloodstream infections are also common complications in the ICU. Approximately 80,000 occur in intensive care units in the US alone each year.

The consistent application of best science using protocol-based strategies for ventilator management, ventilator weaning, sedation and analgesia management, and central line protocols have proven to significantly improve outcomes and reduce costs.

Organizations participating in this Breakthrough Series Collaborative will reliably implement ventilator and central line "bundles."

A bundle is a group of precautionary steps with approximate time and space characteristics that, when executed collectively and reliably, have an enhanced affect on patient outcomes. The "ventilator bundle," for example, includes:

Elevating the head of the patient’s bed to 30 degrees or higher
Prophylactic treatment for deep venous thrombosis
Prophylactic treatment for peptic ulcer disease
Daily "sedation vacation" accompanied by an assessment of the patient’s readiness to wean from the ventilator

While most hospitals likely follow some of these steps some of the time, few if any ICUs complete them all of the time. The bundle provides a "forcing function" for teamwork, and this teamwork has led to outstanding results.

Areas of Focus

Significantly reduce VAP and catheter-related bloodstream infections through:

Ventilator bundle
Central line bundle
Multidisciplinary rounds
Daily goal sheets
Effective weaning protocols

Aims

Participants will implement a proven change package for achieving the following goals:

Reduce incidence of ventilator-associated pneumonia by 25%
Reduce incidence of central line infections by 25%

Related Learning Opportunity

Creating High-Performance Teams

Jump start your group into becoming a team by attending a one-day workshop on creating effective teams, offered prior to the first Learning Sessions.