How a QI Project Prevented Infections and Saved Millions
Why It Matters
A national QI initiative to prevent HAIs in critical care settings dramatically reduced harm, saved millions, and can serve as a model for other low- and middle-income countries facing similar challenges.
While the primary goal of health care-associated infection (HAI) quality improvement (QI) interventions is to prevent harm and death, this work can also result in sizeable cost reductions for the health systems. An article published recently in the Journal of Hospital Infection, co-authored by Paulo Borem, MD, of the Institute for Healthcare Improvement (IHI) and colleagues, describes the financial impact of an initiative called Saúde em Nossas Mãos (SNM) (Portuguese for “health in our hands”) that was implemented in Brazil between January 2018 and December 2020.
Borem and others show how the SNM project significantly reduced the rates of HAIs across 116 participating ICUs. They calculate the average cost for each analyzed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CA-UTIs). The authors estimate that the SNM project prevented 1,727 CLABSIs, 3,797 VAP, and 2,150 CA-UTI cases during the implementation period, resulting in an overall savings of US$68.8 million for the health care system. The authors also estimate that for every dollar invested in the project, it saved US$7.65.
The article also highlights key factors that contributed to the success of the SNM project, which used a modified IHI Breakthrough Series Collaborative QI learning model. In addition to typical QI approaches — including engagement of frontline staff and leaders, and simplified measurement and data feedback approaches — the project used innovative staff training methods to support the adoption of evidence-based practices and bundles.
The authors show how they calculated financial savings for each patient when harm was avoided and conclude that a national QI initiative to prevent HAIs in critical care settings is both feasible and value based. They also suggest that the SNM project can serve as a model for other low- and middle-income countries facing similar HAI challenges.
This work demonstrates the potential of QI methods and tools to address complex health care problems at scale and with impact, and the cost-saving implications of the work. Partnering with local organizations and stakeholders, IHI continues to expand its work in support of large-scale improvement efforts in different contexts and settings.
The SNM project is part of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI) health care improvement initiative coordinated by the Brazilian Ministry of Health. It includes a partnership of five private hospitals: Hospital Albert Einstein, Hospital Moinhos de Vento, Hospital Sírio Libanês, Hospital do Coração, and Hospital Oswaldo Cruz. PROADI aims to strengthen Brazil’s Unified Health System (SUS) by promoting the exchange of knowledge, skills, and best practices among health professionals and institutions. PROADI is funded by tax incentives granted to the private hospitals participating in the program.
Pierre Barker, MD, is IHI's Chief Scientific Officer. Paolo Borem, MD, is an IHI Senior Project Director.
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