The New Jersey Hospital Association is launching its most ambitious effort to date under the umbrella of its 2-year-old Quality Institute, an initiative aimed at reducing death, infection and average length of stay in the intensive-care units of participating hospitals.
With quality at the top of virtually every hospital's agenda, the Quality Institute is focusing on the intensive-care unit, one of the riskiest places for adverse events in any hospital, for its first major undertaking. Serious adverse events occur to approximately 17% of all ICU patients nationwide, said Kerry McKean Kelly, a NJHA spokeswoman, citing one national study. Another study of hospital ICUs determined that 1.7 errors are committed on each ICU patient each day, she said.
ICUs also represent a major chunk of hospitals' expenses. There are nearly 6,000 ICU units in the U.S. caring for about 55,000 patients each day and accounting for 10% of all inpatient beds. More than 5 million patients are admitted to these units annually at a cost of approximately $180 billion, or 30% of all acute-care costs, according to the Quality Institute.
So far, 25 of the NJHA's 109 hospitals have signed up for the ICU project, committing core teams of at least three professionals who will collectively devote at least one day per week to the yearlong project that officially kicks off June 7. The effort is led by Peter Pronovost, associate professor and medical director of Johns Hopkins University's Center for Innovations in Quality Patient Care in Baltimore, and Thomas Rainey, president of CriticalMed, a consulting company in Bethesda, Md.
Participating hospitals, which are paying a $7,500 fee, will attend three two-day learning sessions, have access to a nationally recognized faculty and will be provided with benchmarking data, said Aline Holmes, director of the Quality Institute. Specific goals of the program include reducing mortality by 20% over the course of the year, reducing the incidence of ventilator-associated pneumonia to the 25th percentile or less of data reported to the Centers for Disease Control and Prevention, and reducing catheter-related bloodstream infections to a similar degree. The collaborative also aims to reduce ICU patients' average length of stay by one day.
Professionals at 435-bed Atlantic City (N.J.) Medical Center see it as "a large opportunity to get many different perspectives on how different organizations manage their issues within critical care," said Louise Giese, clinical manager of a 12-bed medical ICU at the hospital's Pomona campus. "We all basically have the same issues and we all have to find ways to do better with less." Professionals at a 10-bed ICU at the hospital's Atlantic City campus will also participate, she noted.
Holmes said she was a little disappointed in the number of hospitals that signed up for the New Jersey program. "I think a lot of hospitals either don't understand collaboratives or don't have a frame of reference where they know what that can mean," she said. "CEOs didn't understand and didn't push the issue and there are a lot of competing priorities."
There apparently has been more enthusiasm for a very similar project in Michigan, which is already six months into a two-year program also under Pronovost's tutelage. There, 77 out of 135 hospitals signed up. The Michigan program is free for hospitals thanks to Pronovost's two-year federal grant, said Sherry Mirasola, a spokeswoman for the Michigan Health & Hospital Association. Some parts of the program will eventually be tied to a Blue Cross and Blue Shield pay-for-performance initiative, she said.
"It's still in a very formative stage, but that's how serious we are about linking performance to outcomes," Mirasola said.