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IHC Work Plan Description — Clinical Initiatives (pg. 1)


Executive Summary

Healthcare is by nature a team sport. Though healthcare organizations may compete for market share, the delivery of services at the patient level is a collaborative exercise. In today's environment of innovation, there is great opportunity to learn from each other. The Iowa Healthcare Collaborative works to build an "all-teach, all-learn" culture among Iowa providers. Providers can dramatically raise their level of care by working together. The Clinical Initiatives in the IHC work plan are projects geared toward collaborative, rapid-cycle performance improvement. Providers can share best practices and improve the culture of care delivery. Two leading clinical initiatives for IHC are the Institute for Healthcare Improvement's 100,000 Lives Campaign, and the IHC Healthcare Associated-Infections Initiative.

Institute for Healthcare Improvement's 100,000 Lives Campaign

The IHI 100,000 Lives Campaign (100K Campaign) is an initiative to radically reduce morbidity and mortality in American healthcare. Building on the successful work of healthcare providers all over the world, IHI introduced proven best practices across the country. The goal of the 100K Campaign was to save 100,000 lives from January 2005 to June 2006. This was the first national effort to promote saving a specified number of lives by a certain date. The Campaign was endorsed by the American Medical Association, Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, National Patient Safety Foundation, and the Joint Commission on Accreditation of Healthcare Organizations.
In this initiative, U.S. hospitals implemented changes in care proven to enhance patient care and prevent avoidable deaths. The program began with six interventions:
  • Deploy Rapid Response Teams at the first sign of patient decline.

  • Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attack.

  • Prevent Adverse Drug Events by implementing medication reconciliation.

  • Prevent Central Line Infections by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle."

  • Prevent Surgical Site Infections by reliably delivering the correct perioperative care.

  • Prevent Ventilator-Associated Pneumonia by implementing a series of interdependent, scientifically grounded steps called the "Ventilator Bundle."

Results of the Campaign

This first phase of the 100K Campaign clearly surpassed national expectations. Using sophisticated statistical models to track national mortality, IHI estimated that 122,342 lives were saved nationally as a result of the campaign. In Iowa, IHI estimated that at least 1,316 lives were saved as a result of the work of Iowa providers.

Focus of 2007

The second phase of the campaign begins on December 12, 2006, with the announcement of the next series of interventions by IHI. IHC is working to prepare Iowa providers for the next phase. IHC will coordinate the next phase of the campaign in Iowa and believes that all hospitals should:
  1. Participate in the campaign (100% of Iowa hospitals have already indicated they will be participating).
  2. Participate in as many interventions as are applicable to that facility.
  3. Actively participate in IHC sponsored campaign learning opportunities.
  4. Consistently report process and mortality data.

Healthcare-Associated Infections

National Status

Healthcare-associated infections (HAIs) are a major public health problem in the United States. According to the 2005 Report of the Healthcare Infection Control Practices Advisory Committee (HICPAC), HAIs account for an estimated 2 million infections, 90,000 deaths, and $4.5 billion in excess healthcare costs annually in hospitals alone. Industry measurement of HAIs is undergoing widespread reevaluation. Advances in medicine such as shortened lengths of stay, increased antibiotic availability, and the use of medical devices has altered HAI issues. New challenges such as antibiotic resistance, difficultly in tracing where the infection began, and the administrative cost of tracking the great numbers of procedures are rendering previous methods of measurement obsolete.

The measures of the past are no longer adequate. Because of this, the CDC and other authorities recommend no longer collecting or reporting hospital-wide HAI rates. Several national organizations are working to identify new measures, standardize definitions, and focus improvement efforts where they will be most effective. These efforts, though not yet completed, are focusing on measurement of immunization of healthcare workers, device-related infection rates, and surgical site infection rates.

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