The Challenge

More than 5 million people are treated each year in U.S. hospital intensive care units (ICUs). Care delivered in ICUs costs about $180 billion a year, which represents almost 30 percent of total annual acute care spending. Improving the delivery of care and reducing medical errors in ICUs can improve patient outcomes and improve financial performance.

The Response

MHA Keystone, with patient safety experts from Johns Hopkins University, launched Keystone: ICU in October 2003 with a matching grant from the Agency for Healthcare Research and Quality.

Keystone: ICU provides evidence-based, “best-practice” interventions to participating hospitals aimed at making ICU care safer, improving the quality of care, enhancing the culture of safety and staff satisfaction, and eliminating unnecessary or avoidable costs.

Keystone: ICU has been an overwhelming success. It now represents the largest regional partnership of ICUs ever assembled in a single initiative — nearly 120 ICUs participating.

In most participating hospitals, the Keystone: ICU implementation team includes a senior executive (vice president or above), an ICU director, ICU nurse manager, ICU physician, ICU nurse, pharmacist and a department administrator. Each team commits to collecting required data, attending two meetings annually, and participating in project conference calls. Each team also agrees to implement the interventions as presented and to share what they learn with other teams. During the first two years of Keystone: ICU, the interventions included:

• Intervention 1: Implement Comprehensive Unit-based Safety Program
• Intervention 2: Implement Daily Goals Sheet
• Intervention 3: Eliminate Bloodstream Infections (BSI)
• Intervention 4: Eliminate Ventilator-associated Pneumonia (VAP)
• Intervention 5: Implement and evaluate an intervention to reduce ICU mortality
• Intervention 6: Evaluate characteristics of ICU teams and senior leaders that are associated with successful improvements in patient outcomes

MHA Keystone manages the project, focusing particularly on strengthening relationships and forging new ones between hospital leadership and ICU teams. Dedicated project Web space, weekly conference calls that are recorded and provided back to each team, e-mail rapid response times, data support and report development, shared tools and consistent encouragement to share what is being learned all help ICU team members understand the importance of their work and Keystone’s commitment to supporting them.

The Results to Date

Keystone: ICU participating hospitals have achieved significant and measurable clinical improvements. Keystone: ICU is saving lives by improving patient safety and reducing medical errors in intensive care units.

Keystone: ICU Milestones

• Nearly 120 ICUs including five in other states — are participating in Keystone: ICU.
• Of the participating ICUs, nearly half have reported zero bloodstream infections or ventilator associated pneumonias for six months or more.
• Overall ventilator-associated pneumonia rates in the Keystone: ICU project continue to decrease.
• Using a predictive model and data collected from ICU project participants between March 2004 and March 2007, the total savings in the 18-month span were estimated to be:
  • Patient Lives Saved – more than 1,729
  • Hospital Days Saved – 127,857
  • Health Care Dollars Saved - $246,638,054

* These impact estimates are based on projections from the Johns Hopkins Opportunity Calculator. This model applies estimates of the prevention of deaths and decreased hospital stay as extrapolated from published empirical studies. The estimated dollar savings is based on an average cost of a hospital day and an ICU day in Michigan from a sample of Michigan hospitals.

Other Important Outcomes

• MHA Keystone has expanded the vision of what constitutes important hospital and health system advocacy and policy efforts. Michigan legislators have welcomed presentations about Keystone. Nationally, Keystone: ICU stands out as an important example of innovative improvement that can be sparked by modest federal funding.

• Blue Cross Blue Shield of Michigan (BCBSM) provides incentives to hospitals that achieve certain quality and safety thresholds. Hospital participation in Keystone: ICU was so significant that BCBSM agreed to nearly $10 million in financial incentives for hospital participation in 2004.

• MHA Keystone has identified a new role for state hospital associations, and other state hospital associations are taking notice. As a neutral convener and project leader, the association can truly lead local implementation of evidence-based health care improvements. The biggest winners are patients.

• The MHA Keystone ICU project has furthered the work of adding validity and rigor to the work of improving quality and patient safety. The New England Journal of Medicine published an original article about the Keystone: ICU participants gains in reducing bloodstream infections.