MHA Intensive Care Unit (ICU)

Background: MHA Keystone: ICU recently celebrated its fifth year of reducing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia (VAP) that occur in ICU patients. According to the federal Centers for Disease Control and Prevention (CDC), an estimated 250,000 to 500,000 CLABSIs occur in United States hospitals each year, leading to longer hospital stays, increased health care costs and a greater risk of patient death.

The MHA Keystone: ICU collaborative remains the largest regional partnership of ICUs ever assembled in a single patient safety initiative. In most participating hospitals, the MHA Keystone: ICU implementation team includes a senior hospital administrator, ICU director, ICU nurse manager, ICU physician, ICU nurse, pharmacist and department administrator. Each team commits to collecting required data, participating in regular project conference calls, and attending meetings annually. Each team also agrees to implement the interventions as directed and to share what they have learned with other hospital teams.

MHA Keystone: ICU interventions include:

• Intervention 1: Implement comprehensive unit-based safety program

• Intervention 2: Implement daily goals sheet

• Intervention 3: Eliminate central line-associated bloodstream infections

• Intervention 4: Eliminate ventilator-associated pneumonia

• Intervention 5: Implement and evaluate an intervention to reduce ICU mortality

• Intervention 6: Evaluate characteristics of ICU teams and senior leaders who are associated with successful improvements in patient outcomes

Results: MHA Keystone: ICU has achieved significant, measurable patient safety improvements while saving lives and reducing health care costs. From March 2004 to March 2009, MHA Keystone: ICU resulted in:

• 1,830 lives saved

• more than 140,700 excess hospital days avoided

• more than $271 million in health care dollars saved

The overall VAP rate has been reduced to less than two per 1,000 ventilator days in 2009; however, the opportunity to further reduce VAP remains. One area demonstrated to reduce VAP is oral care. In 2008, MHA Keystone: ICU created and distributed an “oral care toolkit,” based on current best-practice guidelines, to further reduce VAP in ventilated ICU patients. The toolkit uses basic interventions such as brushing the patient’s teeth every 12 hours, using chlorhexidine-based (chemical antiseptic) mouth rinse every 12 hours, suctioning of oral secretions every four hours, and providing mouth moisturizer every four hours.

Future: MHA Keystone: ICU continues to implement new programs to improve patient safety. Led by a team of Michigan-based clinicians, efforts currently under way include developing and implementing a sepsis¹ bundle² to significantly reduce sepsis mortality. Because hyperglycemia, or high blood sugar, is common in ICU patients, glucose control will also be a focus this upcoming year. Monitoring and aggressively controlling glucose levels can result in positive patient outcomes. In addition to its ongoing clinical efforts, the MHA Keystone: ICU business case study is being conducted to identify and compare the costs and benefits of MHA Keystone: ICU.

¹ Sepsis is a serious medical condition characterized by a whole-body inflammatory state caused by microbes in the blood. The related layman’s term is blood poisoning.
² A “bundle” is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. The individual bundle elements are built upon evidence-based practices