MHA Keystone: Intensive Care Unit (ICU)

The Opportunity Estimator is a tool designed to engage clinicians and hospital leadership, educate staff about preventable harm and avoidable costs, and evaluate the impact of performance on financial and clinical outcomes, such as infection rates. Published estimates of mortality and costs associated with central-line-associated bloodstream infections (CLABSIs) are used to translate a hospital's individual CLABSI rate into the number of potentially preventable deaths, excess dollars and excess intensive care unit (ICU) days. In addition, the tool estimates the potential savings in deaths, dollars and ICU days based on graduated reductions in CLABSI rates from participating in a CLABSI intervention.

Launched in October 2003, MHA Keystone: ICU reduces central-line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia (VAP) that occur in ICU patients. In most participating hospitals, the implementation team includes a senior hospital administrator, an 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.

The effort to reduce CLABSIs resulted in an estimated 36 lives saved and $6.4 million net savings from March 2010 to March 2011. During that same time, the collaborative saved 79 lives and a net savings of $2.2 million by reducing the number of patients experiencing VAP. 

A joint septic shock initiative was launched in March by MHA Keystone: ICU and MHA Keystone: Emergency Room. Participating hospitals were encouraged to create an interdisciplinary team and unified approach to the initiative, improving the flow of patients through the hospital by removing the focus on one condition per unit. Data collection began in June and monthly webinars are being held to instruct participants on the early identification and treatment of sepsis using early goal-directed therapy.

In addition, a special project yielded a study called the “Business Case for Quality,” published in the September/October 2011 issue of the American Journal of Medical Quality. Six hospitals that have participated in MHA Keystone: ICU since its inception were selected for the study, which used cost-benefit analysis to compare the costs of implementing the improvement initiative with the generated financial savings. The hospitals included large, medium, small and rural hospitals with a mix of staffing arrangements.

The study determined that participating MHA Keystone: ICU hospitals prevent between 3.4 and 7.2 CLABSI deaths annually and receive a 10-to-1 return on investment for implementation. On average, 29.9 CLABSIs and 18 cases of VAP were averted for the six participating hospitals, totaling 47.9 averted infections. CLABSIs are also associated with additional hospital costs that range from more than $12,000 to about $56,000 per case. Using conservative estimates for averted costs of $36,500 per CLABSI and $10,000 per VAP, an average hospital would not only save lives by implementing an MHA Keystone: ICU intervention, but save approximately $1.1 million in costs per year.