California hospital reduces VAP with 'stoplight' system

Eisenhower Medical Center (EMC) in Rancho Mirage, Calif., has successfully used a new type of clinical alerting system to reduce the incidence of ventilator-acquired pneumonia (VAP) and to improve stroke care, according to an article in Healthcare Informatics.

Co-developed by EMC and McKesson, the quality dashboard monitor works like a stoplight, flashing green, yellow or red lights, depending on whether the care electronically documented by clinicians follows evidence-based protocols.

"It's the first tool I've implemented at the bedside that proactively allows the caregiver to know where they stand with some of the evidence-based care they are supposed to deliver," EMC CMIO Steven Arendt told Healthcare Informatics.

The healthcare system rolled the dashboard out in early 2011 for clinical quality improvement "bundles" it had already implemented for VAP and stroke care.

In the first quarter of last year, the VAP rate dropped 33 percent, from 2.48 cases per thousand ventilator days to 0. In the third quarter of 2011, when the dashboard was turned off to accommodate another go-live, the VAP rate jumped to 4.68. After the alerting system was restored, it dropped to 1.23, and in the first quarter of 2012, to 0.9, EMC reports.

Hospitals have had difficulty stamping out VAP in their intensive care units, partly because it requires a robust effort by all staff members. Some institutions have used a disciplinary approach to reduce VAP, while others have relied on team spirit, according to a Hospitals & Health Networks article. EMC falls into the latter category but attributes much of its success to the quality dashboard alerts.

The organization also used the dashboard to increase the use of deep vein thrombosis (DVT) prophylaxis after strokes. DVT prophylaxis, which was at 78 percent before the launch of the stoplight system, shot up to 95 percent after it went live. Currently, the rate is 93 percent.

In the future, EMC plans to apply the stoplight alerts to other quality metric bundles, the article said. Next up will probably be catheter-related urinary tract infections, heart failure, and other chronic diseases. These conditions are common among EMC's patients, 70-80 percent of whom are on Medicare.

To learn more:
- read the Healthcare Informatics article
- see the Hospitals & Health Networks piece on safety improvement

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