ICU effort saved lives, money: organizers.

A quality-improvement program involving intensive-care units at more than 70 hospitals saved an estimated 1,578 lives, $165.5 million in healthcare costs and 81,020 hospital days from March 2004 to June 2005, according to the organizers.

Keystone: ICU, a joint effort launched in October 2003 by the Michigan Health & Hospital Association and Johns Hopkins University Quality and Safety Research Group, targeted 127 ICUs, largely at Michigan hospitals.

Results of the effort were unveiled last week. Three hospitals in Iowa, one in Indiana and one in California also participated. The ICUs reduced central-line infections nearly 50%, and 68 of the ICUs reported no cases of bloodstream infection and no cases of ventilator-associated pneumonia for at least six months. MHA reported that improvements were so significant that Blue Cross and Blue Shield of Michigan agreed to provide nearly $10 million in financial incentives to participating hospitals in 2004.

Different conditions called for different ways to improve quality. "For bloodstream infection, the primary focus is the line insertion and keeping a sterile field with the surgeon properly gowned, gloved, the patient draped, the whole nine yards," said Sam Watson, MHA associate executive director. "Probably the most critical part of this is the ability of the nurse to stop the line and say 'Doctor, did you wash?' 'Doctor, the patient is not properly gowned.' We found that that had a dramatic effect on bloodstream infections." For reducing ventilator-associated pneumonia, wherever appropriate, patients' beds were raised at a 30-degree angle, patients were given "sedation holidays," and attempts were made to wean patients from ventilators as soon as possible, Watson said.

In most participating hospitals, a team was assembled to implement the best-practices interventions. Most teams included a senior executive, an ICU director, an ICU nurse manager, an ICU physician, a pharmacist and a department administrator.

Researchers estimated the number of lives and hospital days saved based on the typical frequency of the conditions and associated mortality and length of stay. Cost savings were based on average costs at a sample of Michigan hospitals.

Watson said the University of Michigan has begun to analyze the Keystone: ICU results to see how they were affected by physician- staffing levels and whether the ICUs were open or managed by hospitalists or intensivists.

PHOTO (COLOR): Watson: Results to be analyzed to see if staffing was an issue.

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By Andis Robeznieks