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Collaborative Efforts Cutting Hospital Infections, Costs, Researchers Say

By John Reichard, CQ HealthBeat Editor

January 24, 2013 -- Researchers and hospital officials say that various projects around the country to improve quality and lower costs are bearing fruit, with the most recent example showing savings from a sharp drop in bloodstream infections in hospital neonatal intensive care units.

Central line infections—which are associated with tubes placed in the neck or chest of a hospital patient to deliver important medicines—fell by 58 percent in less than a year in a program involving 100 neonatal intensive care units in nine states, according to the Agency for Healthcare Research and Quality (AHRQ).

"These remarkable results show us that, with the right tools and dedicated clinicians, hospital units can rapidly make care safer," Carolyn Clancy, director of AHRQ, which collaborated with hospitals in the public-private effort, said in a news release.

By relying on teamwork to ensure safe practices were followed, including the use of checklists with simple steps such as hand washing to avoid infection, the program prevented 131 infections and up to 41 deaths, the agency said in a news release. It also avoided more than $2 million in health care costs in treating 8,400 newborns.

Central lines can remain in place for long periods of time, making them a gateway for germs if safe practices aren't followed. Last fall, AHRQ announced a 40 percent drop in central line infections from a separate four-year public–private effort that involved 1,100 adult intensive care units in 44 states.

The program to prevent central line infections—called the Comprehensive Unit-based Safety Program—was developed by Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore.

"The successes of the projects are proof that a great deal of improvement can happen in a relatively short time frame," said Maulik Joshi, a senior vice president at the American Hospital Association (AHA).

Joshi highlighted other projects at a briefing sponsored by AHA. Projects involving the Hospital Engagement Network, an AHA initiative resulting from a two-year contract with the Centers for Medicare and Medicaid Services, have saved $74 million in 2012, Joshi said. They include reductions of urinary tract infections, surgical infections, pressure ulcers, and hospital readmissions. The network supports the Center for Medicare and Medicaid Services' Partnership for Patients campaign, which former CMS Administrator Donald M. Berwick called the most ambitious national effort ever to reduce medical errors.

Executives from various individual hospitals at the briefing acknowledged that in a fee for service payment environment, reducing infections and cutting readmissions lowered their revenues but said patient well-being is a paramount. Harry Alberti, vice president for medical affairs at Verde Valley Medical Center in Cottonwood, Ariz., said that his facility's approach is that if an initiative does the right thing by patients, "the money will come."

Research released this week also showed that helping patients stick to follow-up treatment regimens after they are discharged from the hospital helps to prevent readmissions.

A study published Jan. 23 in the Journal of the American Medical Association examined the impact of efforts by so-called quality improvement organizations to prevent readmissions in this way. The "QIOs," which contract with the Medicare program to improve care, worked in 14 communities on projects to assist patients after they leave the hospitals.

The average rate of rehospitalizations within 30 days of discharge in those communities fell from 15.21 per 1,000 Medicare beneficiares in 2006 to 2008 to 14.3 per 1,000 in 2009 to 2010. Among the efforts to reduce readmissions were in-home visits and phone calls by nurses to make sure patients understood what medications they were supposed to be taking and that they were making needed follow-up appointments.

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