Lean Improvements Really Do Reduce Hospital Infections

I’ve written several times about efforts to reduce infections in hospitals through lean process improvement.

A couple of months ago I described how Blue Shield of California was spending nearly $6 million in such an effort. The insurer recognized that reducing hospital-acquired infections means patients are healthier, they spend fewer days in the hospital, and they – as well as the hospital and/or insurer – save lots of money.

Well guess what? Lean efforts to reduce infections actually work. A recent example was reported last week by the Wall Street Journal’s
Health Blog:

One kind of hospital-acquired infection — ventilator-associated pneumonia — plummeted by 78% between 2005 and 2007 at the New York City Health and Hospitals Corp., the organization said. Another, central-line infections, fell 55%. Surgical-site infections fell as well, but not as dramatically.

Another way to look at it: The country’s biggest public hospital chain — with 11 facilities and 30% of its patients uninsured — has averaged 5.2 months without a central-line infection, and 5.8 months without a case of ventilator-associated pneumonia.

These remarkable improvements are achieved by adopting “best practices,” which are often quite simple – for example, keeping the patient’s head elevated (in the case of ventilator-associated pneumonia) or making sure medical staff wash their hands frequently (in the case of central-line infections).

(There is also an article about this progress in The New York Times today.)

The WSJ blog article, written by Theo Francis, poses an interesting question:

HHC boasts that it now has 3.4 central-line infections for every thousand days patients have the catheters, and 2.3 hospital-acquired pneumonia cases for every thousand days patients are on ventilators. But how does that stack up against other hospitals?

Good luck finding a clear answer. Some studies suggest a national rate of central-line infections could be 5.3 per thousand central-line days. But most hospital-quality groups point to the CDC, which in turn collects data from a sample of facilities — 211 last year, out of nearly 5,000 acute-care hospitals — that aren’t necessarily representative….

Still, don’t expect to see such comparisons come up much. Health-care quality gurus frown on it as critically flawed.

“It’s hard to even the playing field between hospitals that see different types of patients,” says Andy Hackbarth, who heads up measurement for the Institute for Healthcare Improvement’s Five Million Lives campaign to improve hospital quality. “A hospital that’s taking a lot of really serious cases, like trauma patients, you would expect to see a higher rate of infection there given the same quality of care.”

That may be. But if you spend less time in the hospital and feel better because you weren’t infected while there, so what? The goal here, as it should always be in lean improvements, is not to match the record of someone else, but to always strive for perfection.


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