The Washington Hospital Center's Medical Intensive Care Performance Improvement Committee's efforts have resulted in improved outcomes for our patients. We have decreased overall length of stay from 6.2 days to 3.6 days. For our mechanically ventilated patients, we have decreased our mean length of stay from 9.5 days to 6 days and mortality from 36% to 23%. We accomplished this while seeing an increase in mechanically ventilated patients. Ventilator associated pneumonia has remained below the Centers for Disease Control's (CDC's) 50th percentile. We estimate our weaning protocol has saved the hospital $8 million per year.
In 2003, catheter-related bloodstream infections (CR-BSI) in our unit were consistently above the CDC's 90th percentile. We created a central line bundle that consisted of physician education on central line technique and site selection, assisted central line insertion (two-person procedure - RN observer) with an equipment cart and checklist, maximum barrier protection, procedural pause, empowerment and accountability of the RN to stop the procedure for any breaks in technique. Each day on rounds all CVCs are evaluated for necessity, site and catheter day. Unit-based CR-BSI rates were posted monthly and discussed in staff meetings. Education efforts included annual updates, bedside rounds and morbidity and mortality reviews for the nursing staff, and monthly education for rotating house staff. Infection Control undertook a public awareness campaign. We emphasized patient safety as our ultimate goal.
The results of this collaboration include a decrease in CR-BSI rates from the CDC's 90th percentile to well below the 50th percentile since July 2006. For the past three months we have had no CR-BSIs. As a result, a decrease in morbidity, mortality, associated costs and length of stay has been realized; we estimate that in the last year we saved eight lives and approximately $2 million.
