Algorithm 3: Case Study 1


Who wants to be an outlier when it comes to quality metrics? No one. So when nsqip data revealed that the rate of surgical intensive care unit (sicu) patients at university hospital receiving more than 48 cumul ative hours of mechanical ventilation was higher than the nsqip average, a team of experts got together to figure out how they could improve.

SICU physicians, respiratory therapists, nurses and quality experts formed a Performance Excellence Team to identify the problems and then devise and implement a series of interventions to improve patient care. "It turned out to be less about establishing new protocols and more about communication, timing and education," says SICU medical director Richard Barton, M.D. "Getting everyone on board was key to getting the job done."

The result? In one year, the new protocols reduced ventilator hours by 8,747, decreased the average length of stay from 13 days to 11.2 days (which added up to 1,458 total hospital days), and reduced the number of ventilator-associated pneumonia cases by 18. The direct cost savings for respiratory therapy alone was $100,000, and the UHPP Committee awarded $50,000 to the Department of Surgery. If associated costs, such as pharmacy, nursing and room charges, had been assessed the potential savings were even greater.

General surgery resident Gillian Seton, M.D., submitted the SICU ventilator quality improvement project to NSQIP and won the award for best abstract. She was the only resident invited to present at the NSQIP annual meeting.