Reduction in Ventilator Acquired Pneumonia (VAP)

Clinical Initiatives to reduce Ventilator Acquired Pneumonia (VAP) – Children’s Hospital desire to improve outcomes and reduce medical errors

Case Study Details

90% reduction in VAP …¬†Translated:

  • 0.25% fewer VAP/admission
  • 0.043% patients go home safely (lives saved)
  • 575 Bed Days Saved (time previously occupied by patients with VAP)
  • 131 additional patients can be supported with the savings

Interventions aimed at reducing VAP rates were developed from published best practices and the institution’s internal observations and thoughts

  • Developed process and procedures built around evidence based best practices, teamwork, and communications
  • Used simulation to provide deliberate practice of these skills in simulated high risk, time pressured critical environments¬†
  • IRB granted exempt status, obtained confidentiality and video consent from all participants
  • Participants required to participate in simulation but were not required to complete aptitude or knowledge surveys

2 days of non-clinical duty for each learner

  • additional faculty time to develop curriculum
  • additional cost to support simulation training for staff

< 1 year (2007)

Clinical resources to review best practices literature and adjust for internal constraints

  • space to conduct simulation training
  • properly trained faculty to support training initiative
  • learner time to train away from clinical duties

Ventilator Acquired Pneumonia Rate on par with national average (4 per 100 patients on ventilators)

  • based off of a 450 bed hospital
  • based off of an admission rate of 28,000 per year
    • 28% of admissions that had patients on ventilators
    • 4% of patients on ventilators had VAP
    • 15% to 20% are at risk of mortality
  • Unnecessarily put at risk 70 patients per year
  • prevent 131 patients to be cared for with the resources currently being used to treat patients with VAP
  • wiithin the US, potentially those costs must be absorbed by the institution since these are HAI, ~ $4.84 million/year¬†
  • loss of additional revenue from the 131 prospective patients, ~ $4.53 million/year
  • net cost due to SSI if nothing is done ~ $9.37 million/year

Decision Maker Talking Points

  • Unnecessarily put at risk 70 patients per year
  • 12 patients get to go home to continue to be part of their families
  • prevent 131 patients to be cared for with the resources currently being used to treat patients with VAP
  • net cost due to SSI if nothing is done ~ $9.37 million/year
  • If we implement program, for community PR show advocacy for Patient Safety, blowing past national average
  • can be part of any number of patient safety movements, also good for PR
  • Unnecessarily put at risk 70 patients per year
  • 12 patients get to go home to continue to be part of their families
  • risk of potential liability cost if publically know, preventable VAP
  • potential liability of ~9.37 million/year
  • cost of learners is 2 days of simulation and training/year
  • training can be merged with SSI training (savings)
  • Unnecessarily put at risk 70 patients per year
  • 12 patients get to go home to continue to be part of their families
  • prevent 131 patients to be cared for with the resources currently being used to treat patients with VAP
  • If we implement program, for community PR show advocacy for Patient Safety, blowing past national average
  • can be part of any number of patient safety movements, also good for PR
  • training can be merged with SSI training (savings)
  • need to train medical students with evidence based best practices
  • need to have medical students training in an IPE environment to best prepare for current needs in Hospitals
  • have students prepared to operate in high risk, time pressured critical environments
  • better preparing the medical students given limitations on clinical hours
  • practicing in a simulated environment instead of on actual patients
  • need to train nursing students with evidence based best practices
  • need to have nursing students training in an IPE environment to best prepare for current needs in Hospitals
  • have students prepared to operate in high risk, time pressured critical environments
  • better preparing the nursing students given limitations access to clinical placements
  • practicing in a simulated environment instead of on actual patients
  • Unnecessarily put at risk 50 patients per year
  • ability to retain staffing by showing value for patient safety
  • higher retention of learning through deliberate practice in team environments
  • ability to better adjust behavior as teams train together
  • training can be merged with SSI training (savings)
  • making the case will involve a fully engaged staff of passionate educators
  • make clear that faculty educators must be trained to conduct deliberate practice and feedback
  • support a part of the institutions patient safey initiative to align with mission focus
  • focus on capturing the appropriate ROI metrics for you environment
  • training can be merged with SSI training (savings)