The Intensive Medicine Clinical Program was established in 2003 and now comprises seven Development Teams: Critical Care Medicine; Emergency Medicine; Trauma; Transport; Hyperbaric Medicine; Hospitalist Medicine; and Stroke. Teams in the Clinical Program share clinical and administrative strategies while promoting best practices through the use of evidence-based care processes.
Recent initiatives in the program include:
- Reduction of ventilator-associated pneumonia (VAP) through compliance with the VAP bundle.
- Improvement of care for patients with sepsis through use of the sepsis bundle.
- Quick identification and early intervention for treatment of patients with stroke or near strokes called transient ischemic attacks (TIA).
Ventilator-associated pneumonia is a bacterial pneumonia that develops in patients who are receiving mechanical ventilation. VAP is the leading cause of death among hospital-acquired infections and has an associated mortality rate as high as 46 percent. The 2004 baseline rate for VAP at Intermountain was 13 cases per 1,000 vent days. Reduction of VAP through promotion of and compliance to the ventilator bundle interventions was a board goal for the Intensive Medicine Clinical Program during 2006 and 2007. Reduction of VAP to <6.65 cases per 1,000 ventilator days and compliance with documentation of ventilator bundle at 80 percent was the goal in 2006. In 2007 the goal was to achieve a VAP rate of <6 cases per 1,000 vent days and a 90 percent compliance rate on documentation of bundle interventions. The board goals were achieved for 2006 and 2007. Intermountain in 2010-11 has achieved a rate of 3.23 cases per 1,000 ventilator days-representing a 75 percent relative reduction in VAP cases between 2004 and 2011.
Sepsis is a serious, sometimes overwhelming, bloodstream infection that may eventually involve the whole body and become life-threatening. Quick identification and early treatment, including consistently implementing the 11 care interventions of the sepsis bundle, are critical to best care and improved patient outcomes. The focus of the board goal for 2008 through 2010 was to improve compliance with the sepsis bundle. In 2008 we focused on compliance with two bundle elements-lactate and glucose control-and set a goal to meet those at an 85 percent compliance rate. In 2009 we focused on all 11 bundle elements and set a goal to meet those at a 60 percent compliance rate. In 2010 we set a goal to meet all 11 bundle elements at a 77 percent compliance rate. All bundle goals were met or exceeded. The Intermountain mortality rate for sepsis was 27 percent in 2003, and it dropped to 9.3 percent by the end of 2010. By contrast, the national mortality rate for sepsis averages between 30 percent and 50 percent.
Stroke is a diagnosis that affects more than 795,000 people in the United States each year. It ranks third among all causes of death, behind heart disease and cancer. It is the leading cause of serious, long-term disability in the United States, leaving 30 percent of victims moderately to severely disabled. As a leading healthcare provider, Intermountain has a responsibility to decrease the incidence and consequences of stroke, and quick identification and early treatment are critical in that effort. In 2011, the Intensive Medicine Clinical Program board goal is to attain an improved composite rate of compliance to stroke care (the proportion of eligible stroke patients receiving five measures of appropriate care). The hospitals participating in this goal are Intermountain Medical Center, Utah Valley Regional Medical Center, McKay-Dee Hospital Center, Dixie Regional Medical Center, LDS Hospital, and American Fork Hospital.
The baseline compliance rate of the combined areas of measure was 70 percent for the third quarter of 2010. By August 1, 2011, the compliance rate reached 76 percent and is expected to remain steady through September 30, 2011. The goal will be measured at the end of the third quarter of 2011; during the second quarter, the compliance has been as high as 85 percent.
These are just a few of the examples of the work being done within the Intensive Medicine Clinical Program. Ask your regional leadership about your region's work towards the achievement of these goals.