3M Global I.V. Summit Introduction - 2013

Transforming Leaders. Transforming Care.

© 3M 2012. All Rights Reserved.

Leading change in a cost constrained environment

Patrick J Parks MD PhDMedical Director, 3M Critical & Chronic Care Solutions Division

Adjunct Associate Professor, Dept of Clinical & Experimental Pharmacology, University of Minnesota


© 3M 2012. All Rights Reserved.2

Global IV Summit:outline for conference

Review

Current Status

Summit Program



Argentina Australia Brazil Canada China Ecuador El Salvador India

…..maintaining the nature of a ‘global’ summit…

Saudi Arabia South Africa Spain Sweden Thailand United Arab Emirates United Kingdom United States

Japan Jordan Lebanon Mexico New Zealand Philippines Poland Russia


© 3M 2012. All Rights Reserved. 4

Policy

Guidelines

Patient groups

Outcomes

Clinical practice

Practice protocols

CDC, EPIC2,WHO, RNAO

Clinical studiesRCT,

InterventionalDRG, PGD

IHI bundles. Saving Lives, CUSP

Safer Healthcare now

Technologies:Antiseptics, dressings, catheters, vessel health, ultrasound placement

Preclinical expts:PFGE

Microarrays

Standards of care(INS)

Education audits

competence

Government(s)

Regulatory approval

Experiments

National

Patient

Molecular

2011 Global IV Summit



2011 Global IV Summit – Guidelines and Standards



Policy

Guidelines

Patient groups

Outcomes

Clinical practice

Practice protocols

CDC, EPIC2,WHO, RNAO

Clinical studiesRCT,

InterventionalDRG, PGD

IHI bundles. Saving Lives, CUSP

Safer Healthcare now

Technologies:Antiseptics, dressings, catheters, vessel health, ultrasound placement

Preclinical expts:PFGE

Microarrays

Standards of care(INS)

Education audits

competence

Government(s)

Regulatory approval

Experiments

National

Patient

Molecular

2012 Global IV Summit



The 4 “E”s of Implementation Science

Farber M and Hanchett M, Success through implementation science: reducing HAIs in the ICU. Prevention Strategist, Winter 2011, 44-46.

EVALUATE ENGAGE

EXECUTE EDUCATE

Toolkits, reminders and learning from mistakes

Measure performanceExplain why intervention is

important to front line staff and executives

Share the evidence



Olmstead, R., “Where did Semmelweis go wrong in Leadership and Followership?” 3M Global IV Leadership Summit, 25-27 April 2012.




Review

Current Status

Summit Program



Intravascular (IV) devices

Short term (<10-14 days)– Peripheral IV catheters– Arterial catheters– Central venous catheters

(CVC)• Non cuffed• Not tunneled

Long Term (>10-14 days)– Subcutaneous central venous

ports– Peripherally inserted CVC

(PICC)– Central venous catheters

• Cuffed• Tunneled

IDSA guidelines 2009



Attributable mortalityTacconelli E et al J Hosp Inf (2009) 72:97-103 France: 11% Germany: 12-15% Italy: 18%

Worth LF et al Cancer (2007) 109:1215-1226. Australia: 12% (haematological malignancy)

Wenzel RP and Edmond MB Emerg Inf Dis (2001) 7: 174-177 United States: 15% (estimated)

Peng S and Lu Y J Critical Care (2012) http://dx.doi.org/10.1016/j.jcrc.2012.09.00.007

China: 52% (vs 28% without CRBSI)

11



Problem convergence

PERIPHERAL

We estimate that there may be as many as 10,028 PVC-related S. aureus bacteremias yearly in US adult hospitalized inpatients.

PVC-related S. aureus bacteremia is an underrecognized complication.

TT Trinh et al., Peripheral venous catheter related Staphylococcus aureus bacteremia. Infect Control

Hosp Epidemiol. 2011 Jun;32(6):579-83.

CENTRAL

1st 2nd final1

10

100

Hazard ratio

Risk of infection rises as the number of unintentional dressing changes rises.Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter related infections. Crit Care Med (2012) Apr 6 epub.



Framing the problem:Problem convergence

Infection

Central venous Peripheral

catheters catheters

Securement

13

TT Trinh et al., Peripheral venous catheter related Staphylococcus aureus bacteremia.Infect Control Hosp Epidemiol (2011) 32:579-83



Incremental cost per CRBSI:– $82 000 (in 2008 United States Dollars [USD])– 14 additional hospital days (12 in MICU)Cohen ER et al Cost savings from reduced catheter related bloodstream infection after simulation based education for residents in a medical intensive care unit. Simul Healthc (2010) 5:98-102.

Length of stay and cost per CRBSI: case control study– Length of stay WITH CRBSI – 16 days vs 5 days WITHOUT

CRBSI– Weighted mean total charges for patients:

• WITH CRBSI $110 183• WITHOUT CRBSI $22 302

– Total healthcare burden for CRBSI: $37.24 BILLION

Omar M. AL-Rawajfah OM et al., Length of stay and charges associated with healthcare acquired bloodstream infections. Am J Infec Ctrl (2012) 40:227-242.

Attributable morbidity: Cost & Duration of Hospitalization



The problem: confluence of immutable forces

15

Increased insured population = increased healthcare demand

Baby Boomer impact - 2.8 million new Medicare beneficiaries each year!

2010 Medicare pop.=47 million2011 projection = 49.8 million2030 projection = 80 million

Health care spending is 16% of GDP (2007)





Support

50%

30%

29%

34%

45%

45%

6%

7%

6%

8%

14%

16%

4%

3%

4%

Strongly agree Somewhat agree Somewhat disagree Strongly disagree Not sure

My administration knows the extent to which CRBSIs are a problem at my facility

It is clear who is in charge of preventing CRBSIs at my facility

My administration is willing to spend the necessary money to prevent CRBSIs

34%

45%

45%

Olmstead, R., “Where did Semmelweis go wrong in Leadership and Followership?” 3M Global IV Leadership Summit, 25-27 April 2012.




Review

Current Status

Summit Program



Virtual summit (content in English)



Enhance leadership skills needed to advance clinical practice.

Share ‘best practices’ in vascular access and infusion therapy.

Form a global network that extends well beyond the Summit.

Summit objectives:




Post-It® Notes have been placed on each table Please use them to capture transformational

moments Place the Post-It® Note on one of the two easels at

the front of the room We’ll share these on Friday



Day 1– Lectures (whole group)– Networking

Day 2– Lectures (whole group)– Cultural exchange– Case study

Day 3– Lectures (whole group)– Networking

Summit Program



Economic capital Human capital (education) Cultural capital Social capital (benefits derived from cooperation)

– Trust – honesty, reliability, consistency and caring

2013 theme: “capital development”



Day 1: commonalities

Devices & Hardware

3M Global I.V. Summit Introduction - 2013