When the North Shore-Long Island Jewish Health System (NSLIJHS) in Great Neck, N.Y., sets its sights on achieving as close to a zero tolerance of infections as possible, it knew it faced an intricate and complex journey, but according to Karen Nelson, RN, vice president of clinical excellence and quality, the health system took it in stride as part of its ongoing commitment to excellence. “Leadership has established priorities and set clear expectations,” Nelson explains. “The use of evidence-based best practices, an interdisciplinary approach to care across the continuum, a consistent message from administrative and clinical leaders, staying focused, engaging frontline staff and physicians, rewarding successes, sharing best practices and lessons learned, providing regular feedback utilizing data and benchmarks are the keys to success. We’ve set our benchmarks at the top decile of performance nationwide.”
NSLIJ Health System hospitals signed on to the Institute for Healthcare Improvement (IHI)’s 100,000 Lives Campaign in addition to launching a central line-related iInitiative as commitment to system-wide philosophy of zero tolerance for healthcare-acquired infections (HAIs). Hospitals included in the campaign are: Forest Hills, Franklin, Glen Cove, Huntington, Long Island Jewish Medical Center, North Shore University Hospital-Manhasset, Plainview, Schneider Children’s, Southside, Staten Island and Syosset.
The improvement initiative upon which NSLIJHS embarked was designed to increase the quality of care and decrease HAIs by standardizing best-practice approaches used throughout the health system. “NSLIJ has developed a consistent methodology and rigorous monitoring procedure to manage the process of care and control the incidence of infection,” Nelson says. “Leadership prioritized, with the use of measurement, an integrated approach to standardize infection control practices. One area of focus was on our rates of central line-associated bacteremias (CLABs), which were examined to improve patient care and safety in 22 intensive care units (ICUs), encompassing over 330 ICU beds. This approach included standardizing evidence-based infection control practices, policies and procedures, reporting and training modules. A root-cause analysis is conducted when a CLAB occurs to assess opportunities for improvement. In addition, each site reviews collected CLAB data in the unit-based interdisciplinary forums, site specific Performance Improvement Coordinating Group (PICG), and Health System PICG. The message of zero tolerance was spread to all employees through these surveillance efforts, as well as through the intranet, collaborative care councils, and newsletter articles. The outcome of this targeted intervention has resulted in a 60.3 percent decrease in the CLABS rate from 2004 to 2008. In addition, central line days decreased by 8.7 percent. Zero is achievable and this has been demonstrated by several units across our health system. Staff can tell you how many days it has been since the last infection on their unit.”
Nelson says that physician and nursing leaders partnered to co-chair the clinical initiatives, utilized data to review performance, and reduced variation in care through use of evidence-based guidelines and ensure patient safety. “We developed tools for the improvement of care coordination, and through our collaborative care model we engage patients and their families. Standardization of educational material, which is available on the health system’s intranet, videos, equipment and a non-punitive approach was also key.”
