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By Jill Freeman-Stack
East Alabama Medical Center (EAMC), a352-bed regional hospital in Opelika, Ala, serves a five-county area. EAMCsinfection control professionals work hard to identify and preventhospital-acquired infections (HAIs).
EAMCs infection identification and prevention effortscentered for many years on traditional methods: manual targeted surveillance ofinfection data. This work required the time-consuming manual review of patientcharts and lab reports in order to find the source of each infection.
According to Benja Morgan, RN, BA, MPA, infection control andemployee health manager at EAMC, the paper chase was a daily challenge. You got lost in a paper shuffle, Morgan says. I wouldgo to the lab and pick up the reports and then visit the floors to find thepatient. Were the patients still in the hospital? Had they gone home? Had they been moved five times? I had to wear a detective hat,and the work consumed a large amount of time. The delays just compounded theproblems.
In January 2004, the hospital adopted the Data MiningSurveillanceÂ® service (DMSS) from MedMined of Birmingham, Ala. The DMSS usesa combination of database technology, machine learning, statistical analysis,and modeling techniques to find patterns and subtle relationships in data. Theservice features the Nosocomial Infection Marker (NIM), an objective, electronicsurrogate marker for HAIs. Data mining identifies patterns within hospital data without predefined search criteria that indicate specific opportunitiesto improve patient care processes.
Morgan says that her introduction to the service and itspotential to reduce infection rates, save staff time, and reduce costs wasimpressive. The service electronically provides infection-related data tothe hospitals clinical staff so that the daily work of monitoring for HAIsand antibiotic resistance, performing public health reporting, generatingreports for medical and administrative staff, and other activities can beperformed electronically and efficiently. It can track significant organisms,sites of infections, facility locations, physicians, and antimicrobialresistance in any combination.
With the support of the director of quality managementservices and other key executives at EAMC, Morgan planned to adopt thetechnology as part of the hospitals capital acquisition strategy. However,the service came to EAMC sooner than expected. The hospital was asked to partnerwith Blue Cross and Blue Shield of Alabama, other Alabama hospitals, andMedMined in the Alabama Hospital Quality Initiative (AHQI) to reduce theincidence of HAIs and improve patient safety.
Installation and training were straightforward, andinformation on HAIs was almost immediately available. As part of the hospitalscommitment to the monitoring technology, Nancy Patterson, RN, BSN, outcomescoordinator for quality management, joined Morgan shortly after the service wentonline to handle the data monitoring and reports, freeing Morgan to handle therange of infection control and prevention tasks, clinical questions, andemergencies that surface daily.
We started seeing the issues identified by DMSS patternsand taking the information to the units shortly after the service went online, Patterson says. The service provides almost instantaneousavailability of information. Every day, we pull up a hospital-wide culturereport so that we can survey what is going on throughout the facility. I can gothrough a list of current patients, see what cultures are out there, theirstatus, and where the cultures came from. The system has helped us reduce thetime spent reviewing data tenfold.
The availability of real-time, house-wide information has beena tremendous aid in the hospitals battle against HAIs. According to Morgan,the service allows the presentation of timely feedback to staff members. Wecan get the information out to the floor and take care of the patient as soon aspossible, she says. It is not as if they had a patient on the floor lastweek with an HAI and we are just finding out about it. It is a current patient.If there is an issue to address, we can do it quickly instead of retroactively.
After using the system for approximately 13 months, thehospital analyzed financial data and was able to demonstrate a significantreduction in infection rates and the high costs associated with treating them. For example, during a nine-month baseline period from March2004 through November 2004, there were 54 urinary tract infections (UTIs) in oneskilled nursing unit. Based on 667 unique admissions to the unit, thehospital-acquired UTI rate was 8.1 percent. In contrast, during a three-monthactive surveillance period between December 2004 and February 2005, there wereonly six hospital-acquired UTIs. Based upon 280 unique admissions to the unit,the hospital-acquired UTI rate was 2.14 percent a 73.3 percent reductionrate.
In addition to its positive effect on the quality of care, thetechnology has impacted the financial bottom line at EAMC, evident through thecost-savings that resulted from its use of the automated surveillance service.In the year since Data Mining Surveillance began, infection rates across thehospital have fallen 12.33 percent. EAMCs cost accounting system data wereused to compare patients with an HAI with those without an HAI in the samediagnosis-related group (DRG). Patients with an HAI had relatively highervariable costs and lengths of stay. With little offsetting reimbursement of theextra costs, those patients were incrementally more unprofitable than patientswithout HAIs in the same DRG. The drop in both the rate of infection and averageimpact per infection resulted in 427 fewer patient days, a $303,350 reduction invariable costs, and a $226,789 improvement in net operating profits.
Morgan says that being able to quantify the costs associatedwith HAIs and the savings that result from the hospitals use of theinfectiontracking technology have helped the executive staff better understandthe scope and impact of HAIs. Patterson adds, For the first time, we havebeen able to demonstrate in real numbers comparative statistics showing thefinancial impact of HAIs and quality improvement measures. We can tie dollars to infections and show how infectioncontrol will impact the financial bottom line.
JillFreeman-Stack is a senior program director at Sullivan & Associates, astrategic healthcare communications organization located in Huntington Beach,Calif.