Infection Control
Only about one hospital patient in 20 acquires a nosocomial infection, but those infections all too often can be silent killers. They also add an extra financial burden for hospitals, frequently wiping out razor-thin operating margins.
So an infection-tracking technology that significantly reduced both infection rates and related hospital operating costs in an Alabama pilot study has opened the eyes of health care professionals in that state and beyond. Encouraged by its success, 40 hospitals are participating in the Alabama Hospital Quality Initiative, and similar efforts are taking shape in California, New Jersey, New York and Texas.
Susan Taylor, the infection control coordinator at Providence Hospital in Mobile, Ala., was won over the first time she saw a detailed report produced by the new electronic service that identified hospital-wide infection trends and possible preventive and corrective measures.
It represented a big leap forward from the frustrating system of tardy, incomplete paper reports that has historically typified hospitals' infection control efforts.
"When they showed me that report, I said, 'Where were you for the last two years of my life?'" says Taylor, who recently joined Providence after two years in a similar job elsewhere. "I felt like I was not missing things like when I was doing the traditional paper trail."
The system uses number-analysis--or data-mining--technology developed by MedMined, a medical information technology company based in Birmingham,Ala. In June, MedMined announced that a review of clinical data from the six initial medical centers that participated in the pilot from 2002 to 2004 showed that they lessened their infection rates by 19 percent, thereby reducing the average length of stay and avoiding unnecessary readmissions.
According to MedMined, hospitals using the service have achieved a measurable 300 percent financial return in the first year.
"There aren't many opportunities in health care when something that is good for the patient is also good for the hospital and is a cost saving measure for the payers of health care," says G.T. LaBorde, chief operating officer of MedMined. "When there's something good, usually it costs more."
While it's too early to say whether the system will catch on nationwide, experts say effective infection control technology is long overdue and badly needed.
Nosocomial or hospital-acquired infections affect two million U.S. patients a year and kill about 88,000, the CDC estimates, making nosocomial infections the fourth leading cause of death in the United States.
A recent study by Health Grades showed that nosocomial infections worsened by 20 percent from 2000 to 2003. The proliferation is partly attributable to the fact that the infections include antibiotic-resistant bacteria that are increasingly difficult to treat, such as Staphylococcus and Streptococcus.
Financially, the Consumers Union advocacy group, Yonkers, N.Y., estimates that nosocomial infections cost the U.S. health care system $5 billion annually. That's largely because such patients require an extra 8.7 days of hospital treatment on average, at a cost of about $14,000. Much of that cost is not reimbursed, particularly among Medicare and Medicaid patients and the uninsured.
LaBorde says the additional expenditures because of infections is what pushes many hospitals into the red, with the 5 percent of patients with infections eroding about 63 percent of organizations' inpatient operating profit.
The spread of technology
The data-mining system was developed by Stephen Brossette, M.D., MedMined's founder and president. Relying on a combination of electronic patient monitoring and historical data, it finds sources of infections via a sophisticated system that can track, cross-reference and analyze signs of an infection. The service then alerts infection control staff to processes causing increased infection risk so improvements can be made to prevent future infections.
Blue Cross and Blue Shield of Alabama (BCBSA) is providing the majority of the financial support, paying MedMined about $3 million over three years to provide services to the hospitals. BCBSA already has saved over $3 million from the cost improvements made by the system, with other hospitals sure to add to that total.
BCBSA spokesman Jim Brown, however, downplays the financial pluses and says it's the better health outcomes that really demonstrate the effectiveness of the Alabama Hospital Quality Initiative. Putting a premium on information-sharing, the agency hosts quarterly meetings for the hospitals' professionals to discuss the infection control effort.
"We know that shorter lengths of stay and reduced costs on the hospital side for admissions is going to reflect in some overall reduction in costs," Brown says. "But we don't want to get onto the treadmill that says we've got to make savings of X to determine that the program was worthwhile. We're looking at just the utilization aspect--that's the driver, not whether it's $500,000 or $11 million in savings. That takes care of itself over time."
MedMined touts its system as the first comprehensive, automated service allowing hospitals to track and reduce the occurrences of infections. With the era of sweeping technological advances in health care long under way, why has it taken so long for hospital infection control to be revamped?
Experts say identifying patterns has been especially difficult because thousands of patient care processes take place throughout the hospital daily that affect infection risk--such as surgery, drawing blood and cleaning equipment--creating billions of data permutations.
Like other hospitals, Providence--a 349-bed Ascension Health System facility--has only one infection control professional and the kinds of data analysis done with the MedMined system would have been impossible before.
"The lab would give us paper reports on infections every day but ... we were limited in how quickly we could (quantify results) and take special precautions with a patient," says Ann Doss, R.N., the hospital's director of education, who was infection control coordinator until May. "With MedMined, we can very quickly, every day, look at every patient and identify if a certain area or unit of the hospital is having more infections. We can trend the type of organism. It's important for us to pick up trends early in clusters of infections."
Under earlier systems, it took months to identify such trends. "To have these patterns every month and be able to tell what areas are affected right away has much more meaning to the staff than if three months down the road you tell them there was a problem," Taylor says. "It helps you address issues before they become a big problem."
Providence's hospitalwide infection rate has declined by more than 20 percent since 2003, putting it 30 percent below the national average. Its cumulative savings from reducing infections is $846,000 in less than two years. The technology has provided another benefit, too, according to Doss. Medical staff is better able to get advanced supplies ordered because it can demonstrate cost effectiveness under the new system.
"It's not possible except using general CDC data from what they published many years ago to show how much an infection would cost," she says. "Your administrator and CFO may look at it as soft dollars, but the MedMined data shows bottom-line costs on what the hospital is losing due to infections. It makes it easier to get those products."
To respond to this article, please click here.
