Original scientific articleUse of Corporate Six Sigma Performance-Improvement Strategies to Reduce Incidence of Catheter-Related Bloodstream Infections in a Surgical ICU
Section snippets
Methods
This performance-improvement effort centered on the Leapfrog-compliant, semi-closed SICU at Yale New Haven Hospital, an urban university hospital with trauma, transplantation, and elective and emergent surgical patients, exclusive of cardiac surgery and burns. The SICU team placed all invasive catheters and approved all orders, admissions, and discharges by the primary team. Second-year surgical, anesthesia, and emergency department residents staffed the SICU with fellow supervision and
Results
Yale New Haven Hospital is a participant in the CDC’s NNIS program. For the 9 years from 1992 to 2001 our CR-BSI rate of 11 per 1,000 catheter days exceeded the NNIS median for more than 200 other SICUs (∼5 per 1,000).
From April 1, 2001 through April 2003, the YNHH SICU reduced its CR-BSI rate from an average of 11 infections per 1,000 catheters days to 1.7 infections per 1,000 days. This represents a highly notable improvement (p < 0.0001) from the January 1993 through March 2001 baseline mean
Discussion
This work represents the successful deployment of a statistically rigorous corporate quality-management tool in a patient-safety arena, resulting in and sustained performance improvement. CR-BSIs have an attributable mortality in some series of 12% to 28% and up to a 22-day excess hospital length of stay.10, 11 A very conservative estimate of cost, based on excess medication, meals, diagnostic tests, and other services directly used by the patient, is $3,000 per CR-BSI. In this study, CR-BSI
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Competing Interests Declared: None.