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The University of Texas MD Anderson Cancer Center Receives Statewide Award for Quality. see here md anderson cancer center

Obesity, Fitness & Wellness Week February 19, 2011 For its efforts to reduce the incidence of ventilator-associated pneumonia in the ICU to zero, the Texas Hospital Association has honored The University of Texas MD Anderson Cancer Center with the inaugural Bill Aston Award for Quality. Established in 2010, the award recognizes a hospital’s measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative. It will be presented Feb. 3 at the THA Annual Conference in Austin (see also Ventilator-Associated Pneumonia).

When Joseph L. Nates, M.D., joined MD Anderson Cancer Center in Houston in 2002, he learned that the intensive care unit ventilator-associated pneumonia rate was 34.2 cases per 1,000 ventilator days, double the national average for trauma ICUs (used as the benchmark).

Nates was concerned; VAP increases ICU stay by up to 22 days and hospital stay by up to 25 days, and it has the highest mortality of health care-associated infections. The following year, Nates and his colleagues implemented aggressive multidisciplinary strategies to reduce the VAP rate. By 2009 that rate had dropped to zero, and it has stayed at zero for the past year.

“When we started, a lot of people were skeptical that we could reduce that rate. Our ventilated cancer patients are very sick, and many of them are immunosuppressed from chemotherapy,” said Nates, who serves as medical director of the ICU.

“Many of the techniques we are using today had not even been published when we started eight years ago. That’s why you have to keep learning and working on the problem. We haven’t eliminated the causes. If we don’t continue to work on the factors that lead to VAP, the infections will come back,” Nates said. “The main reason for achieving a rate of zero VAPs for the past year is that we have been persistent. We have a cohesive and aggressive multidisciplinary team that consists of physicians, nurses, respiratory therapists and infection control specialists who work together toward this common goal.” Thomas Burke, M.D., executive vice president and physician-in-chief at MD Anderson, points to the impassioned leadership Nates provided.

“Quality projects require a champion, and he’s the guy that drove this team,” Burke said. “To be successful, you have to be relentless.” Another important driver of success was the impact on patient lives. VAP is a deadly complication. In 2005, the American Thoracic Society published data that showed a 30 – 40 percent death rate for VAP cases occurring in the general population. Other more conservative estimates put the death rate at 25 percent of all VAP patients. For the MD Anderson ICU, which averaged more than six cases per month in 2002, a drop to zero represents dozens of lives saved during the past eight years. go to web site md anderson cancer center

The drop in VAP rates also saves an enormous amount of money and helps patients recover more quickly and leave the hospital sooner, freeing up critically needed hospital beds. The average cost of treating a VAP infection is about $57,000. With at least six cases per month, MD Anderson’s cost for treating VAPs in 2002 was more than $4.1 million per year.

Burke said the ICU team has inspired the work of other quality improvement projects at MD Anderson.

“This is a classic quality improvement project,” he said. “There isn’t one thing that made all the difference — there was a series of things that got the team members part-way there. They didn’t abandon their gains, and they didn’t settle for their initial gains. They kept working.”