possible to not only collect, track and report, but ulti- mately gain insight into the diff erences among a hospital’s ventilated patients. In this scenario, the question can shift from “Who had
VAP?” to “Who is likely to get it, and how can we intervene to try to improve outcomes?” Being able to pinpoint which patients have had two days of PEEP and/or FiO2 stability followed by worsening oxygenation provides actionable intelligence that clinicians can use to pinpoint which pa- tients need intervention. Trying to track this data manually would be a much heavier burden on infection-control de- partments, which are already spread thin from their responsi- bilities for prevent- ing many different types of HAIs, not just VAP. Automated surveillance can also help identify best practices from units within a hospital or across a hospital system that can be shared to improve overall infection rates. Such tools help quality improvement and infection
The new NHSN VAE defi nitions are a welcome change to ventilated patient surveillance, thanks to their objectivity and ability to automate collection and perform analytics.
control professionals interpret ventilator data to understand when changes in PEEP and FiO2 have met the threshold of signifi cance. Because it provides near real-time visibility into where on the VAE spectrum the patient is, it can trig- ger the involvement of clinicians to address deteriorating conditions earlier in the process and measure adherence to best practices. Several healthcare systems have been early adopters of technology that automates the collection and analytics of the new VAE algorithm into a hosted dashboard application that displays patient baselines, reporting thresholds and markers of protocol anomalies in an easy-to-read format. Mission Regional Medical Center in Mission, Texas, is one of the early adopters. “We deployed a VAE surveillance dashboard that is so easy to look at, it’s the fi rst thing I do in the morning,” says Hector Contreras, infection prevention manager at Mission Regional. “It’s a 100 percent validation of our process, and it is objective and actionable.” Although VAP reporting is not required in Texas, Mis-
sion Regional wanted to use all tools available to help improve care. “It has brought us effi cient and concurrent surveillance of multiple detailed reports presented in real time – a bedside view from our offi ce,” says Susan Barlow, MHA, RRT, NPS,
IMAGE COURTESY CAREFUSION www.healthmgttech.com HEALTH MANAGEMENT TECHNOLOGY August 2013 17
CPFT, CPHQ, Mission’s cardiopulmonary director. “T e result is the ability to see variability in not only patient status – for example, if the FiO2 data point increases, it signals a worsening oxygenation status that is a huge red fl ag – but also in clinical practice, such as weaning. Both are essential in making inroads toward VAP reduction.” Good Samaritan Hospital in Los Angeles also sought to make quality improvements in the area of VAP surveillance and is working with the new app. “We felt we had a well-tuned weaning protocol, but we wanted more controls that could help us keep improving,” says Michael Muth, MBA, RRT, RCP, director of pulmo- nary, neurology and sleep lab at Good Samaritan. “We want to be ready for regulatory changes down the road.” From an infection-control perspective, using this ad-
vanced technology has changed the game almost overnight at Good Samaritan. “T e NHSN algorithm is challenging to collect and ana-
lyze manually, but the technology has shifted our perspec- tive,” says Joan Finney, RN, BSN, CIC, Good Samaritan’s director of infection prevention and epidemiology. “T e new visibility through the VAE surveillance dashboard has also shown the infection preventionist that cross-functionality has a role to play in infection control that we didn’t previ- ously consider, with respiratory technicians now included as part of our ICU surveillance team. Instead of working in silos, we are now working from the same playbook.” T e new NHSN VAE defi nitions are a welcome change to
ventilated patient surveillance, thanks to their objectivity and ability to automate collection and perform analytics. With to- day’s advances in technology, VAE surveillance will continue to help improve clinicians’ abilities to track and perform inter- ventions to improve outcomes.