Monday, May 17, 2010

Did someone get fired for using NHSN or NNIS definitions to count CLABSIs?

Wow. I just read the second article that Mike posted Saturday out of the Chicago Tribune and I kinda wish I didn't. I'll paste the section that scared me a bit below, but it appears that someone might have been fired for "over-reporting HAIs", which is a bit scary to me. There is tremendous pressure to not call a BSI , a CLABSI, which I think is now part of the getting to zero culture. I wonder what percent of the way towards zero will be paved with these sorts of statements:

"Thorek's infection rate was the highest of all medical centers in Illinois. Frank Solare, Thorek's president and chief executive officer, said hospital officials have collected medical charts for the 22 infected patients and have "started an independent review … to try and understand this."

Asked why the Lakeview hospital didn't take action last year, Thorek's compliance officer Morgan Murphy said a former employee didn't alert senior management to the problem. "It wasn't making its way up the chain, unfortunately," he said.

Senior management also suspects that the employee may have counted central line infections incorrectly, inflating the hospital's numbers. "There may have been over-reporting," Murphy said."

3 comments:

  1. I have to cry hearsay on this comment, but I believe the IP retired.
    I'd like to point out that counting CLABSIs "incorrectly" is almost certainly a very common occurrence, and sadly, more likely towards the null or "zero infections." The criteria for defining a CLABSI are clearly defined for clear cases, but are much less clear for complex cases. Of course, we never have complex cases in an ICU now do we? The difficulty comes in when the clinical evidence is clear but the case fails to meet surveillance/NHSN criteria for a secondary source. It is at this crucial juncture between clinical and surveillance definitions we find ourselves pressured from a variety of sources. Is it possible some of the 22 were over-called? Sure it is. Could we find cases where CLABSIs were missed/under-called? Definitely. How do we fix this?
    1. Less subjective metrics. Arguably, CLABSI is the least subjective of the criteria (VAP anyone?), but it still leaves room for interpretation.
    2. Better education. This will probably help. It may not change the pressure IPs are under, but will make them better equipped to make the right call and defend to critics.
    3. More validation. I am confident that some of this will occur, but not nearly as much as is needed.

    For #2, look to the June issue of AJIC, where the first in a series of case studies to challenge and educate IPs on the surveillance definitions will be printed along with an online assessment intended to test our knowledge.

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  2. I hope the reporter does some follow up to determine what the "independent review" entails. Was it a review by hospital officials and unit leadership, all of whom have a vested interest in claiming misclassification? Or have they invited an independent outside expert to review the charts and make a determination?

    And speaking of validation, there are quite a few hospitals in Illinois reporting ZERO CLABSIs...

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  3. Here is the quote I read: "Asked about the high number of infections, officials blamed a former employee for possibly "over-reporting" infections and not keeping management informed."

    WOW. Not keeping management informed? Did it not occur to management to ask their employee about their rates? Shouldnt hospital leadership be actively seeking these data? I guess that is one good thing about public reporting. whether the rates were correctly reported or not, it is frightening that this hospital didnt seem to care to pay attention until the report was published.

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