Tuesday, July 13, 2010

Pronovost on accountability

Peter Pronovost has a commentary in JAMA this week that is worth a read. Check out the whole thing, I'll post only one small paragraph here:
So who is accountable for reducing CLABSIs? Clinicians inserting and maintaining catheters must be accountable for performance, complying with evidence-based practices. Hospital leaders must be accountable for infection rates, monitoring rates, and supporting prevention initiatives. These mechanisms must be supplemented with the public reporting of valid infection rates, financial incentives from insurers, and when needed, sanctions from regulators. This pandemic of infections can be remedied and prevention of other types of preventable harm can be attempted if clinicians—physicians and nurses—work as a team.
My only comment: public reporting of valid infection rates...is much easier said than done, as we've discussed at length in prior blog posts. Meanwhile, the overzealous pursuit of zero perpetuates the daily battles being waged in some centers between infection preventionists (who are "calling" CLABSIs) and ICU clinicians and administrators (who are challenging these calls).

2 comments:

  1. I essentially agree with Pronovost’s commentary with the following caveats:

    (1) While the vast majority of CLABSis are preventable, some are not and it’s dishonest to imply otherwise. The bloodstream infection rates at his hospital were presented at the SHEA meeting this year, and they are NOT zero. In fact, his rates are higher than those at my hospital, and I’m not writing books about how well we’re doing or castigating those who are still struggling.

    (2) As Dan points out, validity of the data is extremely important. It is becoming increasingly apparent that some hospitals have modified the CDC case definitions to their advantage which makes their rates appear lower than hospitals who strictly apply the definitions.

    (3) While the checklist is a simple tool, widespread implementation of it, particularly in large medical centers, is not easy. In some cases, implementation has been made more difficult by well-meaning but inexperienced personnel in quality organizations and hospital associations.

    I still credit Pronovost for conducting the most important studies in hospital epidemiology that have ever been performed, and readily admit that he changed my thinking about preventability of CLABSI, but I don’t think the situation is as black and white as he leads you to believe in his commentary.

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  2. I agree to the Pronovost's commentary that the pandemic of infections can be prevented if and only if clinicians-physicians and nurses work as a team. Because as the saying goes, two heads are better than one. Thanks for the share. It was really worth a read. Keep it up!

    Ashley

    disinfecting cap

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