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HIGH INTENSITY ICU STAFFING MODEL REDUCES VENTILATOR ASSOCIATED PNEUMONIA

Saint Barnabas Medical Center, NJ

PURPOSE: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection. It is the leading cause of death among hospital-acquired infections and increases cost of care by as much as $40,000. The VAP bundle was endorsed by the IHI and adopted by our institution in 2005 in efforts to reduce this complication. The VAP "bundle" includes: head of bed at 30 degrees; sedation vacation with assessing readiness to extubate daily; venous thromboembolism prophylaxis; and gastrointestinal ulcer prophylaxis. High intensity staffing by intensivists, endorsed by LeapFrog, has been reported to improve mortality, shorten ICU and hospital length of stay. The effect of high intensity staffing on infection rates is not clear. The objective was to evaluate the efficacy of high-intensity staffing in a medical-surgical ICU to reduce VAP in a community hospital.

METHODS: An Intensivist model was adopted in a 16-bed medical-surgical ICU from mid 2007. Prior to 2007 patients with respiratory failure were managed by non-intensivists in concert with pulmonary consultants. We compared pre-intensivist VAP rates to data from 2008, after implementation of the intensivist model.

RESULTS: Incidence of VAP decreased from 2.8 to 0 per 1,000 vent days (P < 0.01).

CONCLUSION: The IHI initiated the 100,000 lives campaign in 2005 to prevent deaths directly attributable to health care system, VAP reduction representing one initiative. The intensivist model utilizes the specialized knowledge and skills of physicians trained in caring for critically ill patients. They are on-site "team leaders" who coordinate the otherwise fragmented care of critically ill patients.

CLINICAL IMPLICATIONS: The results demonstrate a significant reduction in VAP rates after implementation of a high-intensity staffing model.