Case study: Hospitalwide huddles curb catheter infections at Saint Anthony

This February, Saint Anthony Hospital in Chicago won the Illinois Health and Hospital Association’s (IHA) “Innovation Challenge: Partners in Progress Award.” In just two years, the facility cut its hospital-acquired infection (HAI) rate by 90% and saved itself $498,000. 

How did the facility make such tremendous strides in infection control? Short answer: daily interdisciplinary safety huddles (DISH).

While most hospitals conduct safety huddles, what makes DISH different is that participation is hospitalwide. Representatives from all departments (security, nursing, emergency services, infection control, etc.) meet every morning for a 15-minute daily briefing.

Alfredo Mena Lora, MD, is the medical director of infection control (IC) at Saint Anthony. DISH is just one aspect of their HAI reduction program, he says, but it’s a unique part of it.

“We know that huddles have been proven to improve outcomes and reduce certain variables, whether it’s in surgery or catheter placement,” he says. “But a hospitalwide huddle is what I think is novel.”

At DISH, nurse managers report on which patients have indwelling catheters (urinary or central venous). Then it’s decided which patients still need their catheters. If not, the device is expected to be removed within 24 hours. The reason this matters is because the longer a patient has a catheter, the more likely he or she is to develop an infection.

After one year of DISH meetings, Lora became curious. He felt the meeting was making a difference—after all, he saw the catheters being removed. But he wanted to prove it.

“Everything we do, every small quality improvement initiative, as the IC person here I always try to study it to see if there are empirical ways to assess the before and after,” he says. “I knew the meeting was being effective; my objective was to look at the before and after.”

In the summer of 2016, he made a chart of his findings and submitted it to the IHA’s innovations competition. While he’s glad to be recognized, he says winning the award wasn’t the point.

“Our goal wasn’t to win any specific award, but rather our day-to-day quality improvement objectives here in the hospital,” he says.

Setup
For an improvement program, DISH is pretty simple and cheap to set up. Saint Anthony started doing DISH meetings in late 2014. While it took a few months to get rolling, Lora says they saw results almost immediately.

They tracked their progress by tracking their device usage rate (DUR). While the definition of HAIs have changed over time, DUR has remained a constant variable for measuring the effects of medical intervention.

“When we reviewed this retrospective, we saw a downtrend after we were assessing the needs of catheters on a daily basis and forcing their removal,” he says. “I do think it promotes quick removal and is pretty cost-efficient and easy to do.”

There are always small challenges in trying a new improvement project, he says. But DISH is very sustainable and it helps correct any kind of challenges they have.

Right now, he’s working on a way to better assess why certain catheters remain. For example, was there a rise in the DUR because there were more sick patients? Because a new physician didn’t know the catheter policies? Or something else?

“Because I’m the infection control physician here, I know why some catheters remain—because some patients are sick and so forth,” he says. “As part of optimizing DISH, I’m looking for better ways to obtain that data moving forward and report it at DISH in a more efficient way.”

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