Central Line-Associated Bloodstream Infections (CLABs) affect roughly 200,000 Americans each year, with 15%-20% mortality. Using methods refined by Value Capture principals, two ICUs at Allegheny General Hospital (AGH) in Pittsburgh redefined their processes and redesigned their system to reliably reduce these infections.
Using principles of the Toyota Production System, adapted to healthcare, AGH observed and analyzed their processes, revealing the root causes of the CLABs. With the problems identified, workers were empowered to implement countermeasures to eliminate the defects in the processes of central line placement and maintenance.
Within 90 days, new processes were implemented. Within a year, CLABs decreased from 49 to 6, and mortalities from 19 to 1, despite an increase in the use of central lines and number of line-days. These results were sustained during a 34-month period.
This work produced direct bottom line benefits to the health system totaling over $8 million over three years. It was the earliest demonstration in American hospitals that the elimination of nosocomial infections is possible. This work has been published in several academic, improvement, and business journals, including: Using real-time problem solving to eliminate central line infections. Jt Comm J Qual Patient Saf. 2006 Sept; 32(9):479-87; and Economics of Central-Line Associate Blood Stream Infections, American Journal of Medical Quality November/December 2006 vol. 21 no. 6 suppl 7S-16S.