Higher Quality Costs Less
The Salt Lake Tribune is reporting about an effort at Primary Children's Medical Center to improve the care of febrile infants (http://www.sltrib.com/sltrib/news/54397821-78/infants-infection-hospital...). Excerpts:
Intermountain Healthcare decided to implement evidence-based standards across its hospitals to guide how infants with fevers are treated. It recently reported in the journal Pediatrics that the standardized treatment saved millions of dollars, by reducing unnecessary antibiotic treatments and shortening hospital stays while keeping infants safe.
Nearly 1,500 infants a year go to an Intermountain facility — mostly a hospital — to be evaluated for fever.
Ten percent of those infants develop a serious bacterial infection, including meningitis, bacteremia (a blood infection), or urinary tract infection.
The latter is the most common cause of a serious infection, but the number of infants who received urinalysis varied by hospital, from 19 percent to 70 percent, before standards were put in place in 2008.
The standards for infants up to 90 days old now call for obtaining a complete blood count, to look for signs of a bacterial infection, and urinalysis. If the results are negative, the infant is at low risk for a serious infection, doesn’t need antibiotics and goes home.
If the results are positive on either test, doctors start antibiotics and the search for a bacterial infection. Infants who are admitted to the hospital also are checked for viral infections.
If they have a virus and no evidence of a bacterial infection, the antibiotics are stopped and in many cases the infant can go home by 24 hours. The standard before was a three-day stay.
If those inpatient infants don’t have a virus, they continue antibiotics. If culture tests don’t show a bacterial infection, they can go home at 36 hours.
The Pediatrics study shows the average length of hospital stays for infants without a serious infection dropped from 60 hours to 44 hours, reversing an earlier trend of longer stays. And inpatient costs at four Intermountain hospitals dropped an average of $1,500 from 2008 to 2009, thanks to fewer antibiotics and shorter stays.
Even accounting for increased laboratory costs, the four hospitals saved $1.9 million in 2009.
Intermountain Health Care is a world leader in reducing health care costs through improved quality. How is it that they do this?
First and foremost, they are in a secure position. Primary Children's Medical Center is the intermountain region's only pediatric hospital. No competitive edge is necessary. This outstanding facility is able to cooperate with all other hospitals in a 5 state region to develop best care for children. Many of Intermountain's hospitals are the only hospital in the community that they serve. Intermountain has had a premier facility in Salt Lake County as well (first LDS Hospital, now Intermountain Medical Center) which has been able to selectively choose highly intense services to deliver (trauma and open heart surgery, for instance, but not burn care) because of the nearby University Medical Center. There is no advantage to patients through having hospitals compete. The advantage comes when health care delivery systems cooperate. Intermountain's strong position in Utah gives it the clout to forestall the need to compete.
And Intermountain's leadership has used its strong position to show the way towards improved quality. I give them full credit for that. I have heard the leaders often articulate the importance of non-profit status in focusing the institution on its mission: the care of patients.
Isn't it time to really attend to this success story?
Let's push to have all hospitals in Utah return to non-profit status and then join in the cooperative effort to reduce cost through improving quality.
Dr. Joe Jarvis