CLAB In The Mainland

Overview

Christchurch ICU

Where were we?

Where are we now?

Where are we going?

The ChallengeSouth Island56% New Zealand23% population5 DHBsCulture

ChristchurchSingle ICUAll subspecialties except paeds cardiac and burnsPopulation 550,000

Christchurch ICUSize of unitStaffed 16 ICU bed equivalents120 nurses, 8 SMO and 18 registrars2.9 beds/100,000 (4.8 NZ average)

Interventions65% ventilation rateMean length of stay 3.5 days

OutcomesMortality 12%Low SMR

CLAB ConsiderationHistoryInsertion process established 2009

Patients1250 admissions PA (70% CVC)350 cardiac patients120 LTM patients

ProcessAntibiotic impregnated lines for high riskPICC service for LTM lines

ObservationAverage 300 line days per month

Quality Healthcare in Christchurch

Historic Chch CLAB Data

CLAB ResultsStructureTeam Dr, nurses, educator, data, IPC + guestRegular meetingsGoalsSimple -Awareness/EducationProcessCompliance insertion/maintenance/culturesAlliance and complement DHB processesRobust data

OutcomeCLAB rate 0/1000 line days352 CLAB free days10 CLAB avoided1-5 lives savedUp to $500,000 savedEndorsement CEORole out to NICU

ProblemsEducationData burdenE-databaseGlobal IT issuesComplianceInsertion 80-100% (10/week)Maintenance- 60-70% (150 episodes/week)Blood culture- recent reduction in compliance

Key Success

CLAB rate

QI profile

MDT

Future

Maintain high profileFormalise competenciesCompliance improvementBlood culture simplicitySustainability beyond April 2013

Key ObjectivesReduce the rate of CLAB in New Zealand ICUs towards zero (

The Region

CityPopulationDHBChristchurch380,900CDHBDunedin117,700SDHHNelson60,800NMDHBInvercargill49,200SDHBBlenheim30,300NMDHBTimaru27,700SCDHBAshburton17,950CDHBOamaru13,000SDHBQueenstown10,442SDHBGreymouth10,100WCDHB

A presentation that outlines the unique characteristics of the Central Regional units, patient population, volumes, acuity and an outline of the practices that support the CLAB rate results in the region

*PatientsGeneral medicineGeneral surgeryCardiothoracic NeurosurgerySpinal injuriesPaediatrics

*Is there a problem?Regression of the meanNo local problem

Is there a solution?Bundle approach Scarce resource diversion

*6.6 to 0.9 in middlemore

Nationally 3.32/1000 line days*At risk lines

*200 000 not in these centres*