Leapfrog Who, What, Why, Where,When

1
LeapfrogWho, What, Why, Where,When

• Gary L. Weinstein M.D.
• Director of Pulmonary and Critical Care
• Presbyterian Hospital of Dallas

2
The Leapfrog Group Who

• Founded by The Business Roundtable in 2000
• Consortium of over 120 Fortune 500 companies and
  other large public and private health care
  purchasers
• Provide health benefits to over 34 million
  Americans in all 50 states
• Members and and their employees spend billions on
  health care each year

3
The Leapfrog Group Who

• Their mission is to trigger a giant LEAP
  forward in quality, customer service and
  affordability of health care by
• Making the American public aware of a small
  number of highly compelling and easily understood
  advances in patient safety and
• Specifying a simple set of purchasing principles
  designed to promote these safety advances, as
  well as overall customer value

4
The Leapfrog Group Who

• Their effort is rooted in four ideas
• American health care remains far below
  obtainable levels of basic safety and overall
  customer value
• The health care industry would improve more
  rapidly if purchasers better recognized and
  rewarded superior safety and value

5
The Leapfrog Group Who

• Voluntary adherence to purchasing principles by a
  critical mass of Americas largest employers
  would provide a large jump-start and encourage
  other purchasers to join
• These principles should not only champion
  superior overall value but also focus on a
  handful of specific innovations offering great
  leaps in basic patient safety to maximize media
  and consumer support and adoption by other
  purchasers.

6
The Leapfrog Group What

• Initial Leaps in Patient Safety
• Computer Physician Order Entry (CPOE)
• Shown to reduce errors in hospitals by more than
  50
• Evidence-Based Hospital Referral (EHR)
• Patients risk of dying could be reduced by more
  than 30
• ICU Physician Staffing (IPS)
• Shown to reduce the risk of patients dying in the
  ICU by more than 10

7
The Leapfrog Group What

• Recommendations regarding Critical Care
• ICUs should be staffed by Board-certified
  intensivists, to coordinate and manage care of
  patients
• Intensivists should staff ICUs during daytime
  hours, a minimun of 8 hours, 7 days a week
• Intensivists should respond to more than 95 of
  calls for assistance within 5 minutes
• The intensivist, a FCCS certified physician or
  physician extender should arrive at the bedside
  within 5 minutes in 95 of cases

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The Leapfrog Group Why

• ICU Physician Staffing (IPS)
• More than 4 million patients are admitted to ICUs
  each year in he US 1
• Mortality rates average 10 - 20 in most
  hospitals 2
• Approximately 500,000 patients die in US ICUs
  each year 1
• Quality varies widely across hospitals 3
• Birkmeyer VD et al. Leapfrog safety standards
  potential benefits of universal adoption. The
  Leapfrog Group. Washington, DC 2000
• Zimmerman JE et al. Evaluation of APACHE III
  predictions of hospital mortality in an
  independent database. Crit Care Med.
  1998261317-26.
• Knaus WA et al. Variations in mortality and
  length of stay in intensive care units. Ann Int
  Med. 1993118753-61

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The Leapfrog Group Why

• Evidence Based Medicine in the ICU
• Drakulovic, et al. Supine body position as a risk
  factor for nosocomial pneumonia in mechanically
  ventilated patients a randomized trial. Lancet
  1999354 1851.
• Cook, et al. A comparison of sucralfate and
  ranitidine for the prevention of upper
  gastrointestinal bleeding in patients requiring
  mechanical ventilation. N Engl J Med 1998 338
  791
• Attia, et al. Deep vein thrombosis and its
  prevention in critically ill adults. Arch Intern
  Med 2001 1611268
• Pronovost et al. Improving Communication in the
  ICU using Daily Goals. J Crit Care 200318 vol 2
  71-75

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The Leapfrog Group Why

• Evidence Based Medicine in the ICU(contd)
• Kress, et al. Daily interruption of sedative
  infusions in critically ill patients undergoing
  mechanical ventilation. N Engl J Med 2000
  3421471.
• E. Wesley Ely. Effects on the duration of
  mechanical ventilation of identifying patients
  capable of breathing spontaneouly. N Engl J Med
  1996 335 1864.
• Herbert, et al. A multicenter, randomized,
  controlled trial of transfusion requirements in
  critical care. N Engl J Med 1999 340 409.
• Wu, et al. Blood transfusion in elderly patients
  with acute myocardial infarction. N Engl J Med
  2001 3451230.
• Van den Berghe, et al. Intensive insulin therapy
  in critically ill patients. N Engl J Med 2001
  345 1359

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The Leapfrog Group Why

• Evidence Based Medicine in the ICU(contd)
• Brown, et al. Effect of ICU mortality of a
  full-time critical care specialist. Chest.
  198996127-129 (ICU mort from 27.8 to 13.4,
  hospital mortality from 35.5 to 24.5)
• Manthous, et al. Effects of a medical intensivist
  on patient care in a community teaching hospital.
  Mayo Clin Proc. 199772391-399 (Hospital
  mortality from 34 to 25 , hospital stay reduced
  by 5 days, improved housestaff knowledge)
• Hanson, et al. Effects of an organized critical
  care service on outcomes and resource
  utilization a cohort study. Crit Care Med.
  199927270-274 (No effect on mortality fewer
  complication (0.5 vs 1.7 per patient) shorter
  ICU ( 2 vs 2.8 days) and hospital ( 20.3 vs 23.6
  days) stay lower cost (34,500 vs 47,500)

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The Leapfrog Group Why

• Review of published data regarding IPS in the Feb
  2004, Am J Med
• Many of the Leapfrog groups standards for
  critical care are not grounded sufficiently in
  evidence to mandate their implementation
• Outcomes of critically ill patients are better
  when their care is managed directly or with the
  help of intensivists 1
• Pronovost et al. Physician staffing patterns and
  clinical outcomes in critically ill patients. A
  systematic review. JAMA. 200262151-2162.

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The Leapfrog Group Where

• Wave 1 - 2001
• Atlanta, GA
• California
• Knoxville TN
• Minneapolis, MN
• St. Louis, MO
• Seattle, WA
• Michigan

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The Leapfrog Group Where

• Wave 2 - 2002
• Central Florida
• Colorado
• Dallas-Fort Worth, TX
• Kansas City, MO
• Wisconsin
• Massachusetts
• Memphis, TN
• New Jersey
• New York Metro
• Rochester, NY
• Savannah, GA
• Wichita, KS

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The Leapfrog Group Where

• Wave 3 - 2003
• Hampton Roads, VA
• Illinois
• Maine

16
The Leapfrog Group

• As of October 2003
• Over 1000 hospitals voluntarily participated in
  the online survey to report their progress
  towards implementing the recommended practices
• 5 of hospitals in the regional roll-outs report
  they have implemented CPOE, and an additional 17
  committed to implement CPOE by 2005
• 21 have implemented ICU Physician Staffing and
  an additional 5.4 have committed to by 2004
• 80 of health care consumers in the US now have
  access to patient safety data for one or more
  hospitals in their area

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The Leapfrog Group DFW

• DFWBGH is the local representative
• 3 workgroups made up of system administrators,
  system administrators and DFWBGH members
• ICU outcomes
• CPOE
• Evidence based referral
• Meeting for about 1 year and have accomplished
  ????????

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The Leapfrog Group

• QUESTIONS?