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Leapfrog Who, What, Why, Where,When

Leapfrog Who, What, Why, Where,When. Gary L. Weinstein M.D. Director of Pulmonary and Critical Care Presbyterian Hospital of Dallas. The Leapfrog Group: Who. Founded by The Business Roundtable in 2000

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Leapfrog Who, What, Why, Where,When

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  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 America’s 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

  8. 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. 1998;26:1317-26. • Knaus WA et al. Variations in mortality and length of stay in intensive care units. Ann Int Med. 1993;118:753-61

  9. 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 1999;354: 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; 161:1268 • Pronovost et al. Improving Communication in the ICU using Daily Goals. J Crit Care 2003;18 vol 2: 71-75

  10. The Leapfrog Group: Why • Evidence Based Medicine in the ICU:(cont’d) • Kress, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471. • 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; 345:1230. • Van den Berghe, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359

  11. The Leapfrog Group: Why • Evidence Based Medicine in the ICU:(cont’d) • Brown, et al. Effect of ICU mortality of a full-time critical care specialist. Chest. 1989;96:127-129 (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. 1997;72:391-399 (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. 1999;27:270-274 (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)

  12. The Leapfrog Group: Why • Review of published data regarding IPS in the Feb 2004, Am J Med: • Many of the Leapfrog group’s 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. 2002;6:2151-2162.

  13. The Leapfrog Group: Where • Wave 1 - 2001 • Atlanta, GA • California • Knoxville TN • Minneapolis, MN • St. Louis, MO • Seattle, WA • Michigan

  14. 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

  15. 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

  17. 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 ????????

  18. The Leapfrog Group QUESTIONS?

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