Sunday, October 25, 2009

H1N1 - How We Can Help

I've been asleep at the wheel, and I'll be the first to admit it. In a conversation with Elizabeth Cowboy this week, she pointed out that an ideal use of our critical care collaborative would be to track cases of H1N1 influenza in our ICUs. Those of us who participate in the Midwest Critical Care Collaborative represent the lion's share of ICU beds in the state of Kansas and in several metropolitan areas, including Wichita, Topeka, Kansas City, and Lincoln. We are in an ideal position to volunteer information of use to officials at the state, county, and regional levels as they and we respond to the growing epidemic. Some of us have been involved at the state and local levels, preparing ourselves for a surge in requirements for ventilators and ICU beds, all the while wondering when and if such a surge would hit and wondering how we would actually know when it did. This is a mechanism whereby we can help ourselves.

I have set up a web-based form to track the important information. The form will ask about 4 types of patients: confirmed H1N1, likely H1N1 not yet confirmed, seasonal influenza, and post-influenza pneumonia. We will assess how many of these sorts of patients are in our ICUs and how many of them are ventilated. We would like to collect this information weekly, by 5 PM Wednesday for the next 8 or 10 months, or until the epidemic has ultimately dissipated. The information will be shared with state and county epidemiologists on a hospital by hospital basis, and published on our web site by region or county. As of now, we have not planned to track deaths, but that is possible, if collaborative members desire it.

My plan is to send reminder emails every week, to collate what comes in by Wednesday, and to have current information posted by Thursday of every week on the mwcritcare web site. The reporting form is live now, and we are ready to rock and roll. Follow the links on the web site (www.mwcritcare.org) to find the active form.

It may be that government officials are coming by this information in another way, but it seems to me that having the info available at least helps us to achieve our goal of helping one another to reach the highest possible quality of critical care for our patients. In this case, if some of the more dire predictions come to fruition, the highest achievable quality could literally mean that more midwesterners survive, because we help each other.

The survey form doesn't ask for a lot of information, and it should be easily completed by almost anyone. Member hospitals may want to ask one person to do it every week. If we get surveys from more than one person at any hospital, we'll probably send emails to the individuals to determine which data to use (unless they are identical). The first questions in the survey ask about numbers of ICU beds and numbers of ventilators in your hospital. Those likely will not change a lot over time.

If you receive my periodic emails, then your hospital is included. Please consider getting together with your colleagues to provide the information every week. Some of you monitor ICU beds at other hospitals; please consider either providing their information or working with people in those hospitals to get them plugged in to the collaborative and providing their own information. If you have colleagues at hospitals that you don't see listed on the mwcritcare web site, please ask them to get involved.

The data collection form is at our web site, www.mwcritcare.org. Look for page links at the bottom of the home page and follow the H1N1 link. If anyone has questions, post them to this blog or contact me at sqsimpson@mwcritcare.org.

Friday, October 2, 2009

What a Mistake!

I've been concerned for awhile that no one in the collaborative had any responses to our blog posting. I fretted over why no one cared about the topic. Until this afternoon. I discovered that I had set up the comments so that only "registered" users could comment. And I had not set up a way to register. So my post sat here contemplating its navel for 3 weeks, hoping that someone had read it. I don't know whether to have any higher hopes for this one, as in it may be literally true that no one is reading - but there's only one way to find out! Happy commenting, and please comment on the last post, as well, if you have any ideas.

Sunday, September 13, 2009

What a great meeting on Thursday (9/10)! To begin with, we had new folks online from Hays, from Hutchinson, and from Nebraska. More and more folks are interested in improving the care of critically ill midwesterners, and I couldn't be happier.

For those who couldn't make it, we spent the lion's share of our time looking at critical differences in how we are reporting our performance in patients with severe sepsis. Jim Kaplan did an ooutstanding analysis of how ICD codes have changed over the past few years and how those changes may affect our reported results; as usual, his presentation was clear, logical, and insightful. Perhaps more importantly, he showed how our benchmarked performances are based on APR-DRG's (a proprietary invention of 3M that stands for All Patient Refined Diagnosis Related Groups; http://www.qualityindicators.ahrq.gov/\downloads\listserv\Understanding%20the%203M%20APR-DRG.pdf); this tool does not identify the same patients in the discharge database that we have been identifying for the past several years in our tracking of severe sepsis patients. Jim showed how those differences arise, i.e. how assigning patients APR-DRG 720 differs in nature from identifying them by use of ICD 9s 995.91, 995.92, and 785.5. The dilemma is twofold: we need to evaluate whether we have identified different sets of patients in successive years by use of ICD codes, and we need to attempt to understand how much credence to place in our benchmarking data. Obviously, benchmarks are imposed upon us from the outside, in that we cannot (at least as of now we don't have the clout to) change what data are used by various organizations for the purpose of benchmarking. However, it will take some analysis on our part to determine what is of more use to the patients we serve. More on that in upcoming posts.

We attempted to record the entire session, but it remains to be seen whether we were entirely successful. If so, we will have it posted on the web site, www.mwcritcare.org, for review by all.

Tuesday, August 18, 2009

Hello World! This is the site of the Midwest Critical Care Collaborative's blog. I'm Steve Simpson, the blogger. We invite comments by anyone, anywhere. SQS