healthcare value analysis
By James Russell , RN-BC , MBA , CVAHP
Sepsis and the Role of Value Analysis : Products , Practices and Procedures
If an infection can be traced to a product used in a patient ’ s hospitalization ( i . e ., a central venous catheter or CVC ), the value analysis department can assist in evaluating whether any products , practices , or procedures should be altered .”
In value analysis terms , sepsis is about products , practice , and procedures . A robust value analysis program will provide repeatable workflow tools to analyze and evaluate products , practices , and procedures , used to combat sepsis to ultimately result in objective outcome data that can be referenced when changes are proposed .
Products , Practices , and Procedures
First , let ’ s define what sepsis is . To be diagnosed with sepsis , you must have a probable or confirmed infection and all the following signs : 1
• Change in mental status
• Systolic blood pressure — the first number in a blood pressure reading — less than or equal to 100 millimeters of mercury ( mm Hg )
• Respiratory rate higher than or equal to 22 breaths a minute
The key , from a value analysis perspective is the word infection . If an infection can be traced to a product used in a patient ’ s hospitalization ( i . e ., a central venous catheter or CVC ), the value analysis department can assist in evaluating whether any products , practices , or procedures should be altered . We ’ ll continue using a CVC as an example of a product related to sepsis , with the understanding that others exist .
Products
If we stay with the CVC example , there are many different CVCs in use in hospitals , from many different suppliers . Some of these catheters come with antibiotic coatings on them , some have antimicrobials or even silver impregnated in the plastic itself . Other CVCs will have pressure transducers connected for hemodynamic monitoring . Some of these catheters will be peripherally inserted yet are still counted as “ central ” lines . Still other catheters will allow for oximetric monitoring ( monitoring oxygenation ) or provide access for hemodialysis .
An effective value analysis process will take all these factors ( and more ) into account , including the evaluation of clinical evidence . There are many platforms used by value analysis professionals to assist in published , evidence-based analyses . One , provides an analysis of the pros and cons to using antimicrobials in CVCs . 2 Analyses such as these can help synthesize the published , peer-reviewed literature and may even take cost into account . Sepsis and CVCs are connected by central line-associated bloodstream infections ( CLABSIs ). There are many resources for healthcare professionals regarding CLABSIs ; an excellent starting place is the Centers for Disease Control and Prevention ( CDC ). 3 CLABSIs , one of the hospital-acquired conditions ( HACs ) 4 established by the federal government to improve patient safety , can have a mortality rate between 10 percent and 30 percent . 5 With these data in mind , the importance of combating CLABSIs , and ultimately sepsis , is clear .
Additionally , other platforms utilized by value analysis can offer unbiased comparisons between different products . 6 These tools , and many others , provide the value analysis department the ability to assist clinical departments in making informed decisions regarding the products used by a facility .
Practices
As important as the products that are used in a healthcare facility are , the ways in which they are used , clinical practice , is equally significant and worthy of examination . Value analysis can assist in this as well . Often , determining whether a problem exists in practice vs product is the first step toward a course of action . A facility can have the best products on the market available to clinicians , but if they are used inappropriately or inaccurately , there may be little benefit . In fact , there are even products on the market to help combat these practice issues . For example , “ scrubbing the hub ” of an IV catheter before accessing it is recognized as an important practice in preventing infections ; even The Joint Commission references it . 7 Recognizing that clinical practice , and competence can vary , there are companies selling products that attach to IV connectors that can negate the need to scrub the hub , as they contain chemicals ( ranging from chlorhexidine gluconate to alcohol ) that are in constant contact with the IV connector or are used specifically for scrubbing the hub correctly .
Determining if correct practices are sufficient can require different skills than referenced in the products section . Essential to analyzing practice is what LEAN practitioners call “ Going to the Gemba ,” or the place where things happen .
8 Rather than asking clinicians what they do , watching them do it is far more telling in determining if their practice is optimal . Analyzing practice data can be tricky , as it involves what clinicians
www . healthcarehygienemagazine . com • september 2022
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