Development of the Report Card for the Infectious Disease Service Line

Abstract

Background. The IDSL is an important value-based activity that brings bottom line improvement through cost and risk reduction rather than increased patient volume. We have developed a report card for this activity and present our 3-year performance. Methods. Performance metrics for the antimicrobial stewardship program (ASP), the infection prevention program (IPP), patient safety (PS), the employee health program (EHP), and resource management (RM) were tracked over the past 3 years. ASP metrics were obtained through the use of MedMined Surveillance Advisor and are reported as days of treatment (DOT) per 1000 Days at Risk (DAR). Prevalence for resistant organisms is reported as percentages of all isolates, hand hygiene as a percentage of action for each observed opportunity, surgical site infection rates, CAUTIS, CLASBI, and VAP are measured according to NHSN guidelines, RM is measured as dollars for antimicrobial utilization and regulated medical waste (RMW) disposal cost, and EHP activity is measured by influenza vaccine rates and sharps injuries. Severity of illness is tracked as institutional case mix index (CMI). Health system mortality is included as a broad measure of potential impact of IDSL. Grades are assigned based on results identified as above average, average, or below average as compared to selected benchmarks. If a comparison was not available, institutional benchmarks (IB) were used. Results. The report card (figure) illustrates performance over the past 3 years. Trends and random variation are easily seen. DOT for the 3-year time period decreased from 492 to 405/1000 DAR, although RM demonstrated an increase in antimicrobial cost and decreased cost of RMW. Despite declines in antimicrobial utilization and increases in CMI, mortality rates were unchanged. Conclusion. The IDSL is an important service line in a health system. It protects patient safety and reduces costs. We have developed a report card to enable reporting in an easy-to-understand format that reflects real-time performance rather than a delayed report of performance typical of the national report cards, is generated through actual measurement of events rather than abstracted from an administrative data base, includes metrics not available through such a data base but which are important to demonstrate value, and provides a comparative benchmark.