Abstract :
INTRODUCTION: This medical center is a 234-bed acute care facility located in Pennsylvania, where hospitals are required by the Pennsylvania Health Care Cost Containment Council (PHC4) to report all nosocomial infections. The medical center has an automated surrogate marker for nosocomial infection that has been accepted by PHC4 as meeting the mandated reporting requirement. The marker electronically analyzes patient clinical data and automatically identifies 1) patients and 2) the site (with the corresponding site code required by PHC4 for reporting). The medical center has been recognized by PHC4 as providing both comprehensive and objective public reporting.
METHODS: In October 2003, the medical center instituted a new addition to surveillance, data-mining technology to perform hospital-wide, early warning surveillance based on electronic microbiology and patient movement information. This system additionally provided a surrogate marker for infection known as an “NIM” (Nosocomial Infection Marker™). The NIM had been validated elsewhere (sensitivity 89%; specificity 98%) and had previously been shown to correlate closely (R2 of.98) with increased variable cost and length of stay. Using the medical centerʹs own data, it was determined that patients with a NIM on average add $2,533 (DRG-adjusted) in variable cost and had an increased length of stay of 3.34 days. In March 2004, the medical center formally petitioned PHC4 to accept the NIM as a valid means for public reporting of nosocomial infections.
RESULTS: The medical center now uses an electronic data interface to automatically produce information for PHC4. This tool identifies all nosocomial infections across all hospital locations, which is the ultimate goal of PHC4 reporting. PHC4 now considers the medical center to be a model for public reporting of nosocomial infections and has requested state funds to support widespread use of the NIM for public reporting by other hospitals.
CONCLUSIONS: Public reporting requirements threaten to tax the overstrained resources of infection control. The automated NIM reporting system solves this problem by using technology to count nosocomial infections, freeing practitioners to spend more time on targeted improvement opportunities. The NIM is comprehensive, allowing automated, hospital-wide surveillance. The NIM is also objective, which means that if all hospitals used it as a basis for reporting a more fair comparison would result.
