title: The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients.
abstract: BACKGROUND
  A retrospective matched (1:1) case-control study was conducted to compare the financial impact and costs attributable to ventilator-associated pneumonia (VAP) in a 25-bed pediatric intensive care unit (PICU) in a 475-bed quaternary-care pediatric hospital from the perspective of multiple stakeholders, including the hospital and payors.
  
  
  METHODS
  For PICU patients with VAP from January 1 2005, to December 31, 2005, 13 patients were matched to 13 control patients by age, sex, severity of illness, primary diagnosis, underlying illness, surgical procedures, and duration of mechanical ventilation.
  
  
  RESULTS
  The mean hospital length of stay (LOS) for VAP patients was 26.5 +/- 13.1 days compared with 17.8 +/- 4.7 days for non-VAP patients (p = .032). The hospital LOS attributable to VAP was 8.7 days. The mean hospital costs for VAP patients was $156,110 +/- $80,688 compared with $104,953 +/- $59,191 for non-VAP patients (p = 0.026). The attributable VAP costs were $51,157. After implementation of the VAP prevention bundle, VAP rates decreased from 7.8 cases per 1,000 ventilator days in fiscal year (FY) 2005 to 0.5 cases per 1,000 ventilator days in FY 2007 (VAP infections: 24 in FY 2005, 9 in FY 2006, 2 in FY 2007; p < 0.001). This reduced hospital days by 400, reduced unreimbursed cost of care by $442,789, reduced hospital costs by $2,353,222, and reduced cost to payors by $2,653,710 for FY 2006 and FY 2007 combined.
  
  
  CONCLUSIONS
  This study provides the first demonstration of significant, sustained reductions in pediatric VAP rates following the implementation of the VAP prevention bundle and the first business case analysis of this pediatric-specific intervention as described from the perspective of multiple stakeholders. A return on investment may speed health care organizations' investment in patient safety and quality improvement.
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio, USA. rbrilli@nationwidechildrens.org
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Karen W
authors.initials: KW
authors.lastname: Sparling
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lake
authors.forename: John
authors.initials: J
authors.lastname: Butcher
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Myers
authors.forename: Marta D
authors.initials: MD
authors.lastname: Clark
authors.forename: Alma
authors.initials: A
authors.lastname: Helpling
authors.forename: Mary E
authors.initials: ME
authors.lastname: Stutler
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D007902:Length of Stay; D008297:Male; D009820:Ohio / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies