A half-dozen individuals sat at a long table as contestants pitched their ideas. They listened without interrupting to each of four presentations. At the conclusion, they fired questions and probed for more details. At the end of the two-hour session only one of the four was left standing, judged most worthy of the additional support needed to nurture a germ of an idea to full growth.

The contestants had plunged into a version of the hit television reality show “The Shark Tank.” They were not entrepreneurs with dreams of making millions on their products, but rather clinicians fixed on finding ways to improve the quality and safety of patient care while managing resources efficiently. The “sharks” they sought to convince were a group of leaders representing University of Colorado Hospital, Children’s Hospital Colorado, the University of Colorado School of Medicine and University Physicians, Inc. (see box).

The drama unfolded May 9 in a conference room of Academic Office One on the Anschutz Medical Campus. The presenters were four finalists in a competition sponsored by CU’s Department of Medicine. The challenge: develop and present a project concept guided by the principles of the American Board of Internal Medicine Foundation’s “Choosing Wisely Campaign” and the American College of Physicians’ “High Value Care” initiative. Both aim to trim the estimated $750 billion the United States spends annually on wasted care.

After the presentations and a period for deliberation, the judges selected a project developed by residents in the Hospitalist Training Program that aims to increase the appropriate placement and removal of intravenous catheters. The prize: a year of support from the Department of Medicine in developing and implementing the concept.

“The judges felt this idea showed the greatest potential,” said Heidi Wald, MD, MSPH, vice chair for quality for the Department of Medicine, who developed the “Shark Tank” idea. “The Department of Medicine is excited to partner with you.” Wald said that the judges selected a project from gastroenterologist Paul Menard-Katcher, MD, on minimizing inappropriate use of proton pump inhibitors in the outpatient setting as an “honorable mention.”

Timely idea

Wald noted that the winning team can expect support from the hospital’s Patient Services Department – and with good reason. With careful attention and monitoring, central lines effectively deliver medications and fluids, but they can spawn infections that are harmful to patients and costly to treat. In addition, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for the care required to treat central line-associated bloodstream infections (CLABSIs).

“The hospital has a stake in making this idea work,” said Raven Astrom, PhD, quality improvement clinical specialist with the Department of Medicine. “Infections are on everyone’s mind in health care.”

The concept came from observation, said Isaac Hernandez, MD, a second-year hospitalist resident who presented his idea at the Shark Tank event. He noted that central lines can also increase the risk of deep-vein thromboses (DVTs). During his hospital shifts last fall, he began noticing instances of what seemed to be unnecessary use of PICCs (peripherally inserted central catheters). Hernandez said he saw examples of DVTs caused by PICCs and worried about the lines being placed for convenient access to a vein rather than for true clinical need. He said he also saw inconsistencies in the ways units use PICCs and other central lines.

“High-value care means utilizing good evidence-based practice for doing or not doing something and avoiding the overuse of care,” Hernandez said. “I felt we didn’t have good evidence for the placement and removal of central lines.” He noted in his presentation that the University of Michigan has developed a protocol for managing central lines that could serve as a model for UCH.

Hernandez developed his Shark Tank concept with the help of Darlene Tad-y, MD, who is associate program director for the Internal Medicine Residency Program; and Michelle Barron, MD, medical director for infectious disease at UCH. Barron provided data on central-line infection rates at the hospital. His proposal was ultimately combined with another that focused on reducing the incidence of invasive line use. That one was submitted by a team led by Erin Bredenberg, MD, also a resident in the Hospitalist Training Program.

Astrom said the project had other important aims, including building strong working relationships between residents and attending physicians, boosting hospital education about central lines, and improving the patient experience. “The time was right for all of this to come together,” she said.

Lining up support

The project dovetails with separate efforts underway at UCH to monitor the use of central lines, said Chief Nursing Officer Carolyn Sanders, RN, PhD, who was one of the Shark Tank judges. She said the hospital plans in July to hire nurses dedicated to monitoring, managing and assessing central lines.

“The Shark Tank project is an opportunity to build a partnership with the hospital,” Sanders said. “It touches many patients whose lives we can improve.” She also noted that UCHealth Northern Colorado and Colorado Springs already have IV teams that have helped their hospitals manage the lines appropriately and reduce infection rates, giving UCH another resource for improving the care it provides.

Work on implementing the concept now begins in earnest, Astrom said. Hernandez and his colleagues will meet with the Department of Medicine Quality Program team June 1 to hear feedback from the Shark Tank judges, narrow the goals of the project, discuss how to measure outcomes, identify who will be involved in the work, and plot milestones along the one-year timeline.

“Right now the team has ideas, but they need support and the know-how to develop the project,” Astrom said.

Sanders said she was impressed with the “Shark Tank” idea and its potential for stimulating change.

“It was very well orchestrated, and the teams were all well prepared,” she said. “It was good from the hospital side to see the Department of Medicine propose opportunities for improvement.”

The Sharks
The six-judge Shark Tank panel:

• Christina Finlayson, MD, associate medical director, University Physicians, Inc.
• Jeff Glasheen, MD, chief quality officer, University of Colorado Hospital
• Dan Hyman, MD, chief quality officer, Children’s Hospital Colorado
• Jean Kutner, MD, chief medical officer, University of Colorado Hospital
• Carolyn Sanders, RN, PhD, chief nursing officer, University of Colorado Hospital
• Jennifer Wiler, MD, vice chair and associate professor of Emergency Medicine, University of Colorado School of Medicine