Simple steps, big payoff in patient safety

IHI aims to save 100,000 lives

You may think your hospital is doing a good job of preventing common errors that result in patient deaths, but the American Medical Asso ciation (AMA) and the Institute for Healthcare Improvement (IHI) think you can do better. In fact, they think hospitals in the United States can save 100,000 lives between now and June 2006.

The 100,000 Lives Campaign is designed to prevent common hospital system errors that can result in unintended patient deaths, and its goal is to involve 1,500 to 2,000 hospitals in an effort to do what the AMA and IHI say hospitals should be doing anyway — following established guidelines and practices so they can avoid mistakes that kill patients.

AMA to educate physicians

The AMA’s contribution to the campaign, which was launched in December at the IHI’s National Forum, will be to educate individual physicians — particularly those who work in hospitals — about the program’s initiatives.

"The AMA plans to use its full range of resources to educate physicians about the campaign and secure their participation," AMA president John C. Nelson, MD, MPH, said at the time, "The AMA’s position has always been (that) one preventable error is one too many. This campaign will allow the AMA to help physicians help their patients while improving health care safety."

Nelson pointed out that the campaign draws much needed attention to the patient safety movement and provides physicians and other health care professionals with specific strategies to meet an attainable goal.

"Saving lives and helping patients is why most physicians choose to enter medicine in the first place," he explained. "Physicians are on the front lines delivering care, and it’s important that the AMA and its member physicians support this campaign."

The 100,000 Lives Campaign centers on six proven initiatives that studies have shown can save lives. The initiatives are:

  • Using rapid response teams at the first sign of decline in patients who are progressively failing outside the intensive care setting.
  • Ensuring the reliable delivery of evidence-based care for patients hospitalized for acute myocardial infarction.
  • Preventing ventilator-associated pneumonia by reliably implementing a set of interventions known as the "ventilator bundle."
  • Preventing surgical site infections (SSIs) by reliably implementing a set of interventions known as the "SSI bundle" in all surgical patients.
  • Preventing adverse drug events by implementing medication reconciliation.
  • Preventing central venous catheter-related bloodstream infection (CRBI) by implementing a set of interventions known as the "central line bundle" in all patients requiring a central line.

IHI president Donald M. Berwick, MD, MPP, says the initiatives are not new, but with strict adherence to what they already know is effective, the efforts of 1,500-2,000 hospitals can achieve the goal of 100,000 lives saved.

"The names of the patients whose lives we save can never be known," he comments. "Our contribution will be what did not happen to them."

In addition to the AMA, a host of other groups have enlisted in the campaign, including the American Nurses Association, the Centers for Medicare & Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Veterans Health Administration.

Hospitals committed to change

Hospitals enrolling in the campaign are committing to actively pursue one or more of the six key interventions. Other interventions devised by individual hospitals may be included, Berwick says.

Hospitals agree to report their mortality data, which will be used to gauge the success of the interventions and the campaign itself. Data will be made public in aggregate, not identified by institution.

IHI provides the information needed to participate in the campaign on its web site (www.IHI.org), and there is no cost to participate. However, participating organizations must be willing to implement changes and to participate in the reporting process.

The AMA will be making conference calls, state by state, to medical directors of all interested or participating hospitals, to assist in starting and implementing the campaign interventions.

Berwick says the campaign is not a retread of what hospitals are already doing — it’s a new way of looking at what the medical community knows works.

"Hundreds of health care organizations have been making changes that improve care and reduce patient harm," he says. "Now is the time to harness those experiences and apply the best methods, reliably, 100% of the time."

He cites statistics that make the consistent use of these methods necessary:

  • The Institute of Medicine estimates that as many as 98,000 people die each year in U.S. hospitals due to medical injuries.
  • The Centers for Disease Control and Prevention in Atlanta estimates that 2 million patients suffer hospital-acquired infections each year.
  • Studies show although the United States spends the most money on health care of all industrialized nations, it still performs poorly on many measures of health care quality.

Nelson pointed out that the results of simply doing what works, all the time, are impressive. A hospital in Heidelberg, Austria, achieved a 65% drop in cardiac arrests and a 37% drop in mortality after introducing rapid response teams, one of the 100,000 Lives Campaign initiatives.

Additionally, Berwick says, prompt administration of aspirin reduces the risk of death in vascular events by 15%, and using beta-blockers reduces death in the first week after acute myocardial infarction by 13% and long-term mortality by 23%. Despite this evidence, a recent RAND Corp. study found that only 61% of these patients received aspirin and only 45% received beta-blockers.

Other groups participating in the campaign include the American Nurses Association, CMS, JCAHO, and the Veterans Health Administration.

To prevent medication errors, a special focus will be on transition points where, according to the IHI, 46% of these problems occur.

Transition points include admission and discharge from the hospital and transfer from one hospital unit to another. Nelson said hospital-nursing home transfers would receive close examination.

To prevent central line-associated bloodstream infections, surgical site infections and ventilator-associated pneumonia, the campaign suggests that no one intervention will eliminate undesired outcomes single-handedly. Instead, a bundle of strategies are recommended, and it’s suggested that the bundle be treated as a single performance measure instead of highlighting each of the individual interventions in the bundle.

Source

  • Donald M. Berwick, MD, MPP, President, Institute for Healthcare Improvement, 20 University Road, Seventh Floor, Cambridge, MA 02138. Phone: (617) 301-4800. Web site: www.ihi.org/IHI.