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Initiative to Implement 6 Key Measures in Hospital Care Called Lifesaving

Initiative to Implement 6 Key Measures in Hospital Care Called Lifesaving An initiative to improve patient care prevented about 122 300 avoidable hospital deaths over an 18-month period, campaign leaders said. The initiative, the “100 000 Lives Campaign,” helped avert patient death by instituting 6 evidence-based interventions among 3000 hospitals, representing an estimated 75% of all US hospital beds, explained Donald Berwick, MD, president and chief executive officer of the Institute for Healthcare Improvement at the International Summit on Redesigning Hospital Care in Atlanta last month. The institute, based in Cambridge, Mass, launched the campaign in December 2004. Using 6 evidence-based interventions, health care professionals at more than 3000 care sites in the United States averted more than 100 000 patient deaths over an 18-month period. The campaign is a response to critics who have questioned whether the health care system had made any significant changes to improve quality of care and outcomes since an expert panel convened by the National Academies’ Institute of Medicine estimated that as many as 98 000 patients die annually due to medical errors (Kohn KT et al. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999). Lucien Leape, MD, an adjunct professor of health policy at the Harvard School of Public Health in Boston and a coauthor of the Institute of Medicine report, hailed the campaign's results. “It's a watershed event in that the big question people kept throwing at us was, ‘Is there any evidence that health care is any safer since our report came out?’” said Leape. “This is an unequivocal, ‘Yes.’ What this does is demonstrate these changes we're trying to make in our health care system can be done on a large scale.” To improve the quality of care, the campaign helped implement 6 changes in hospitals (Berwick DM et al. JAMA. 2006;295:324-327). These include Deploying a rapid response team at the first sign that a patient's condition is worsening and may lead to a more serious medical emergency (1781 hospitals participating). Delivering reliable evidence-based care for acute myocardial infarction, such as appropriate administration of aspirin and β-blockers (2288 hospitals). Preventing adverse drug events by ensuring review and reconciling accurate and continually updated lists of patients' medications during their hospital stays (2185 hospitals). Preventing central line infections by following 5 steps, including proper hand washing (1925 hospitals). Preventing surgical site infections by following a series of steps, including the timely administration of antibiotics (2133 hospitals). Preventing ventilator-associated pneumonia by following 4 steps, including raising the head of the patient's bed (1982 hospitals). To calculate the number of lives saved by implementing these measures, researchers used hospital deaths in 2004 as a baseline, then tallied deaths (adjusting for age and illness severity) for the following 18 months after hospitals had implemented their various quality-improvement initiatives. Lower numbers of deaths in each hospital were considered lives saved. While the changes implemented by these hospitals may appear obvious and fairly straightforward, they required teamwork—a foreign concept in many health care institutions, Berwick said. “Health care was built in fragments; we suboptimized institutions or professions,” Berwick said. These entities are regulated and trained separately, producing a system in which efforts to provide patient care have been poorly coordinated, he added. “But now we're seeing a convergence of teamwork, of vertical integration, from hospital boards right down to those on the front lines.” For Barbara A. Blakeney, MS, RN, president of the American Nurses Association, the campaign validated teamwork across disciplines. “We do train in silos, we do teach in silos, and that has been part of the problem,” Blakeney said. “We need to break away from that. We need to actually teach our clinicians what each other can do. It is amazing what one discipline in health care does not know about the skill sets and the abilities of others.” If hospitals and clinicians remain reluctant to change, change will come to them, because payers like Medicare and private health insurance use findings on improving outcomes to justify rate changes based on quality performance, Leape said. “In our current system, we pay people more when they do more—so they do more,” Leape said. “Payers are very interested in how to link the whole scheme of reimbursement to quality, to pay for outcomes and not just good work.” Berwick hopes the campaign can get all participating hospitals to adopt all 6 quality improvement initiatives by 2007. Leape would like to see the effort expand even further. “I’m very excited by the campaign, but why only 3000 hospitals and 6 quality improvements?” Leape said. “Why not get all 5000 hospitals and institute 30 tools for quality improvement?” http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Initiative to Implement 6 Key Measures in Hospital Care Called Lifesaving

Mitka, Mike
JAMA , Volume 296 (3) – Jul 19, 2006
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.296.3.269
Publisher site
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Abstract

An initiative to improve patient care prevented about 122 300 avoidable hospital deaths over an 18-month period, campaign leaders said. The initiative, the “100 000 Lives Campaign,” helped avert patient death by instituting 6 evidence-based interventions among 3000 hospitals, representing an estimated 75% of all US hospital beds, explained Donald Berwick, MD, president and chief executive officer of the Institute for Healthcare Improvement at the International Summit on Redesigning Hospital Care in Atlanta last month. The institute, based in Cambridge, Mass, launched the campaign in December 2004. Using 6 evidence-based interventions, health care professionals at more than 3000 care sites in the United States averted more than 100 000 patient deaths over an 18-month period. The campaign is a response to critics who have questioned whether the health care system had made any significant changes to improve quality of care and outcomes since an expert panel convened by the National Academies’ Institute of Medicine estimated that as many as 98 000 patients die annually due to medical errors (Kohn KT et al. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999). Lucien Leape, MD, an adjunct professor of health policy at the Harvard School of Public Health in Boston and a coauthor of the Institute of Medicine report, hailed the campaign's results. “It's a watershed event in that the big question people kept throwing at us was, ‘Is there any evidence that health care is any safer since our report came out?’” said Leape. “This is an unequivocal, ‘Yes.’ What this does is demonstrate these changes we're trying to make in our health care system can be done on a large scale.” To improve the quality of care, the campaign helped implement 6 changes in hospitals (Berwick DM et al. JAMA. 2006;295:324-327). These include Deploying a rapid response team at the first sign that a patient's condition is worsening and may lead to a more serious medical emergency (1781 hospitals participating). Delivering reliable evidence-based care for acute myocardial infarction, such as appropriate administration of aspirin and β-blockers (2288 hospitals). Preventing adverse drug events by ensuring review and reconciling accurate and continually updated lists of patients' medications during their hospital stays (2185 hospitals). Preventing central line infections by following 5 steps, including proper hand washing (1925 hospitals). Preventing surgical site infections by following a series of steps, including the timely administration of antibiotics (2133 hospitals). Preventing ventilator-associated pneumonia by following 4 steps, including raising the head of the patient's bed (1982 hospitals). To calculate the number of lives saved by implementing these measures, researchers used hospital deaths in 2004 as a baseline, then tallied deaths (adjusting for age and illness severity) for the following 18 months after hospitals had implemented their various quality-improvement initiatives. Lower numbers of deaths in each hospital were considered lives saved. While the changes implemented by these hospitals may appear obvious and fairly straightforward, they required teamwork—a foreign concept in many health care institutions, Berwick said. “Health care was built in fragments; we suboptimized institutions or professions,” Berwick said. These entities are regulated and trained separately, producing a system in which efforts to provide patient care have been poorly coordinated, he added. “But now we're seeing a convergence of teamwork, of vertical integration, from hospital boards right down to those on the front lines.” For Barbara A. Blakeney, MS, RN, president of the American Nurses Association, the campaign validated teamwork across disciplines. “We do train in silos, we do teach in silos, and that has been part of the problem,” Blakeney said. “We need to break away from that. We need to actually teach our clinicians what each other can do. It is amazing what one discipline in health care does not know about the skill sets and the abilities of others.” If hospitals and clinicians remain reluctant to change, change will come to them, because payers like Medicare and private health insurance use findings on improving outcomes to justify rate changes based on quality performance, Leape said. “In our current system, we pay people more when they do more—so they do more,” Leape said. “Payers are very interested in how to link the whole scheme of reimbursement to quality, to pay for outcomes and not just good work.” Berwick hopes the campaign can get all participating hospitals to adopt all 6 quality improvement initiatives by 2007. Leape would like to see the effort expand even further. “I’m very excited by the campaign, but why only 3000 hospitals and 6 quality improvements?” Leape said. “Why not get all 5000 hospitals and institute 30 tools for quality improvement?”

Journal

JAMA – American Medical Association

Published: Jul 19, 2006

Keywords: hospital care

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