Hospitals join national effort to save 5M lives

The numbers are staggering: Every year, experts estimate, there are 15 million instances of harm at U.S. hospitals – errors, oversights and missteps in how patients are treated that, at best, have minimal impact, but can sometimes make people seriously sick, even kill them.
If you were to review any 100 hospital admissions, says James Conway, senior vice president of the Institute for Healthcare Improvement, you could expect to find 40 instances of harm.
“The best we’ve seen nationwide is 20,” Conway said in an interview.
Worst of all – or best, depending on how you see it – most of these errors could be prevented if hospitals followed methods and strategies that have been shown to work, Conway said.
There’s a large body of evidence on how certain precautions can reduce the risk of ventilator-associated pneumonia, for example, or the chances that an IV drip will give a patient a potentially deadly bloodborne infection.
And there’s extensive evidence that hospitals that get the full support of their boards of directors and their senior leadership – the CEOs, CFOs, chief nursing officers – for quality improvement efforts have better outcomes, actually saving lives, Conway said.
So how do you get hospitals across the nation to start doing all those things? Government can step in with mandates and reporting requirements, and to some extent, it has: The Centers for Medicare and Medicaid Services’ “Hospital Compare” tool is a prime example, and Rhode Island has its own quality reporting system, though its scope is limited.
The Joint Commission, which accredits hospitals, has also made quality measures a priority and, in the process, pushed institutions to standardize and improve their practices. But some of the most valuable efforts to date, national and local experts will tell you, are those in which participation is voluntary, such as the Rhode Island Quality Institute’s ICU Collaborative, which has set out to improve care in intensive-care units across the state.
Now, in a particularly ambitious move, all of Rhode Island’s hospitals have signed on to a national campaign that aims to save 5 million lives within two years by promoting the adoption of 12 key quality improvement strategies.
The campaign, led by the Institute for Healthcare Improvement, a nonprofit based in Cambridge, Mass., was formally unveiled last December and has so far engaged about 3,500 hospitals across the country, Conway said; the goal is 4,000.
Rhode Island is one of only a handful of states in which all hospitals are participating. The Hospital Association of Rhode Island and Quality Partners of Rhode Island have teamed up to coordinate the effort and provide whatever support the institutions need.
Jean Marie Rocha, vice president for clinical affairs at HARI, said the work involved in the 5 Million Lives Campaign coincides to a great extent with other ongoing quality initiatives, “but what’s new and exciting is that all of the Rhode Island hospitals made a commitment to participate.”
It’s also a good follow-up, she and others noted, to recent reports that rated Rhode Island among the top performers in health care quality: The federal Agency for Healthcare Research and Quality ranked the state fifth in the nation for overall quality, based on 129 measures. And the Commonwealth Fund ranked Rhode Island sixth in the nation for its overall performance in terms of health care outcomes, quality, access, efficiency and equity, and No. 1 for providing recommended care to heart attack, heart failure and pneumonia patients.
These kinds of evaluations are made possible by the growing effort nationwide to track quality indicators, said Nancy Fogarty, director of quality for Roger Williams Medical Center. “Hospitals have always had quality programs,” she said. “What’s new is the ability to benchmark with the data that we’re collecting across the country.”
The 5 Million Lives Campaign focuses on 12 specific areas, all involving the implementation of research-based guidelines and strategies:
• Preventing methicillin-resistant staph infections.
• Reducing harm from “high-alert” medications, starting with anticoagulants, sedatives, narcotics and insulin.
• Preventing adverse drug events.
• Reducing surgical complications by implementing changes recommended by another major national initiative, the Surgical Care Improvement Project.
• Preventing central line infections.
• Preventing surgical-site infections.
• Preventing ventilator-associated pneumonia.
• Reducing pressure ulcers.
• Delivering reliable, evidence-based care for congestive heart failure.
• Delivering reliable, evidence-based care for heart attacks.
• Deploying “rapid-response teams” at the first sign of a patient’s decline.
• Engaging hospitals’ boards of directors and senior executives in the quality improvement effort.
Participating hospitals don’t have to agree to work on all 12 points, but Margaret Cornell, the project coordinator at Quality Partners, said that because of the extensive reporting involved, and the overlap between quality initiatives, a hospital could be working in a particular area but just not want to file duplicate reports to, say, the ICU Collaborative and the national campaign.
Individually, hospitals are making changes big and small that they say will reduce complications and save lives.
At Roger Williams, for example, Linda Zaman, director of perioperative services and the hospital’s point person for the Surgical Care Improvement Project, said the use of antibiotics with patients getting knee or hip replacements has changed dramatically. They used to get antibiotics for three to seven days after a surgery; now they get some upfront, “so they’re protected,” and then just for a day after surgery.
But what’s most striking about the quality improvement work being done in Rhode Island and nationwide, both Conway and local health care leaders said, is the extent to which competitors are sharing information and expertise.
Locally, it’s a culture that has taken years to build, Rocha and Cornell said. “We all realize we’re in this together,” Rocha said. •

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