Streamline Training & Documentation: New Standards of Hospital Care

Thursday, June 15, 2006

New Standards of Hospital Care

As successful experiments go, the 100,000 Lives Campaign, an effort to reduce fatal errors in hospitals, is particularly encouraging.

Spearheaded by the non-profit Institute for Healthcare Improvement (IHI), the campaign aims for rapid improvements in patient care at hospitals. At this week's 2nd Annual International Summit on Redesigning Hospital Care, Donald Berwick, a professor of health policy and management at Harvard, and President and CEO of IHI, described the goal-surpassing results achieved in the 18 months since the IHI project began in December 2004.

He also described how the results have been achieved. The 3,100 participating hospitals established new standards of care by implementing some or all of an initial group of six evidence-based and life-saving interventions, namely:¹

Activate a Rapid Response Team at the first sign that a patient's condition is worsening and may lead to a more serious medical emergency.

Prevent heart attack deaths by delivering evidence-based care, such as appropriate adminstration of aspirin and beta-blockers to prevent further heart muscle damage.

Prevent medication errors by ensuring that accurate and continually updated lists of patients' medications are reviewed and reconciled during their hospital stay, particularly at transition points.

Prevent central line infections by following five scientifically grounded steps, e.g., proper hand washing and cleaning the patient's skin with an antiseptic called chlorhexidine. (A central line is a special IV line placed in a large vein that goes to the heart.)

Prevent surgery patients from developing infections by following a series of steps, including the timely administration of antibiotics.

Prevent patients on ventilators from developing pneumonia by following four scientifically grounded steps, e.g., raising the head of the patient's bed between 30 and 45 degrees.

Much of the data used in identifying the best interventions are obtained by voluntary pooling of mortality information, even though, in many cases, the hospitals contributing data are competitors. Berwick comments that he has "never before witnessed such widespread collaboration and commitment on the part of health care leaders and front line staff to move the system giant steps forward."

From the training perspective, the mechanisms for spreading knowledge and lessons learned are of particular note. In addition to hospitals' own internal training, there are a number of external learning resources:

IHI provides a raft of what anybody in the training business would recognize as performance support materials, including How-to Guides and checklists and an FAQ that gives particular attention to overcoming obstacles.

On the state and regional level, IHI has organized more than 50 healthcare organizations, such as state hospital associations and quality improvement organizations, to act as field offices. These organizations coordinate technical assistance, support peer-to-peer learning via phone and e-mail, and host local campaign events.

Almost 100 hospitals that have demonstrated success with specific interventions are "mentor hospitals," sharing their expertise.

As noted in an earlier post, the medical field is especially rich in models of how to use careful data analysis to guide decision-making. The 100,000 Lives Campaign is a powerful example of how the knowledge needed for innovation is acquired, and then turned into effective action, producing ever more valuable outcomes.

To paraphrase Thomas Edison, successful innovation requires hard-slogging. What's inspiring about the 100,000 Lives Campaign is its demonstration that, with concerted effort, we may very well be able to accelerate our slogging and arrive more quickly at rewarding results.

June 29 update: Carl Bialik uses his Wall Street Journal column to point out statistical problems with the IHI report. For example, there would be upward bias in the estimated number of lives saved if reporting was more complete from hospitals with positive results than from hospitals with negative (or neutral) results.
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¹ From IHI's June 14, 2006 press release, available as a pdf file here.

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Labels: Decision-making, Innovation

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