Celeste Derheimer, MultiCare Health System’s director of process excellence in Tacoma, WA, has spent years working to improve the quality of hospital-delivered health care, and in that time she has often seen process trump purpose.
“What does quality mean to the caregiver? That’s something we’ve always had a difficult time articulating,” Derheimer said. “Quality has been more about the ‘what’ than the ‘why,’ and what the 100,000 Lives Campaign did was provide the why. It’s to save lives. [The campaign] helped us tell our story.”
The 100,000 Lives Campaign, a project of the Institute for Healthcare Improvement (IHI), is really all about stories — 122,300 of them. That’s the number of people who, according to IHI estimates, might have died from health care-related complications but lived due to voluntary quality improvements made by thousands of U.S. hospitals during an 18-month period that ended this month.
“This campaign signals nothing less than a new standard of health care in America,” said IHI President and CEO Don Berwick, M.D., a former AHA board member, when announcing the campaign’s results on June 14. (See an excerpt of Berwick’s remarks on page 4.)
About 3,100 hospitals representing roughly 75% of the nation’s acute care beds signed up, far surpassing the stated enrollment goal of 2,000. They pledged to implement some or all of the campaign’s six evidence-based and life-saving changes or interventions. These entailed activating a rapid response team for emergency care of patients whose vital signs suddenly deteriorate and preventing heart attack deaths, medication errors, infections related to central lines (catheters introduced into a major vein to deliver medication or nutrition to the heart and other vital organs), surgical site infections and ventilator-associated pneumonia.
IHI estimated the number of lives saved by comparing 2005 and 2006 mortality data from participating hospitals with data from calendar year 2004.
AHA President Dick Davidson said the association plans to share strategies from the campaign, as well as other leading quality improvement initiatives, through its new Quality Center. “The energy and focus brought by the IHI and hospitals to this campaign have gone a long way to enhancing patient safety programs and efforts underway in America’s hospitals,” he said. “We will continue working with the IHI and other partners to create new tools and techniques to help hospitals make the changes that lead to better, safer care for all.”
Nearly 100 hospitals that achieved dramatic improvements in implementing some or all of the campaign’s interventions are mentoring other hospitals on those quality improvement areas. Representatives from mentor hospitals may give talks or participate in conference calls with hospital executives who have questions about how to perform better in those areas. Experts at mentor hospitals are also available to speak informally with hospital officials who call for advice.
IHI recognizes MultiCare Health System’s Tacoma General and Allenmore hospitals – two urban hospitals with 521 beds operating under one license – as a mentor hospital. After convening a multidisciplinary team in July 2005 to develop and implement a rapid response team strategy, the hospitals witnessed a 34% decrease over 2004 levels in the occurrence of sudden cardiac arrest.
Meanwhile, the hospitals sought to reduce heart attack fatalities by dramatically reducing the amount of time patients wait to have a balloon inserted in their arteries to reduce blockage. They succeeded in reducing this time from 110 minutes to 72.1 minutes — a 34% improvement.
Small rural St. Peter (MN) Community Hospital mentors for five of the campaign’s six interventions (the 22-bed rural hospital has no ventilators and thus cannot reduce the incidence of associated pneumonia). The hospital involved about 40% of its staff in the planning and implementation of its quality improvement changes, giving them a stake in the outcome and a powerful motivation to succeed. The close-knit nature of the small community also helped, said Benjamin Chaska, M.D., the hospital’s medical director and patient safety officer.
“We said to the staff, ‘How many times do you get the chance to change the work that you do so that it improves the lives of your friends, family and neighbors forever, long after you’re gone?’” he said. “They really got excited about that.”
St. Peter Community Hospital customized some of the IHI interventions to better fit its size. For example, heart attack patients are routinely transferred to larger hospitals after they are stabilized, so the hospital approached the goal of reducing heart attack deaths by decreasing transfer times. It did this largely by empowering nurses to begin the transfer process and by calling for the receiving hospitals’ helicopters, complete with cardiac catheterization labs, before and not after stabilization. Patients now receive standard care 100% of the time.
The hospital adapted the IHI Rapid Response Team approach to reduce the number of transfers of patients admitted to the medical surgical area by 28% over the course of the campaign, which Chaska said has achieved savings. The hospital also saw a 60% improvement in the mortaility rate of the patients admitted to its medical surgical area.
“For every transfer that did not happen, we saved $6,200, so the money we saved there paid for all the resources we put into the campaign many times over,” he said. “Not only did we do better in quality, but we increased the revenue at the top line of the organization enough to pay for the entire program.”
Since St. Peter performs on average just three central lines each year, it instead focused on reducing infection on all intravenous access, and reduced the number from 12 per 1,000 each year to just one. It also focused on preventing medication errors by ensuring that patient medication lists are continually updated, particularly at the time of a transfer. This reconciliation, which used to occur about 70% of the time, is now near the 100% mark. Statistics indicate the improvements made by the hospital are preventing 12 unnecessary deaths each year.
IHI’s Berwick has challenged hospitals to continue to improve, extending a “six by seven” challenge to implement all six quality improvements by 2007.
The task will change hospitals’ “expectations as a culture,” said St. Peter’s Chaska. “We’re embracing a new standard of care that says no person will be harmed by the health care system. We want to give our patients the very best care that we can, and we’ll never again accept that being as good as anyone else is enough.”