Keys to Safer Hospitals

Sometime soon, I will need a new right knee. If all goes well, it will be quite a relief. An artificial joint can be a modern miracle, the alternative to decades of pain and hobbling. Here's the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care: preventable bleeding or infections, a medication mix-up, a respirator tube put in the wrong way and a lot more. I have climbed Mount Rainier five times. Each time I made that tough trek, my risk of dying was about 100 times smaller than the risk I will face on the operating table.

Even if the surgery doesn't kill me, it may still cause needless harm. The reason I need a new knee is that I have osteoarthritis--the result of a botched and unnecessary knee operation 30 years ago, when I was a naive and trusting medical student. What could go wrong this time? My postoperative pain may not be adequately controlled. I may receive the wrong dose of blood thinner, causing bleeding in my stomach. Someone may overlook the little patch of pneumonia on my routine postoperative chest X-ray, causing me to remain on a respirator in the intensive-care unit for several days. Or the hospital may fail to take steps that could prevent the pneumonia in the first place.

Fortunately, hospitals are beginning to realize that it doesn't have to be this way. On Dec. 14, 2004, the Institute for Healthcare Improvement, a nonprofit organization headquartered in Cambridge, Mass., launched the 100,000 Lives Campaign, a broad national effort to achieve the most urgent reforms. Mainstream leadership groups like the American Medical Association, the American Nurses Association and the Joint Commission on Accreditation of Healthcare Organizations immediately signed on to the campaign. Several federal agencies--including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Veterans Health Administration and the Agency for Healthcare Research and Quality--pledged support as well.

We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It's surprising to learn that these standards aren't already the norm--but the norms may finally be changing. Nearly 3,000 American hospitals have enrolled in our 100,000 Lives Campaign over the past year, and more than half are reporting their monthly death rates so that we (and they) can track progress. That takes courage in a world where hospitals, fearing blame and lawsuits, too often feel the need to hide their mistakes.

What exactly will it take to improve the quality of care? Here are the prescriptions that we and our partners are advancing. You don't have to be a doctor to understand them.

PREVENT RESPIRATOR PNEUMONIA VAPs, or ventilator-associated pneumonias, are often deadly lung infections that people on respirators can get (after surgery, for example). A few simple maneuvers, like elevating the head of the hospital bed and frequently cleaning the patient's mouth, can eliminate them. Dominican Hospital in Santa Cruz, Calif., just celebrated one full year without a single VAP--a result most doctors would have thought impossible.