Keys to Safer Hospitals

PREVENT IV- CATHETER INFECTIONS Central-line infections occur when bacteria contaminate catheters that deliver food and medicine intravenously. Dr. Peter Pronovost of Johns Hopkins University recently reported that 70 hospitals in Michigan, California, Iowa and Indiana cut their central-line infections by half, saving an estimated $165 million from complications to boot. How did they do it? They made it easy for doctors and nurses to wash their hands between patients, adopted simple procedures for changing the bandages around the catheters and made absolutely sure that no catheter remained in a vein even one hour longer than needed.

STOP SURGICAL-SITE INFECTIONS Surgical-site infections are a major cause of complications and deaths after operations. Last year Mercy Health Center in Oklahoma City operated on 1,200 consecutive patients without a single wound infection--by adopting a series of simple preventive measures. These include giving the right antibiotics at the right time during surgery, enforcing strict hand-washing and avoiding shaving the surgery site before the operation (clipping hair avoids nicking the skin and is safer).

RESPOND RAPIDLY TO EARLY-WARNING SIGNALS A nurse or visitor is often the first person to notice that a patient is in trouble. By setting up special rapid-response teams, hospitals can ensure that these critical warnings are never missed or ignored. Busy physicians may resent the false alarms, but lives are saved when hospitals take nurses' concerns seriously and respond within minutes. Australian researchers have found that rapid-response teams may be able to cut hospital death rates by 20 percent or more. The University of Pittsburgh Medical Center is testing an even more innovative way to use rapid-response teams. The staff trains patients' visiting family members to call for assistance whenever they sense trouble. The new protocol, dubbed Condition H (for "Help"), has already saved lives.

MAKE HEART-ATTACK CARE ABSOLUTELY RELIABLE The scientifically correct treatments for heart attacks could save far more lives if we used them reliably. The 100,000 Lives Campaign simply asks hospitals to ensure that every patient gets every medication --and treatment recommended by the American College of Cardiology and other expert bodies. These measures include aspirin and a beta blocker on arrival and a stent or clot buster promptly after admission. McLeod Regional Medical Center in Florence, S.C., has cut the death rate among its heart-attack patients from 10 per-cent (the U.S. average) to about 4 percent. All the hospital had to do was ensure 100 percent reliability.

STOP MEDICATION ERRORS Medication errors kill tens of thousands of patients a year, yet many are easily prevented. One secret is to "reconcile" medications whenever patients move from one care setting to another--from hospital to home, or even from one place to another within a hospital. The reconciliation protocol assigns a doctor or nurse at every step to check and recheck: are the medicines the patient gets after the transfer exactly the ones planned before the transfer? If not, the mistake gets corrected right away.

How much difference are we making through these efforts? We don't yet know whether the campaign will save 100,000 lives in its first year. Talk is cheap; changing the culture of a hospital is hard. But I've got a stake in it. When I close my eyes on the operating table so that a surgical team can implant my shiny new pain-free titanium knee, I know exactly what I want: safe, effective care, without a single complication.

Berwick is president and CEO of the Institute for Healthcare Improvement (ihi.org) and clinical professor of pediatrics and health-care policy at Harvard Medical School

© 2005