Hospital patient safety effort launched to reduce errors, save lives

By reminding physicians to do what they already know to do, the American Medical Association and the Boston-based Institute for Healthcare Improvement will work to save 100,000 lives over the next 18 months.

Launched last month at the IHI's National Forum in Orlando, Fla., the "100,000 Lives Campaign" is designed to prevent common hospital system errors that can result in unintended patient deaths. It will run through June 2006, and the goal is to get 1,500 to 2,000 hospitals involved. The AMA's focus will be physician education.

"All we're trying to do is get physicians to follow guidelines -- follow them religiously to the letter," said AMA President John C. Nelson, MD, MPH. "Every one of these guidelines is evidence-based. And this is not new. This is stuff we already know works."

The guidelines Dr. Nelson mentioned are included in six initiatives that, according to multiple published studies, can be reasonably expected to save a total of 100,000 lives if they are implemented across the nation.

The initiatives that are included in the campaign are: using rapid response teams at the first sign of patient decline; following quality guidelines for treatment of acute myocardial infarction; and preventing ventilator-associated pneumonia, surgical site infections, adverse drug events and central line infections.

Dr. Nelson said performance measures and outcomes would be recorded to test the effectiveness of the initiatives.

"We'll actually keep score," he said. "We are doing a good job. Let's take it to doing a fantastic job."

Dr. Nelson noted that a hospital in Heidelberg, Australia, achieved a 65% drop in cardiac arrests and a 37% drop in mortality after introducing rapid response teams. "There's no reason we can't replicate what's being done," he said.

Doing what you're supposed to

The IHI provided research showing how prompt administration of aspirin reduces the risk of death in "vascular events" by 15%, and using beta-blockers reduces death in the first week after acute myocardial infarction by 13% and long-term mortality by 23%.

Despite this evidence, a recent RAND Corp. study found that only 61% of these patients received aspirin and only 45% received beta-blockers.

Dr. Nelson said this was a particularly strong example of how lives can be saved if physicians "do things we're supposed to do."

To prevent medication errors, a special focus will be on transition points where, according to the IHI, 46% of these problems occur.

Transition points include admission and discharge from the hospital and transfer from one hospital unit to another. Dr. Nelson said hospital-nursing home transfers would receive close examination.

To prevent central line-associated bloodstream infections, surgical site infections and ventilator-associated pneumonia, the campaign suggests that no one intervention will eliminate undesired outcomes single-handedly. Instead, a "bundle" of strategies are recommended, and it's suggested that the bundle be treated as a single performance measure instead of highlighting each of the individual interventions in the bundle.

Dr. Nelson said the campaign also would take this "all-or-nothing" approach to hospitals that participate in the effort.

"We're recommending they do six things, and it's pass/fail," he said. "If you don't do any one of those, you fail."

The AMA's full range of resources will be employed to educate physicians on the campaign and secure their participation, Dr. Nelson said, and he will be doing his part as well.

State by state, he plans to make conference calls that will include the medical directors of every hospital interested in participating.

The first such conference call, which will include all the presidents of hospital medical staffs in the state of New York, is scheduled to take place later this month.

If the initial response given to the campaign at the IHI National Forum is any indication, Dr. Nelson said, the rest of the nation will react positively to its goal of saving 100,000 lives.

"The 4,000 people in the audience gave a standing ovation," he said. "It was wildly enthusiastic because we know it can be done."