100,000 Lives Campaign: Hospitals join patient safety plan

Aggregate mortality data collected through the project could give a big boost to evidence-based medicine, campaign supporters say.

By Kevin B. O’Reilly — Posted Nov. 7, 2005

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More than half of America's hospital beds are now enrolled in the Institute for Healthcare Improvement's 100,000 Lives Campaign, a patient-safety initiative aimed at helping participating hospitals prevent some of the most fatal and costly medical errors.

IHI President and CEO Donald M. Berwick, MD, said the now 2,800 participating hospitals exceeded the campaign's original goal of 2,000.

The program, in which the AMA is a partner, focuses on six initiatives. IHI estimates that, if implemented reliably by at least 1,600 hospitals, the campaign would save 100,000 lives over 18 months.

The program, launched in January, is scheduled to issue a report in June 2006 detailing the aggregate mortality data for the hospitals that have joined the effort. Dr. Berwick called the early numbers very promising.

"We, as a nation, will be able to have a big party in June 2006 when the results are released," Dr. Berwick said at the Chicago stop in the campaign's promotional 16-city fall bus tour from Boston to Seattle.

Dr. Berwick said he would urge participating hospitals to report their mortality data publicly at an individual or systemwide level once the results are in next June. Such disclosure is not required to participate in the campaign, which will only report aggregate national data.

Participating hospitals pledge to develop rapid-response teams, administer appropriate drugs for heart attack patients, prevent adverse drug events, reduce surgical site and central line infections, and reduce ventilator-related pneumonia. The campaign is organized regionally into geographic nodes -- usually quality improvement organizations, medical societies, hospital associations and ad hoc outfits -- to help support participating hospitals at the local level.

The initiative came in response to a 1999 Institute of Medicine report estimating that as many as 98,000 people die each year due to medical errors -- a figure the AMA has said is "flawed." A study published in the July 25, 2001, Journal of the American Medical Association estimated that medical errors contribute to 5,000 to 15,000 patient deaths annually. Regardless of the numbers dispute, experts say most of these deaths are due to systemic failures rather than individual mistakes.

Since publication of the IOM report, efforts such as the Surgical Care Improvement Project and the Leapfrog Group's quality initiatives have been undertaken to address the problem. What makes the 100,000 Lives Campaign different, Dr. Berwick said, is that hospitals are trusting the public to see how well they do.

Hospital leaders participating in the campaign are "courageous," Dr. Berwick said. "They're working hard every day to do the best for patients, and now they're coming forward to say, 'We can do better. We have defects and we can improve.' They trust the public to hear the bad news but take as a promise that they'll improve. That's a total change in the attitude."

The cultural change

Physician resistance to systemic changes and hospitals' unwillingness to spend money on fixes with an unclear track record have been overwhelmed by emerging scientific evidence, said Charles Watts, MD, chief medical officer at Chicago's Northwestern Memorial Hospital.

"What's changed is the increasing level of evidence for these interventions and many others that can predictably decrease mortality, decrease complications and provide patients a safer journey through the health care system," Dr. Watts said at a campaign news briefing at Northwestern, which is participating in the program. "It's that increasing rigor of evidence that's stimulating us to go through this process."

Dr. Watts said the evidence base and the practical advice provided by Boston-based IHI have helped Northwestern improve. "The way they organize data and give us methods and approaches to get all of the caregivers within the institution to take part in this is incredibly effective for day-to-day care."

Supporters of the 100,000 Lives Campaign contrasted the initiative's focus on evidence-based medicine with a more traditional idea of medicine that revolves around the individual doctor's or nurse's autonomy and creativity. Changing the culture in a hospital and making sure physicians don't feel new systems are being forced upon them is crucial, Dr. Watts said.

"If you don't respect, don't educate, don't inform and don't try to level the playing field before putting the initiative in place," he said, "you'll have guerrilla warfare."

Dr. Watts said Northwestern's decision to join the campaign also has given him leverage when it comes to capital requests that can improve patient safety. "In decisions where two capital requests are relatively even in terms of perceived need, the one that has the best demonstration of improved quality of care and patient care will win every single time," he said. "That's the effect it's had."

The AMA has partnered with the campaign by educating physicians in how to make strides in safety at their hospitals.

"This isn't just about the 100,000 lives we can save," said John Nelson, MD, MPH, immediate past president of the AMA. "This is about the obligation to improve health care for all 294 million Americans by having a better health care system.

"Patients are not widgets," Dr. Nelson added. "If you mess up, you can't throw them away. And sometimes to fix them costs tons of money and an amazing amount of time. We need to get it right the first time."

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Executing procedures

Hospitals participating in the 100,000 Lives Campaign have agreed to implement some or all of these six quality-improvement techniques:

  • Activate a rapid response team at the first sign that a patient's condition is worsening.
  • Deliver evidence-based care to heart attack patients, including administrating aspirin and beta-blockers.
  • Ensure that an accurate and continually updated list of patients' medications are referenced during a patient's hospital stay, particularly at transition points to prevent medication errors.
  • Follow five steps, including washing hands properly and cleaning the patient's skin with chlorhexidine, to prevent patients with central lines from developing infections.
  • Follow a series of steps, including the timely administration of antibiotics, to prevent surgery patients from developing infections.
  • Follow four steps, including raising the head of the patient's bed between 30 and 40 degrees, to prevent patients on ventilators from developing pneumonia.

Source: Institute for Healthcare Improvement

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Who's signing up

The Institute for Healthcare Improvement signed up 40% more hospitals than it hoped to when it began its 100,000 Lives Campaign in January. More than 2,800 hospitals from around the nation are participating.

130-plus: California (199), New York (172), Florida (142), Texas (141)

100-129: Pennsylvania (124), Indiana (107),Ohio (106), North Carolina (100)

50-99: Washington (95), Iowa (80), Wisconsin (75), Illinois (73), Tennessee (73), Massachusetts (71), Missouri (69), Michigan (68), Minnesota (68), Georgia (64), Virginia (64), Colorado (62), Arizona (60)

11-49: Kentucky (46), Kansas (43), New Jersey (43), Oklahoma (39), Louisiana (37), Maine (34), South Carolina (33), Alabama (30), Maryland (30), Utah (29), Connecticut (27), Oregon (27), Mississippi (26), Nebraska (22), New Hampshire (21), West Virginia (17), South Dakota (16), Vermont (15), Montana (14), Arkansas (12), Idaho (12), Wyoming (11)

1-10: Nevada (10), Hawaii (9), Rhode Island (9), Alaska (8), New Mexico (8), North Dakota (8), Delaware (6), District of Columbia (3)

Note: Because some hospitals enrolled in the 100,000 Lives Campaign at the system level, IHI lacks accurate location data for about 150 participating hospitals.

Source: Institute for Healthcare Improvement

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