Group makes push to improve quality care and safety in hospitals

As the Institute for Healthcare Improvement wraps up a two-year safety campaign that helped connect more than 4,000 hospitals, it is challenging the facilities to use a new network and adopt a World Health Organization surgical checklist.

"I propose a 'sprint,' " IHI President and CEO Donald M. Berwick, MD, said in his address at the group's 20th Annual National Forum on Quality Improvement in Health Care in December 2008. "How about adopting and using the WHO surgical checklist in at least one operating room in every campaign hospital within the next 90 days? If we do that, the impact on surgical safety and outcomes ought to be rapid, you ought to be able to measure it locally and it ought to be profound."

December 2008 marked the culmination of IHI's 5 Million Lives Campaign, an initiative that targeted 12 common medical injuries, such as pressure ulcers, staph infections and surgical complications.

IHI has not yet been able to compile national data on how many lives were saved through the campaign. But "at the entity level and individual process level, I am astounded by the results pouring in," Dr. Berwick said. For example, nationwide there are 65 hospitals that have gone nearly a year without ventilator-induced pneumonia.

The institute created local field offices called "nodes" in each state that assisted thousands of hospitals in adopting and adapting the changes. IHI officials are trying to build on that momentum through the institute's new initiative, the Improvement Map. The program is designed to assist hospital leaders in continuing to implement interventions that can improve patient outcomes.

The Improvement Map includes 12 changes from the 5 Million Lives Campaign and its predecessor, 100,000 Lives Campaign. It also includes three new interventions:

• Implementing the WHO surgical safety checklist.
• Preventing catheter-associated urinary tract infections.
• Linking quality and financial management.

Improving patient safety

IHI leaders will continue to add to the program to include ways for hospitals to improve quality and patient safety in all areas of hospital care.

"We have more than 4,000 hospitals eager to keep going on work they have under way," said Joseph McCannon, IHI vice president and 5 Million Lives Campaign manager. "We know at the state level at field offices there is a great deal of energy."

Dr. Berwick hopes the nation's hospitals adopt the WHO surgical safety checklist quickly.

The list is the result of nurses, doctors and patients from around the world identifying the biggest killers in operating rooms -- including bleeding and infections -- and developing a checklist to prevent as many incidents as possible. Health officials in the United Kingdom, Ireland, Jordan and the Philippines hope to have the checklist in place within a year.

"In the absence of a national health system, IHI is a place to come for national impact," said Atul Gawande, MD, a surgeon, author and director of WHO's Global Patient Safety Challenge.

Washington, where one of the pilot programs for the list took place, is among the states that have committed to implementing the program quickly, IHI leaders said.