MARGARET WARNER: Next, reducing medical errors and other problems. Most of the attention and debate surrounding the health care reform law focused on coverage and costs, but the law also included changes to improve patient safety.
NewsHour health correspondent Betty Ann Bowser tells the story of how one hospital in Colorado may offer some lessons.
BETTY ANN BOWSER: It doesn’t look like much, a few feet of plastic ventilator tubing and a small pressure gauge.
BOB WOLKEN, Denver Health: This actually is a device that we just kind of put together from things we had here at the hospital.
BETTY ANN BOWSER: But the simple system respiratory therapist Bob Wolken cobbled together here at Denver Health has cut pneumonia cases in the intensive care unit in half.
BOB WOLKEN: Patients who are laying supine have a better — have an increased chance of aspirating, swallowing their oral and gastric secretions, which can cause a pneumonia.
BETTY ANN BOWSER: So Wolken’s device alerts nurses when the patient is lying too low in the bed.
BOB WOLKEN: It’s going down, and once it’s below 30 degrees, in a second or two, we will hear an audible alarm…
BOB WOLKEN: … that tells us that the angle of the bed is less than 30 degrees.
BETTY ANN BOWSER: It’s estimated as many as 96,000 people die every year from an infection or a medical mistake they experience after going into the hospital. And almost all of those deaths are preventable.
But the chances of that happening at Denver Health are much lower than they were just a few years ago, because this safety net hospital for the poor and uninsured now has the lowest mortality rate of any academic medical center in the country.
Dr. Patricia Gabow is the CEO.
DR. PATRICIA GABOW, Denver Health and Hospital Authority: What that translated to at Denver Health last year is that 213 people walked out of here alive who would have been expected to die. So, that makes the statistic into a very personal aspect for people who, in fact, lives were saved.
BETTY ANN BOWSER: Denver Health’s record for patient safety got national attention recently when Health and Human Services Secretary Kathleen Sebelius and Medicare Chief Dr. Don Berwick toured the hospital and gave it a glowing report.
DR. DONALD BERWICK, Center for Medicare and Medicaid Services: They are getting levels of performance that most of the rest of us in health care can only envy. The vast majority of their patients are either uninsured or Medicaid patients. They deal with a very, very stressed population. And they are proving that that kind of care isn’t just kind of good enough. It can be the best care — actually, the best care in the country. They are showing the rest of us what’s possible.
BETTY ANN BOWSER: One of Berwick’s chief goals is to reduce hospital-acquired infections in the next two years. And starting in 2012, Medicare will start paying hospitals based on how well they do on patient safety.
Denver Health started down that road a long time ago.
DR. PATRICIA GABOW: It was about seven or eight years ago, and I said to my chief of medicine, you know, I can’t stand this anymore. We’re doing things just like we did when I was an intern more than 40 years ago. We have new drugs, we have new technologies, but, basically, the way we are delivering health care is pretty much what it was 40 years ago.
BETTY ANN BOWSER: CEO Gabow wanted a cultural change, so she brought in a team of efficiency experts from the business world and asked how they solve problems.
Out of that grew adoption of the Toyota automobile production system’s Lean principles, to eliminate waste, fix problems, and promote constant improvement.
WOMAN: So, as a group, we’re going to process-map it. We’re going to identify your waste. We’re going to pick part those defects. We’re going to talk to who?
AUDIENCE: The customer.
WOMAN: The customer.
BETTY ANN BOWSER: Now doctors and nurses at Denver Health routinely go through a kind of problem-solving boot camp, looking for ways to improve patient care.
One of the first things tackled was why patients weren’t getting required antibiotics within one hour of surgery. When that one hour window is lost, surgical patients have a higher risk for infection.
The staff recommended a new streamlined process, and now all pre-surgical antibiotics are given by the anesthesiologist in the operating room just before the procedure begins. Post-surgical infection rates went down after this became part of patient care.
Emergency Room Director Seleem Choudhury recently went through the Lean program. The goal was to figure out how to cut wait times for patients in the E.R.
SELEEM CHOUDHURY, Denver Health: People come in and they are sick. And when they are sick, we need to see them as soon as they arrive upon — you know, upon arrival.
And so we had to reexamine our process. We got Post-it notes — we put them on the wall — from every single aspect, from walking through the door, to seeing the nurse, to going through registration. And we had up to maybe two hours’ wait to be seen for that process. And just by making some simple changes, we cut that wait time by half.
BETTY ANN BOWSER: But Choudhury says it was more than just brainstorming. It changed the way he thinks about patient safety.
SELEEM CHOUDHURY: And I think all clinicians I have spoken to are determined that whatever mistake is ever made — and they do happen, they are ever — made — then people want to sit down and say, how can we make sure that doesn’t happen again?
BETTY ANN BOWSER: Denver Health is what’s called an integrated health system. Unlike most American hospitals, all doctors are on salary and report to CEO Gabow. Health policy experts say that kind of structured environment makes it easier to control infections and mistakes.
The environment in a big teaching hospital like this one at the University of Colorado’s Medical School is less structured. Few of the doctors are salaried employees. Most maintain their own private practices.
But, regardless of the setting, when Medicare starts linking patient safety records to hospital payments next year, those who fail to measure up will be penalized.
DR. MARK EARNEST, University of Colorado Medical School: So, Nancy, they need this by the 8th.
BETTY ANN BOWSER: Dr. Mark Earnest is an associate professor of medicine who works with medical students to improve patient care. He says the new payment system is going to force a change some in medicine have resisted.
DR. MARK EARNEST: There is a perception that — that smart, dedicated, and doing the things the way I have been trained to do it is as good as it can be. And, so, sometimes, it takes — it takes us being pushed.
If you took your car in and somebody repaired the car, and it broke down again next week, and the garage got paid to fix it the second time just the way they got it the first time, there is not a lot of incentive to get it right the first time. And that’s sort of the environment we have in health care right now.
BETTY ANN BOWSER: But all that’s about to change.
The federal government is going to start linking payment not only to how hospitals measure up with Medicare patients, but also those on Medicaid. And one in five Americans today depend on that federal-state program for their health care.