National Campaign Aims to Curb Hospital Mistakes, Save Lives
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SUSAN DENTZER, NewsHour Health Correspondent: A typical scene in a hospital intensive care unit, or ICU. A very sick patient, Brenda Brisco (ph), is on a ventilator. That’s a machine that takes over the job of breathing through a tube inserted into the mouth or nose and down into the windpipe.
SUE KENNEDY, Sister of Ventilator Patient: Are you sleeping good, huh? Are you sleeping good, baby?
SUSAN DENTZER: A 53-year-old cancer patient who also has diabetes and emphysema, Brisco was hospitalized recently after an apparent seizure. But a relieved sister, Sue Kennedy, told us Brisco would be going home soon.
SUE KENNEDY: Because honestly, the day I brought her in here, I didn’t think I’d take her out. And I’m pleased that I’m going to.
SUSAN DENTZER: That’s in part because this hospital, Community Hospital East of Indianapolis, took special steps to spare Brisco the fate of many ventilator patients. More than one in seven nationwide acquire a potentially deadly pneumonia caused when they cough up stomach juices and accidentally inhale them.
DAN KIDWELL, Respiratory Therapist, Community Hospital East: Let’s just adjust her rate and see if she’s comfortable with that.
SUSAN DENTZER: Respiratory therapist Dan Kidwell told us the condition is called ventilator associated pneumonia, or VAP. It kills almost half of those who get it.
DAN KIDWELL: Their lungs start to show patterns of bacteria growth, and we have to treat them with antibiotics. It takes more staff and more hospital days in that unit in the ICU to take care of them. Some hospitals report $30,000 to $40,000 increased cost taking care of each patient with a VAP.
Saving "100,000 Lives"
SUSAN DENTZER: But the ICU here at Community Hospital Easthas now gone from having two to three cases of VAP a month to having none atall in the last two years. That's a stunningly rare achievement resulting infewer deaths and more than a million dollars in savings.
And it's largely thanks to a campaign aimed at getting U.S.hospitals to improve their care and, in the process, to save 100,000 livesnationwide over a year and a half.
DR. DONALD BERWICK, President and CEO, Institute for HealthCare Improvement: We were fighting death. We're admitting our errors.
SUSAN DENTZER: Health care quality expert Dr. Donald Berwickorchestrated this so-called 100,000 Lives Campaign. At a recent conference in Atlanta, he announced thatit had vastly exceeded the target set in late 2004 when the campaign began.
DR. DONALD BERWICK: Did needless deaths fall between 9:00a.m., December 14, 2004, and this very moment? The answer is yes; there is nodoubt. Using our models to triangulate the difference between observed andexpected deaths, adjusting for severity admission, here's our estimate: 122,342lives.
SUSAN DENTZER: Berwick heads the nonprofit Institute forHealth Care Improvement in Cambridge, Massachusetts. Earlier, he hadbeen among the group of experts assembled by the Institute of Medicinethat issued critical reports in 1998 and 2000. Those cited up to 98,000 deathsa year from errors in U.S.hospitals and called for vast improvements in the quality and safety of healthcare.
DR. DONALD BERWICK: We're wasting tons of money on healthcare on defective processes and defective experiences for patients. It inducesreadmissions; it makes care more complicated; it frustrates people; itfrustrates the work force. So in health care, like in every other industry, ifwe want to save money, do it right.
SUSAN DENTZER: Funded by $16 million in private donations,the 100,000 Lives Campaign brought together top health care groups such asthose representing hospitals, doctors and nurses. More than 3,100 hospitalsagreed to participate, or about two-thirds of all community hospitalsnationwide.
Campaign manager Joe McGannon showed us the map ofparticipating hospitals.
JOE MCGANNON, Institute for Health Care Improvement: ... soin every state where you see the yellow dot, we had a field office. And thatfield office is responsible for the hospitals in the area, giving themopportunities to meet with one another, to learn from one another, and reallyoffering us a way to assess progress out in the field.
Going for perfection
SUSAN DENTZER: It isn't clear why the other third of U.S. hospitalsdeclined to join.
Berwick says a prime goal was to help hospitals catch upwith other major industries in one key respect: reliability. That's not justdoing the right thing for a particular patient; it's also doing the right thing100 percent of the time for everybody.
For example, express shipping companies use computertechnology to aim for 100 percent on-time delivery and airline pilots employsafety checklists to try to land 100 percent of planes safely. Not so withhealth care, Berwick says.
DR. DONALD BERWICK: We now know a lot about the proper wayto care for a person who has an acute myocardial infarction, a heart attack. Anda lot of what works is pretty simple: Give them aspirin the minute you identifythe problem. Give them beta blockers, if they're suitable, and a few othersimple things. Hospitals are pretty good at this in general. They'll give 60,or 70, or 80 percent of the patients the right things, but not 100 percent, notall the time.
SUSAN DENTZER: And when hospitals don't achieve reliability,patients can die. So the campaign set out specific areas of care for hospitalsto tackle.
LORI HUFFORD, Clinical Pharmacist, Community Hospital East: Ijust wanted to talk to you about some of your medications that you take athome.
SUSAN DENTZER: Those include avoiding medication errors. Anew report from the Institute of Medicine says thosetake place a stunning 1.5 million times a year. So at Community East,pharmacist Lori Hufford queries newly hospitalized patients like Jane Rose (ph)about the drugs they regularly take at home.
LORI HUFFORD: Do you still take Detrol (ph)?
PATIENT: Yes, it's only once a day.
LORI HUFFORD: It's a big process, and it doesn't always stopwith just the patients. Sometimes it leads to calls to pharmacies, calls todoctors, calls to family members trying to get them all clarified.
SUSAN DENTZER: But Hufford told us these steps were key. They'dhelp the hospital avoid giving patients new drugs that could cause dangerousinteractions with the ones they're already taking.
Other campaign measures involve avoiding widespreadhospital-acquired infections, such as by regularly giving patients antibioticsright at the time of surgery. Included in this category was averting ventilatorassociated pneumonia.
At Community Hospital East, respiratory therapist Kidwellwas charged with ensuring changes in the delivery of ventilator care. He walkedus through the simple but critical steps, all proven by medical researchpublished years ago to save lives.
DAN KIDWELL: Patients should always have their head abed atleast 30 degrees, and perhaps as high as 40 degrees elevated. Having patientslie flat increases their chance of aspirating or swallowing those gastriccontents that are coming from their stomach.
SUSAN DENTZER: At Community East, the beds have a scale thatshows the precise degree of elevation. That's key, since multiple providers mayhave to raise and lower a bed 30 times a day.
DAN KIDWELL: Any caregiver that enters the patient's roomand a patient is on a ventilator, we look to make sure that head of bed is at30 degrees or higher.
SUE KENNEDY: You're getting better.
SUSAN DENTZER: Patients like Brisco must also be givenantacids regularly to minimize their chances of stomach trouble. What's more,they're given sedation vacations. Berwick explains.
DR. DONALD BERWICK: When a patient is on a respirator, younormally often give them some sedatives so they're not fighting the machine andthey're more comfortable. But if you over-sedate them, you never know when theycould come off the respirator. You don't know it soon enough, and their ownbreathing doesn't get engaged.
So doing what are called sedation vacations, you justlighten the sedation just enough that everyone can kind of know what's goingon, can allow people to get off respirator machines a lot sooner and with a lotless hazard.
SUSAN DENTZER: Another critical step: frequenthand-cleansing with an anti-bacterial disinfectant and wearing gloves aroundthe patient or when touching the ventilator. Even family members like SueKennedy are instructed to comply.
SUE KENNEDY: Basically they've told us that it's reallyimportant for the cleanliness not to touch the ventilator and stuff like that,that it needs to be sterile and clean. They really push that.
Passion to save lives
SUSAN DENTZER: To help keep them focused on results, providerslike Kidwell get regular reports on the in-house computer system.
DAN KIDWELL: Here we have January 1st of 2005 throughDecember 31st of 2005, and we were at greater than 95 percent for all of theindicators that we know that help prevent a VAP.
SUSAN DENTZER: Dr. Glenn Bingle is chief medical officer ofCommunity Health Network, the hospital system that includes Community East. Hesays tools like these are essential to improving any complex process likehealth care.
DR. GLENN BINGLE, Chief Medical Officer, Community HealthNetwork: It just requires a lot of due diligence to meticulous detail. And weget distracted. Humans are distracted by things in the environment. And if youlook at the nursing work, it's unbelievable. It's so multi-task. And they maybe doing multiple things simultaneously. And with that degree of complexity,it's very easy to commit -- just have a lapse and not execute.
SUSAN DENTZER: Here in Indianapolis,Community Health Network has not acted alone. In fact, it's just one of sixlocal health systems with multiple hospitals that joined the 100,000 LivesCampaign. They all agreed to cooperate rather than compete to improve healthcare quality and reliability, in hopes of saving the lives of thousands of areapatients.
Berwick says that's just the kind of enduring systemicchange the campaign sought to spark, but it's when he talks about theindividual lives saved that his passion shows.
DR. DONALD BERWICK: That's where the energy comes from, thatkind of story. But I think there are lots of people out there whose names we'llnever know who have been saved.
I imagine, you know, some trauma victim, you know, a20-year-old guy who would have died on a respirator, as he gets better from hisauto accident, who now won't die. He's going to go on and, you know, meetsomebody and get married; 122,000 people didn't die who otherwise would have. And,man, you know, that was worth trying.
SUSAN DENTZER: The 100,000 Lives Campaign is now continuinginto its next phase, with a goal of getting more hospitals to sign on. Meanwhile,since we saw Brenda Brisco in the hospital, she has been released and is nowundergoing additional care for her cancer.