National Campaign Aims to Curb Hospital Mistakes, Save Lives

SUSAN DENTZER: But the ICU here at Community Hospital East has now gone from having two to three cases of VAP a month to having none at all in the last two years. That's a stunningly rare achievement resulting in fewer 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 lives nationwide over a year and a half.

DR. DONALD BERWICK, President and CEO, Institute for Health Care Improvement: We were fighting death. We're admitting our errors.

SUSAN DENTZER: Health care quality expert Dr. Donald Berwick orchestrated this so-called 100,000 Lives Campaign. At a recent conference in Atlanta, he announced that it had vastly exceeded the target set in late 2004 when the campaign began.

DR. DONALD BERWICK: Did needless deaths fall between 9:00 a.m., December 14, 2004, and this very moment? The answer is yes; there is no doubt. Using our models to triangulate the difference between observed and expected deaths, adjusting for severity admission, here's our estimate: 122,342 lives.

SUSAN DENTZER: Berwick heads the nonprofit Institute for Health Care Improvement in Cambridge, Massachusetts. Earlier, he had been among the group of experts assembled by the Institute of Medicine that issued critical reports in 1998 and 2000. Those cited up to 98,000 deaths a year from errors in U.S. hospitals and called for vast improvements in the quality and safety of health care.

DR. DONALD BERWICK: We're wasting tons of money on health care on defective processes and defective experiences for patients. It induces readmissions; it makes care more complicated; it frustrates people; it frustrates the work force. So in health care, like in every other industry, if we 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 as those representing hospitals, doctors and nurses. More than 3,100 hospitals agreed to participate, or about two-thirds of all community hospitals nationwide.

Campaign manager Joe McGannon showed us the map of participating hospitals.

JOE MCGANNON, Institute for Health Care Improvement: ... so in every state where you see the yellow dot, we had a field office. And that field office is responsible for the hospitals in the area, giving them opportunities to meet with one another, to learn from one another, and really offering us a way to assess progress out in the field.

SUSAN DENTZER: It isn't clear why the other third of U.S. hospitals declined to join.

Berwick says a prime goal was to help hospitals catch up with other major industries in one key respect: reliability. That's not just doing the right thing for a particular patient; it's also doing the right thing 100 percent of the time for everybody.

For example, express shipping companies use computer technology to aim for 100 percent on-time delivery and airline pilots employ safety checklists to try to land 100 percent of planes safely. Not so with health care, Berwick says.

DR. DONALD BERWICK: We now know a lot about the proper way to care for a person who has an acute myocardial infarction, a heart attack. And a lot of what works is pretty simple: Give them aspirin the minute you identify the problem. Give them beta blockers, if they're suitable, and a few other simple 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, not all the time.

SUSAN DENTZER: And when hospitals don't achieve reliability, patients can die. So the campaign set out specific areas of care for hospitals to tackle.

LORI HUFFORD, Clinical Pharmacist, Community Hospital East: I just wanted to talk to you about some of your medications that you take at home.

SUSAN DENTZER: Those include avoiding medication errors. A new report from the Institute of Medicine says those take 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 stop with just the patients. Sometimes it leads to calls to pharmacies, calls to doctors, calls to family members trying to get them all clarified.

SUSAN DENTZER: But Hufford told us these steps were key. They'd help the hospital avoid giving patients new drugs that could cause dangerous interactions with the ones they're already taking.

Other campaign measures involve avoiding widespread hospital-acquired infections, such as by regularly giving patients antibiotics right at the time of surgery. Included in this category was averting ventilator associated pneumonia.

At Community Hospital East, respiratory therapist Kidwell was charged with ensuring changes in the delivery of ventilator care. He walked us through the simple but critical steps, all proven by medical research published years ago to save lives.

DAN KIDWELL: Patients should always have their head abed at least 30 degrees, and perhaps as high as 40 degrees elevated. Having patients lie flat increases their chance of aspirating or swallowing those gastric contents that are coming from their stomach.

SUSAN DENTZER: At Community East, the beds have a scale that shows the precise degree of elevation. That's key, since multiple providers may have to raise and lower a bed 30 times a day.

DAN KIDWELL: Any caregiver that enters the patient's room and a patient is on a ventilator, we look to make sure that head of bed is at 30 degrees or higher.

SUE KENNEDY: You're getting better.

SUSAN DENTZER: Patients like Brisco must also be given antacids 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, you normally often give them some sedatives so they're not fighting the machine and they're more comfortable. But if you over-sedate them, you never know when they could come off the respirator. You don't know it soon enough, and their own breathing doesn't get engaged.

So doing what are called sedation vacations, you just lighten the sedation just enough that everyone can kind of know what's going on, can allow people to get off respirator machines a lot sooner and with a lot less hazard.

SUSAN DENTZER: Another critical step: frequent hand-cleansing with an anti-bacterial disinfectant and wearing gloves around the patient or when touching the ventilator. Even family members like Sue Kennedy are instructed to comply.

SUE KENNEDY: Basically they've told us that it's really important for the cleanliness not to touch the ventilator and stuff like that, that it needs to be sterile and clean. They really push that.