|Originally Aired: August 18, 2006
National Campaign Aims to Curb Hospital Mistakes, Save Lives
|Nationwide, up to 98,000 deaths annually can be attributed to errors in U.S. hospitals, including misprescribed medication and hospital-acquired infections. The 100,000 Lives campaign wants to save money and lives by bringing together health care groups and hospitals.|
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 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
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
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
Campaign manager Joe McGannon showed us the map of
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.
Going for perfection
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
LORI HUFFORD, Clinical Pharmacist, Community Hospital East: I
just wanted to talk to you about some of your medications that you take at
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
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
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.
Passion to save lives
SUSAN DENTZER: To help keep them focused on results, providers
like Kidwell get regular reports on the in-house computer system.
DAN KIDWELL: Here we have January 1st of 2005 through
December 31st of 2005, and we were at greater than 95 percent for all of the
indicators that we know that help prevent a VAP.
SUSAN DENTZER: Dr. Glenn Bingle is chief medical officer of
Community Health Network, the hospital system that includes Community East. He
says tools like these are essential to improving any complex process like
DR. GLENN BINGLE, Chief Medical Officer, Community Health
Network: It just requires a lot of due diligence to meticulous detail. And we
get distracted. Humans are distracted by things in the environment. And if you
look at the nursing work, it's unbelievable. It's so multi-task. And they may
be 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 six
local health systems with multiple hospitals that joined the 100,000 Lives
Campaign. They all agreed to cooperate rather than compete to improve health
care quality and reliability, in hopes of saving the lives of thousands of area
Berwick says that's just the kind of enduring systemic
change the campaign sought to spark, but it's when he talks about the
individual lives saved that his passion shows.
DR. DONALD BERWICK: That's where the energy comes from, that
kind of story. But I think there are lots of people out there whose names we'll
never know who have been saved.
I imagine, you know, some trauma victim, you know, a
20-year-old guy who would have died on a respirator, as he gets better from his
auto accident, who now won't die. He's going to go on and, you know, meet
somebody 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 continuing
into 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 now
undergoing additional care for her cancer.