Ascension Health's systematic approach to reducing preventable inpatient complications and deaths has paid off big at selected hospitals, in some cases dialing down serious dangers to zero in less than a year.
The five-year initiative, now in its second year, has an ambitious goal: eliminating all preventable injuries and deaths at the system's 67 hospitals by July 2008. The project abandons typical definitions of medical mistakes and unavoidable adverse events, says David Pryor, senior vice president of clinical excellence.
"Our goal is not simply to eliminate error," Pryor says. "It really is about preventing these adverse events from happening."
The causes of injury and death unrelated to a patient's reason for being hospitalized are well-known to healthcare professionals: hospital-acquired infections, patient falls, adverse drug events and pressure ulcers that can lead to the type of infections that took the life of actor Christopher Reeve.
Many of these afflictions are not considered errors for reporting purposes but rather part of the hazardous terrain of complicated medical treatment for often frail people with multiple problems, Pryor says. For example, when a patient is hooked up to a machine to help him breathe, "Most people would argue inevitably that some people would get pneumonia on that ventilator."
But at St. Vincent's Hospital in Birmingham, Ala., where the pneumonia rate from ventilators was 5.7% in January, no patient contracted the disease while on a ventilator during the first six months of a coordinated prevention program that began in February.
To get a handle on the problem of preventable deaths, Ascension combed through patient charts for the 15,000 deaths among its total 650,000 admissions and determined that 46% were not expected given the diagnosis and expected treatment. A great many of those involved patients at the end of life and their deaths were considered impossible to prevent. But in up to 25% of cases in which patients were not receiving end-of-life care and were not expected to die in the hospital, the patient had-in the course of hospitalization-a potential preventable event, "which is a staggering figure," Pryor says. "It's much larger than the number of errors that would occur."
Nearly all of those events fall into one of eight categories of problem-reduction priorities; responsibility for developing a plan of attack for six of those priorities has been assigned to nine hospitals in the system. All hospitals were told to address the other two priorities. By spreading the lessons systemwide and eliminating these eight broad sources of harm, Ascension executives say they will achieve their 2008 goal.
In addition, every hospital will have to develop standard approaches to dealing with two of the following four situations that involve giving medication: narcotics and sedatives; blood thinners; insulin; and reconciliation of medications at transfer points in a patient's hospitalization.
The initiatives have produced fresh thinking on old problems such as hospital-acquired infections. In the intensive-care units at Borgess Health Alliance, Kalamazoo, Mich., clinicians "declared war on hyperglycemia" to make patients better able to fight off infections, Pryor says. That's because white blood cells don't function effectively to fight infection when blood-sugar readings get above a certain level, and that vulnerable situation can cause death.
The mortality rate from hyperglycemia was 5.9% in the first quarter of 2003. In the same quarter of 2004, there were no deaths related to high blood sugar.
Borgess also sought to reduce the death rate from cardiac arrest by forming "rapid response teams" that nurses or other clinicians can call if they see signs of deterioration in any patient. By intervening early, they hoped to cut down on the number of "codes" for heart resuscitation, which are a sign that a patient already may have sunk too far to survive. The program began in February, and by August it had resulted in a 50% decrease in codes called.
During that same time, St. John Hospital and Medical Center, Detroit, reduced bloodstream infections by 50%, to 4.5% from 8.9%; and St. Thomas Health Services,Nashville, reduced patient falls by 40%.
"When they focus on eliminating adverse events," Pryor says, "the impact is dramatic, just dramatic."