In April 2005, the American Hospital Association’s magazine, Hospital and Health Networks (H&HN), published the article “25 Things You Can Do to Save Lives Now.”1 In it, experts from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Institute for Healthcare Improvement (IHI), the National Quality Forum (NQF), and the Centers for Medicare and Medicaid Services (CMS), commented on an action plan to advance hospitals’ patient safety activities.
Now The Hospitalist has researched hospitalists’ views on these same 25 items. Those views are presented below.
A number of these items “are already highly ensconced in the JCAHO and CMS criteria,” says Dennis Manning, MD, FACP, FACC, director of quality in the Department of Medicine and an assistant professor at the Mayo Clinic College of Medicine, Rochester, Minn. “In terms of power of the things on the list for potentially saving lives, what we sometimes look at are the things that have the potential for the most prevention.”
Brian Alverson, MD, pediatric hospitalist at Hasbro Children’s Hospital in Providence, R.I., adds his thoughts on the 25 items: “We have to hold in our minds a healthy nervousness about patients being hospitalized, in that there is an inherent danger to that phenomenon. No matter how hard we strive for perfection in patient care, to err is human.”
Shortening hospital length of stay to within a safe range, he believes, is one of the best ways to reduce those daily dangers.
Some of the 25 items pose more challenges for hospitalists than others, and the contrary is true as well. Some were judged to be of lesser concern due to guidelines or imperatives imposed on hospitals by regulatory organizations. Other items fall outside hospitalists’ accountabilities, such as incorrect labeling on X-rays or CT scans, overly long working hours, medical mishaps (such as wrong-site, wrong-person, and wrong-implant surgeries), and ventilator-associated pneumonia. A few items were those that hospitalists found challenging, but for which they had few suggestions for solutions. In some, there were obstacles standing in the way of their making headway toward conquering the menace. These included:
1. Improper Patient Identification
“Until we set up a system that improves that, such as an automated system,” says one hospitalist, “I’ll be honest with you, I think we can remind ourselves ’till we’re blue in the face and we’re still going to make mistakes.”
2. Flu Shots
“Flu shots are probably more important in the pediatrics group than in any [other] except the geriatric group,” says Dr. Alverson, who strongly believes that pediatricians should be able to administer flu shots in the inpatient setting, “because we can catch these kids with chronic lung disease—many of [whom] are admitted multiple times.”
3. Fall Prevention
This item is one of the National Patient Safety goals, and one that every institution is trying to address. In pediatrics, says Dr. Alverson, the greater problem “is getting people to raise the rails of cribs. Kids often fall out of cribs because people forget to raise the rail afterwards, or don’t raise it high enough for a particularly athletic or acrobatic toddler.”
The other items on the list of 25 are below, including a section for medication-related items and the sidebar on a venous thromboembolism (VTE) prevention program.
4. Wash Hands
Provider hand-washing has been well studied, says one hospitalist, and “the data are so depressing that no one wants to deal with it.” Another says, “We just nag the hell out of people.”
One of the hospitalists interviewed for this story read the H&HN article and responds, “We do all these things.” But a lack of self-perception regarding this issue—as well as others—is also well-documented: Physicians who are queried will say they always wash their hands when, in fact, they do so less than 50% of the time.2-5