In the football-loving state of Michigan, legendary athletes take their cues from a coach and map their strategies for one big group effort. But Michigan is also home to what may be the first-ever homegrown regional consortium for patient safety and quality improvement—and in this case—after a huddle each team member gets to call his own plays.
The Hospitalists as Emerging Leaders in Patient Safety (HELPS) Consortium of Southeastern Michigan (funded by a grant from the Blue Cross Blue Shield of Michigan Foundation) includes representatives from nine regional hospitalist programs representing 11 hospitals and approximately 75,000 patients.1
The participants in this program identify proven patient safety practices and facilitate widespread dissemination of those practices among hospitalists.
The member institutions include academic medical centers, large private teaching and non-teaching hospitals, federal facilities, and urban and rural hospitals.
Each institution is represented by a hospitalist—usually the director of the hospitalist program or the individual most interested in and familiar with quality improvement—and a representative from quality improvement or patient safety. The issues they have addressed, which emerged from a variety of sources, such as the Agency of Healthcare Research and Quality, the National Quality Forum, and the Joint Commission on Accreditation of Healthcare Organizations, are those that are commonly encountered in hospitalist practice. These physicians “are bridging the gap between that which they know to be effective and that which is actually practiced.”1
HELPS builds on the experience of medical professionals who have united geographically dispersed physicians from the same specialty to boost quality. The HELPS consortium also aids participating institutions in evaluating outcomes after implementing a targeted patient safety practice, thereby allowing rapid cycle improvement while identifying factors associated with success.
“We have gotten the work that is being done by these different organizations out there, brought it up a notch in certain situations—we like to think—and have gotten it effectively disseminated to a larger group of hospitalists,” says Scott Flanders, MD, an associate professor of medicine at the University of Michigan (Ann Arbor), director of the hospital medicine program there, and an SHM board member.
Where They Are
The consortium is about three-quarters of the way through its overall estimated project period, says Dr. Flanders. It originally planned to have nine gatherings over two years. (See Table 1, p. 35.) To date the consortium has held seven of those sessions and have met roughly every two to three months. End-of-life care and the final wrap-up are the only sessions still to be completed.
The individual sites took on projects that included reducing errors with heparin use in hospitalized patients, reducing falls in hospitalized patients, improving care transitions (a collaborative multidisciplinary approach), reducing unnecessary ICU admission and preventing in-hospital cardiac arrests, reducing urinary catheter infections, improving rates of appropriate deep vein thrombosis prophylaxis, and implementing best practices for reducing central line infections. A national expert conducted a session on implementing a program to reduce perioperative cardiovascular events while ensuring the appropriate use of perioperative beta-blockers.
Challenges and Lessons Learned
From the outset, the HELPS group knew that its primary challenge would be to fulfill the intention to meet as a complete group four or five times per year. “There aren’t a lot of hospitalists who have big parts of their jobs carved out for dedicated time to work on quality improvement research or patient safety,” says Dr. Flanders. “It’s part of what we do in our day, but in terms of taking on a big project, designing it, implementing it, and measuring its effect, it is hard to do in the day-to-day job of most hospitalist groups.”