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Calling in Outside Experts
To focus on the issue of preventing hospital-acquired urinary tract infections (UTIs), the consortium invited Russell Olmstead, MPH, an infection control expert and epidemiologist at one of the HELPS sites and past president of the Michigan Society of Infection Control.
“We’d like to do a Keystone[-type] UTI project,” says Dr. Saint, referring to the federally funded statewide three-year initiative, conducted in collaboration with the Michigan Hospital Association and Johns Hopkins Research and Safety Group, that focused on applying evidence-based medicine and quality improvement efforts to prevent ventilator-associated pneumonia and central line-related infections. “We’ve called it the Bladder Bundle; that is, you bundle a group of practices together, and you give the hospitalists who want to participate a toolkit in order to roll this out.”
Although the details still need to be finalized, the project would include ensuring that patients have appropriate indication for an indwelling catheter, that the indwelling catheter is inserted in an aseptic manner, that there was some type of assessment of discontinuation after a certain amount of time, and that alternatives to an indwelling catheter are considered.
Another expert consulting with the consortium was Peter Lindenauer, MD, MSc, with the Division of Healthcare Quality, Baystate Medical Center, Springfield, Mass., and the Department of Medicine, Tufts University School of Medicine, Boston. Dr. Lindenauer came to discuss lessons he and his colleagues have learned from efforts to improve appropriate perioperative beta blocker use.
The final HELPS wrap-up session for the group will include another nationally renowned expert in patient safety.
SHARP: Research Translated into Practice
Another project initiated by the Michigan hospitalists will generate and disseminate new knowledge in the realm of clinical research. The Specialist-Hospitalist Allied Research Program (SHARP), directed by Dr. Flanders and Brahmajee Nallamothu, MD, MPH, an interventional cardiologist, is the first specialist-hospitalist clinical research program in the United States. This hospitalist delivery model alters the way clinical problems are approached and creates opportunities and challenges in implementing best practices, including those surrounding drugs and devices. A successful clinical and translational research program will combine specialists and hospitalists working collaboratively to better understand the best ways to care for inpatients.
This project is similar to what cardiology and oncology specialties have done over the last several decades, says Dr. Saint. In the future, he foresees that the NIH will increasingly focus on translating research into practice in diverse settings. Both specialists and hospitalists who work in a particular area together—such as prevention of lower extremity clots or of nosocomial infections—can use the health consortium to roll out protocols and studies in order to tackle some of the important inpatient topics.
SHARP was awarded funding through the University of Michigan Department of Medicine and was scheduled to take off in February. “Our hope is that we will be able to take advantage of and build upon the health collaborative that we have and bring in our subspecialty expertise to help inform clinical investigations,” says Dr. Saint.
Where They’re Going
Both Dr. Flanders and Dr. Saint are pleased about the HELPS consortium’s progress so far. They believe that they have found a group of people who are interested in patient safety and are willing to learn from one another and that they have done an excellent job of disseminating the best practices they have been exploring.
Ultimately, their goal is to grow this into a “more robust clinical research consortium,” says Dr. Flanders. Instead of disseminating best practices and focusing on just a few targeted patient safety quality improvement areas, they will begin to take on studies that could center around patient safety and quality improvement but will also move toward multi-center projects that might address issues related to management of common clinical problems that hospitalists are now managing and focusing on.