The Campaign to Save 100,000 Lives
I am on a plane on my way back to Minnesota after being professionally rejuvenated by the content of the Institute of Healthcare Improvement’s 16th Annual Forum, in Orlando, FL. The theme of the meeting called on all hospitals, and hence I believe all hospitalists, to save lives. Dr. Donald Berwick, President and CEO of the Institute of Healthcare Improvement (IHI) kicked off this years’ Annual Forum with his plenary speech “Some is not a number, Soon is not a time.” Saving some lives, some time in the future is not a clear goal. “Some is not a number and soon is not a time.” So, he put the challenge forth for hospitals to join IHI in a campaign to save 100K lives by June 14, 2006 at 9:00 a.m. EDT.
“Some is not a number. Soon is not a time.” We all get “why” this is important, at least in so much as what we have been told by the Institute of Medicine Reports “To Err is Human” and “Crossing the Quality Chasm”. But “how” can this be done? By doing things that we already know impact mortality in a hospital setting. By engaging in the reliable care delivery of six changes that save lives. These include recommendations in each of the following areas: rapid response or emergency medical teams, reliable care for acute myocardial infarctions, reliable use of the ventilator pneumonia and central venous line “bundles”, surgical site infection prophylaxis, and prevention of adverse drug events with reconciliation. Each is described in more detail below.
- Rapid Response Teams (also known as Medical Emergency or Pre-Code Teams): This is a team of healthcare providers that may be summoned at any time by anyone in the hospital to assist in the care of a patient who appears acutely ill, before the patient has respiratory failure, a cardiac arrest or other adverse event. The aim is to prevent situations of “failure to rescue”, to recognize the early signs and symptoms of clinical deterioration prior to requiring transfer to the intensive care unit.
- Reliable Care for Acute Myocardial Infarction (AMI): For appropriate AMI patients, reliable use of all of the following treatments: early administration of aspirin, aspirin at discharge, early administration of a beta-blocker, beta-blocker at discharge, ACE‑inhibitor or angiotensin receptor blocker (ARB) at discharge (if systolic dysfunction), timely reperfusion, and smoking cessation counseling.
- Reliable use of the Ventilator Bundle: A number of hospitals have initiated the use of the ventilator bundle to prevent ventilator associated pneumonia (VAP). VAP carries a high mortality rate. The “bundle” is a grouping of 5 treatments/preventions measured as a composite (% of patients that get all 5).
- Elevate head of bed to 30 degrees
- Peptic ulcer prophylaxis
- Deep venous thrombosis prophylaxis
- Daily “sedation vacation”
- Daily assessment of readiness to extubate
Not all of the items have a specific relationship to VAP (e.g., DVT prophylaxis), but when reliably performed in concert with the other items, leads to a decrease in VAP.
- Reliable use of Central Venous Line Bundles: This is a grouping of 5 preventative measures that when done in concert and measured as a composite have had maximal effectiveness for the reduction of central line associated blood stream infections (CLABs) in some hospitals.
- Hand hygiene
- Maximal barrier precautions
- Chlorhexidine skin antisepsis
- Appropriate catheter site and administration system care
- No routine line replacement
- Surgical site infection (SSI) prophylaxis with a “SSI bundle”: Hospitals participating with the IHI in a variety of different formats have found the most substantial reduction/prevention of SSIs when 3 preventative measures are done in concert with each other for every surgical patient. These preventative measures include:
- Guideline-based use of prophylactic perioperative antibiotics (including both choice and timing of administration of antibiotic)
- Appropriate hair removal (avoiding shaving)
- Perioperative glucose control
- Prevention of adverse drug events with medication reconciliation: This refers to the procedures that can be put in place at the time of any transition of care to mitigate the increased risk of wrong dose of medication or even wrong drug being administered immediately following that transition. Each time we have to transfer information from one sheet of paper to another or from a sheet of paper to a computer, there is chance for human error. Medication reconciliation can virtually eliminate errors occurring at transitions in care.
