Zero heroes. Three years ago Brilli and his team announced that they would aim to eliminate preventable harm to patients by 2013, by making patient safety central to every medical and surgical protocol. To track their progress, they created what they call a preventable-harm index, a simple list of all hospital-acquired infections, adverse drug events, cardiac arrests, major surgical complications, hospital-acquired pressure ulcers, and serious falls, with the total being patients who were injured but shouldn't have been. When mistakes occur, hospital staffers are encouraged to report them. "We can't fix things that we don't know are happening," Brilli says. Each report triggers a review, often leading to changes in protocols, procedures, or technology. Anyone who needs added training gets it; anyone found to have taken a shortcut could be reprimanded. Those who advance the cause, whether they're clerks or heart surgeons, are acclaimed as "Zero Heroes."
So far, Nationwide Children's has cut the number of preventable incidents and errors in half, Brilli says. At Beth Israel, Levy helped persuade the board to endorse a policy in 2008 of eliminating preventable harm over four years. Just a year earlier, the hospital documented 300 cases in which patients were hurt by their medical care. After a year of monitoring these episodes and putting fixes in place, the number dropped to 160 cases, reports Kenneth Sands, the hospital's senior vice president of healthcare quality. By the end of 2011, the hospital had reported just 96 adverse events for the year, 40 of them surgical site infections in a hospital where nearly 6,400 operations are performed each year.
The idea has caught on in Washington. The Centers for Medicare and Medicaid Services has given a consortium of Ohio children's hospitals a $5 million grant to help eliminate preventable errors; Brilli says he hopes that every children's hospital in the country will have signed on by the end of 2013. The government has set a more modest goal for adult hospitals. An initiative by the Department of Health and Human Services, "Partnership for Patients: Better Care, Lower Costs," intends to reduce preventable injuries in U.S. hospitals by 40 percent, saving 60,000 lives, by 2014.
There's proof from Michigan that zero harm may be an attainable goal. In just 18 months, a partnership between the Michigan Health and Hospital Association and Johns Hopkins University, known as the Keystone Project, reduced the rate of bloodstream infections by two thirds among patients in intensive care units receiving central lines, the catheters that carry medicines and nutrients directly into blood vessels. That translates into more than 1,500 lives, and at least $100 million, saved each year. About one quarter of the ICUs have eliminated the infections altogether. At Keystone's core is a checklist—from hand-washing to wearing masks, gowns, and gloves—that medical teams must follow. Team members tick off each item on the list to make sure that each procedure is carried out in the proper order and nothing is missed. They also relentlessly monitor infection rates, working collaboratively to identify sources of infection and wipe them out. Peter Pronovost, a Johns Hopkins anesthesiologist and critical care specialist who launched the program, says he's now received government funding to extend the program to more than 1,400 ICUs in 48 states.
And that's just the beginning, Pronovost says. Next, he plans to introduce checklists for virtually anything that could conceivably harm an ICU patient and figure out ways to prevent them all. An even more powerful approach, he says, would be to build a smart ICU, with safety procedures "baked in" to the technology. "You should be able to buy an ICU that's integrated, so that everything talks to each other," he says. In standard ICUs, doctors, nurses, or respiratory therapists must adjust ventilators manually to make sure they're delivering the right amount of air, leaving the process open to human error. In an interactive ICU, a ventilator could constantly check the patient care plan and the patient's vital signs to make sure it's delivering just enough oxygen to sustain the patient without giving too much, which can lead to a potentially fatal complication called acute lung injury. "It's engineering 101," says Pronovost, who has obtained a grant to get the project started.