Saving Lives
Hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths
Before 1999, dying in a hospital because of shoddy care was a real enough possibility, but only the paranoid or pessimistic gave it much thought. Then came To Err Is Human, a j'accuse-style thunderbolt from the prestigious Institute of Medicine. Medical errors in hospitals, charged the institute's report, kill at least 44,000 and perhaps as many as 98,000 patients a year. On its heels, other studies found widespread failure to heed well-known "best practices" that could save lives. Horrific tales of individuals betrayed by mistakes and inattention popped up in the news like poisonous mushrooms. Medical centers suddenly were seen as death traps.
In truth, no one knows now, or knew with any precision in 1999, how many hospital patients die from errors and inadequate care. Even agreement on the meaning of "error" is elusive--should deaths caused by substandard care be counted along with deaths caused by mistakes?
It's also important to maintain a sense of perspective. Suppose the institute's higher estimate is right and is rounded up to 100,000. Here's what it means to you when that number is placed alongside total yearly hospital admissions of about 37 million: The arithmetic works out to roughly one death from medical errors for every 370 admissions. Or, to put it another way: A patient undergoing major surgery probably faces a risk of dying, if everything goes right, of 2 percent or more. Including the worst-case possibility of death due to a mistake adds about one quarter of 1 percentage point to this risk.
Careless care . This view provides no comfort, of course, if you are a friend or family member of someone who needlessly died in a hospital. And although the IOM report called for an all-out improvement effort, it just hasn't happened. Hospitals in the wealthiest nation on the planet are still killing tens of thousands of people every year by infecting them after surgery, mixing up their medications, treating them with entrenched, outdated medical practices, or reacting too slowly when they show danger signs.
Robert Wachter, a longtime safety and quality expert and chief of the medical service at the University of California, San Francisco Medical Center, calls it an epidemic that most hospitals still don't take seriously until a high-profile disaster occurs on their watch. "Show me a medical organization," he says, "that really has walked the walk when it comes to safety and has not [itself] made a terrible error."
There's been plenty of talk about safety, and even meaningful activity. The federal Centers for Medicare and Medicaid Services began posting performance numbers showing how well more than 4,200 hospitals comply with basic guidelines for treating heart attack, heart failure, and pneumonia (www.HospitalCompare.hhs.gov). The accrediting body for hospitals, the Joint Commission for Accreditation of Healthcare Organizations, has added new patient safety requirements year by year. Safety and quality initiatives pioneered by organizations such as the Leapfrog Group and the National Quality Forum have been hammered out.
But if these efforts have had an effect beyond a handful of medical centers, it's hard to see. "It's a question of leadership," says Donald Berwick, president and chief executive of the Institute for Healthcare Improvement in Cambridge, Mass. Since 1991--nearly a decade before the Institute of Medicine's error report--he has proselytized for grass-roots-level quality improvements in hospitals. "They must do better. 'Trying harder' is the world's worst plan."
So last December, at an annual gathering of hospital and public and private healthcare leaders who went to Orlando to exchange ideas on safety and quality improvements, Berwick took the microphone. "I'm losing my patience," he announced, and then offered a challenge: Join IHI in an ambitious initiative called the 100K Lives Campaign. Its goal is to save 100,000 hospital patients' lives by 9 a.m. on June 14, 2006, exactly 18 months from Berwick's call to arms, by introducing six changes in hospital procedures. Each change addresses a problem, such as deaths from infections following surgery, and presents an arsenal of weapons to fight it, such as tighter timing of antibiotic doses before surgery.
Making real changes. Most of the proposed initiatives are "tried and true," says JCAHO President Dennis O'Leary, whose group worked closely with IHI to select and refine the measures. Reducing deaths from medication errors, for instance, is already a JCAHO patient safety goal, and the measures that reduce deaths in heart-attack patients are the same ones now being tracked on the CMS Hospital Compare site. But there are some new ideas, too. "Rapid-response teams," called when a patient seems to be losing ground but isn't yet a true emergency, is an innovative concept for U.S. hospitals.
Joining the 100K project involves no fee, and paperwork is minimal. Still, some might be reluctant to sign on. Many of the measures cost little to put in place, but others, such as reducing medication errors, can involve expensive new technology.
Yet many hospitals actually jumped at this opportunity to make these lifesaving changes. By June's end, more than 2,300 were on board--more than enough to meet the 100,000 goal. If all 6,000-some U.S. hospitals joined, says IHI, 183,000 lives could be saved every year.
Two early adopters were Hackensack University Medical Center, a large teaching hospital in northern New Jersey with nearly 700 beds, and McLeod Regional Medical Center, a 460-bed community hospital in Florence, a small city in the northeast corner of South Carolina. The following pages describe the six parts of the 100K initiative and how these two hospitals are meshing them into the hospital routine.
Saving 100,000 Lives, One By One
The goal of the Institute for Healthcare Improvement's 100K Lives Campaign is to reduce inpatient deaths by 100,000 a year. IHI says 75 lives a year easily could be saved at a moderately sized hospital with 15,000 patient admissions annually--call it "Metro General." Many hospitals are much smaller, so to reach 100,000 lives IHI had to enlist 2,300 hospitals--which it has done. If all 6,000 U.S. hospitals signed on, IHI says, 183,000 lives a year could be saved.
Reaching for 183,000 lives
Enough hospitals have signed up for IHI to feel confident of reaching its 100,000 goal. But if every U.S. hospital took part 183,000 lives could be changed:
Targeted: 100,000 (55 pct.)
Remaining: 83,000 (45 pct.)
One hospital could save 75 lives each year
A hospital seeing 15,000 patients a year could save at least 75 lives by putting the six parts of the 100K Lives Campaign in place.
45 from rapid-response teams
7.5 by reducing central-venous-line infections
7.5 from improved care for heart-attack victims
7.5 by reducing ventilator-related pneumonia
6 by preventing surgery-related infections
1.5 by reducing medication errors
Danny Dougherty-- USN&WR
This story appears in the July 18, 2005 print edition of U.S. News & World Report.