innovation to improve quality and patient...
TRANSCRIPT
INNOVATION TO IMPROVE QUALITY
AND PATIENT SAFETY
Christine Goeschel ScD, RN, FAAN
The Armstrong Institute for Patient Safety and Quality
The Johns Hopkins School of Medicine
Miracles of Technology
Healthcare Quality
The Problem is Large
• In U.S. Healthcare system
– 7% of patients suffer a medication error 2
– On average, every patient admitted to an ICU suffers an adverse event 3,4
– 44,000- 98,000 people die each year as the result of medical errors 5
– Nearly 100,000 deaths from HAIs 6
– Estimated 30,000 to 62,000 deaths from CLABSIs 7
– Cost of HAIs is $28-33 billion 7
• 8 countries report similar findings to the U.S.
2. Bates DW, Cullen DJ, Laird N, et al., JAMA, 1995
3. Donchin Y, Gopher D, Olin M, et al., Crit Care Med, 1995.
4. Andrews L, Stocking C, Krizek T, et al., Lancet, 1997.
5. Kohn L, Corrigan J, Donaldson M., To Err Is Human, 1999.
6. Klevens M, Edwards J, Richards C, et al., PHR, 2007
7. Ending Health Care-Associated Infections, AHRQ, 2009.
The Johns Hopkins Armstrong Institute*
Model to Improve Care
Comprehensive Unit
based Safety Program
(CUSP)
1. Educate staff on
science of safety
2. Identify defects
3. Assign executive
to adopt unit
4. Learn from one
defect per quarter
5. Implement
teamwork tools
Translating Evidence
Into Practice
(TRiP)
1. Summarize the
evidence in a
checklist
2. Identify local barriers
to implementation
3. Measure
performance
4. Ensure all patients
get the evidence
• Engage
• Educate
• Execute
• Evaluate
N Engl J Med 2006;355:2725-32;
BMJ 2010;340:c309.
Michigan Keystone ICU
Median and Mean CRBSI Rate
0
1
2
3
4
5
6
7
8
9
Basel
ine
Inte
rven
tion
0-3
4-6
7-9
10-1
2
13-1
5
16-1
8
19-2
1
22-2
4
25-2
7
28-3
0
31-3
3
34-3
6
Time (months)
CR
BS
I R
ate
Median CRBSI Rate Mean CRBSI Rate
If a new drug were as effective at saving lives as Peter
Pronovost’s checklist, there would be a nationwide
marketing campaign urging doctors to use it.
Medical Breakthrough '08: Lifesaving Hospital Checklist
A detailed checklist has been saving lives -- and money -- in
the ICU. By Tara Conry
From Reader's Digest
The New Yorker
December 30, 2007
A Lifesaving Checklist
Diverse Interest: Pressing Need
On the CUSP: STOP BSI
This work was funded by a grant from the Agency for Healthcare Research and Quality, and for every dollar invested, approximately $200 was SAVED.
The Keystone Project reduced infections by 66% throughout the state, saving over 1,500 lives and $200 million in the first 18 months alone.
Condition % of Recommended Care Received
Low back pain 68.5
Coronary artery disease 68.0
Hypertension 64.7
Depression 57.7
Orthopedic conditions 57.2
Colorectal cancer 53.9
Asthma 53.5
Benign prostatic hyperplasia 53.0
Hyperlipidemia 48.6
Diabetes mellitus 45.4
Headaches 45.2
Urinary tract infection 40.7
Hip fracture 22.8
Alcohol dependence 10.5
RAND Study Confirms Continued Quality Gap
1. McGlynn EA, Asch SM, Adams J, et al., N Engl J Med, 2003.
COURAGE
“Never doubt that a small group of
thoughtful committed citizens can
change the world. Indeed, it’s the only
thing that ever has.”
Margaret Meade