February 1, 2011

Safety Checklist = Drop in Hospital Deaths

(Ivanhoe Newswire) -- A new study reveals a Johns Hopkins-led safety checklist program that virtually eliminated bloodstream infections in hospital intensive-care units (ICUs) throughout Michigan also appears to have reduced deaths by 10-percent.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, was quoted as saying. "Thousands of people are believed to have survived because of this effort to reduce bloodstream infections."

According to experts, about 80,000 patients a year with central lines get infected, about 31,000 patients die, and the cost of treating them may be as high as $3 billion. Previous research showed coupling a cockpit-style, infection-control checklist with a work environment that encourages nurses to speak up if safety rules aren't followed reduced ICU central-line bloodstream infections to nearly zero at the Johns Hopkins Hospital and hospitals throughout Michigan and Rhode Island.

For this new study, Pronovost and his team analyzed the hospital mortality of patients admitted to ICUs in Michigan before, during and after the checklist program, which is known as the Keystone Project, was implemented. They compared the data in Michigan to similar data from 11 surrounding states. Results showed the patients in Michigan were significantly more likely to survive a hospital stay during and after the Keystone Project.

While the researchers cannot definitively attribute the reduced death rates to the Keystone Project, Pronovost says no other known large-scale initiatives were introduced across Michigan during the study period. "This is perhaps the only large-scale study to suggest a significant reduction in mortality from a quality-improvement initiative," Pronovost said.

The Keystone ICU Project includes a checklist for doctors and nurses to follow when placing a central-line catheter. It highlights five cautionary and basic steps from hand-washing to avoiding placement in the groin area, where infection rates are higher. The program also includes safety science education, training for how to identify potential safety problems, development of evidence-based solutions, and measurement of improvements. It also empowers all caregivers to question each other and stop procedures if safety is compromised.

SOURCE: British Medical Journal, Jan. 31, 2011