Program Slashing Deaths in U.S., Tucson Hospitals
By Jane Erikson, The Arizona Daily Star, Tucson
Jun. 15–Tucson hospitals say they are saving lives by taking part in a nationwide campaign to reduce errors and other preventable causes of patient deaths.
Nationwide, the Institute for Healthcare Improvement’s “100,000 Lives Campaign” has saved an estimated 122,300 lives in its first 18 months, the project’s director said Wednesday.
“I think the campaign signals no less than a new standard of health care in America,” said Dr. Donald Berwick, a Harvard pediatrician and professor of health policy who founded the Institute for Healthcare Improvement, which launched “100,000 Lives” in December.
The institute released no supporting data and local hospitals offered little data, saying most of their numbers were preliminary.
But through the use of “rapid response teams” deployed to patients’ bedsides at the first warning signs of trouble, TMC and UMC report a dramatic 50 percent reduction in the number of times patients “code,” plunging into cardiac and respiratory arrest.
The campaign’s recommendations for preventing infections helped Tucson’s VA hospital to get through April with no cases of pneumonia in patients on ventilators — a common and often-fatal complication that used to occur once or twice a month, the hospital said.
The VA also has reduced by about 80 percent the incidence of infections in critically ill patients with “central line” catheters, the hospital said.
And the smaller University Physicians Healthcare Hospital at Kino has had no cases of pneumonia in ventilator patients since opening its intensive-care unit last October, the hospital said.
Other campaign strategies include double-checking a patient’s medication orders at every stage of the hospital stay and again on the day the patient goes home; giving antibiotics to reduce the risk of surgical infections; and giving aspirin as soon as possible to a patient who has just had a heart attack.
The 100,000 Lives Campaign is an effort to reverse an alarming trend revealed seven years ago by a study that found up to 98,000 hospital patients die each year from errors and other preventable causes.
The rapid-response team is the most innovative of the campaign’s six recommended changes, but all will help prevent patient deaths, said Dr. Andreas Theodorou, co-director of University Medical Center’s Center for Quality and Safety.
“The campaign has given us a structure to help us do the small things that add up to a big change in outcome,” Theodorou said.
Participation is voluntary, but about 3,100 hospitals signed up with “100,000 Lives,” representing 75 percent of the nation’s acute-care beds, said the Institute of Healthcare Improvement.
In Arizona, 55 hospitals are participating, representing about 80 percent of the state’s hospital beds, said the Arizona Hospital and Healthcare Association. Eleven Tucson-area hospitals are part of the program.
“You think, ‘My gosh, why haven’t we been doing this all along,’ ” said Barb Weber-Ayert, the association’s director of patient-safety initiatives. “You don’t need new equipment. You don’t need new staff. It requires discipline, but it’s all doable.”
Carondelet Health Network’s St. Joseph’s and St. Mary’s hospitals joined the campaign early last year. By August, the hospitals had seen a 38 percent reduction in unexpected patient deaths and 30 percent fewer “code blues” — the overhead pages that send doctors and nurses racing to the rooms of dying patients.
Carondelet officials did not want to release new data, but they described their experience with rapid-response teams of critical-care nurses, respiratory therapists and others who come within a few minutes of being called to a patient’s bedside.
“Patients often become symptomatic about six hours before they code,” said Peggy MacMacken, St. Joseph’s vice president for patient care. “Their temperature can become elevated, their breathing can change, there can be changes in pulse rate — subtle things that could be an early sign of something serious.”
On Tuesday, the St. Joseph’s rapid-response team was called to evaluate a woman whose blood pressure had plummeted. The team started the patient on intravenous fluids, and her blood pressure returned to normal — potentially preventing a heart attack or other catastrophe.
The woman was one of six rapid-response cases that day, said Yolie Ruboyianes, a critical-care nurse with the team. “On a day like that, you’re never sitting down,” she said. “But on average, it’s about three patients a day.”
The VA hospital started its rapid-response team just last month, so has no data to report yet, said Dr. Jayendra Shah, the hospital’s chief of staff.
“When a ‘code blue’ occurs, it’s often too late,” Shah said. “I think the rapid-response team is really going to save patients’ lives.”
Reducing mortality is the single goal of the “100,000 Lives Campaign,” but hospitals are taking other steps to improve patient safety, MacMacken said.
Two years ago, St. Joseph’s nurse Ginny Goldner started a “Ruby Red Slippers” program to help prevent falls in elderly patients and others unsteady on their feet.
Those patients are given red socks to wear so that anyone — from a housekeeper to a head nurse — who sees them walking around unattended will know to stay with them until they are safely back in bed.
The program has reduced patient falls by nearly 75 percent, MacMacken said.
Weber-Ayert of the Arizona hospital association said such efforts should restore the public’s confidence in hospital care, shaken seven years ago by the report on accidental patient deaths.
“Nobody goes into health care without the desire to do good and help people,” she said. “So it’s satisfying to see we are turning the curve.”
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Copyright (c) 2006, The Arizona Daily Star, Tucson
Distributed by Knight Ridder/Tribune Business News.
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