Fewer mistakes decrease unnecessary hospital deaths

Thursday, June 15, 2006

From staff and wire reports

U.S. hospitals have saved an estimated 122,300 lives in the last 18 months through a massive campaign to reduce lethal errors, the leader of the national effort said Wednesday.

"I think this campaign signals no less than a new standard of health care in America," said Dr. Donald Berwick, a Harvard professor who organized the campaign.

About 3,100 hospitals, including Saint Francis Medical Center in Cape Girardeau, participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes.

Experts say the cooperative effort was unusual for a competitive industry that traditionally doesn't like to publicly focus on patient-killing problems.

"We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.

Berwick announced the campaign's results Wednesday morning at a hospital conference in Atlanta. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.

Medical mistakes were the focus of a widely noted 1999 national report that estimated 44,000 to 98,000 Americans die each year as a result of errors and low-quality care.

That year, Berwick -- president of the Institute for Healthcare Improvement, a Massachusetts-based nonprofit organization -- challenged health care leaders to improve care quality and prevent mistakes.

In December 2004, he stepped up the challenge by announcing a "100,000 Lives Campaign." He set a June 14, 2006, deadline to sign up at least 2,000 U.S. hospitals in the effort and implement six types of changes.

Perhaps the best known of the six changes was to deploy rapid response teams for emergency care of patients whose vital signs suddenly deteriorate.

That single change has helped improve patient outcomes at Saint Francis, said Lisa Newcomer, manager of respiratory care. The hospital set a goal of reducing "code blue," or emergency resuscitation, calls by 50 percent or more when the program was implemented in October, she said.

In May, code blue calls were down 80 percent over a year ago, she said.

"Any time a patient has a code blue, their mortality increases," Newcomer said. "If we can stop the code from happening, we improve that patient's outcome."

Staff writer Rudi Keller contributed to this report.

Hospitals generally have teams that respond when patients develop sudden heart or breathing problems. That work is common in emergency departments. The measure was designed to make sure the service is available around-the-clock to other units, and to encourage lower-ranking medical staff members not to be intimidated about calling for help.

Another urged checks and rechecks of patient medications to protect against drug errors. A third focused on preventing surgical site infections by following certain guidelines, including giving patients antibiotics before their operations.

The hospitals also were asked to contribute monthly mortality data to Berwick's organization, which attempted to track the impact.

About 3,100 hospitals signed up, representing about 75 percent of the nation's acute care beds.

About 86 percent sent in mortality data. Roughly a third said they were implementing all six measures, and more than half committed to at least three, Berwick said.

Campaign workers examined 2004 data for the participating hospitals to determine how many people were expected to die during the 18 months of the campaign.

They then checked the count of actual deaths reported. They also made mathematical adjustments for severity of illnesses and for volume of cases, to make a more fair comparison of the two time periods more fair. They also made estimates for participating hospitals that did not report data, Berwick said.

"This is estimation -- it isn't counting," he said.

Various estimates placed the number of saved lives at between 115,000 and 149,000, but the best guess was 122,342, he said.

Berwick challenged the hundreds of hospital representatives at the conference to continue to improve. He also proposed another goal -- all hospitals should implement all six changes by the beginning of 2007.

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