Thursday, June 08, 2006

Quality improvement project: Saving 100,000 lives in US hospitals

The British Medical Journal last week included an article, Saving 100,000 lives in US hospitals, describing a US project to reduce the number of unnecessary deaths of patients in our healthcare system. (McCannon JC et al (Institute for Healthcare Improvement). BMJ 2006 Jun 3;332:1328-1330.)

The project includes over 3,000 participating institutions in the US, comprising > 80% of the total number of national hospital discharges. Over 18 months, this program is attempting to more rapidly disseminate proven strategies for improving the quality of healthcare delivery; it includes a strong focus on the role that internal politics and buy-in within an institution plays with regard to the success (or failure) of any QI initiative.

The six interventions for the project are listed in Box 1 of the article -

  • Deploy rapid response teams to patients at risk of cardiac or respiratory arrest

  • Deliver reliable, evidence based care for acute myocardial infarction

  • Prevent adverse drug events through drug reconciliation (reliable documentation of changes in drug orders)

  • Prevent central line infections

  • Prevent surgical site infections

  • Prevent ventilator associated pneumonia

The BMJ issue also includes editorial commentary on the piece, "Improving health care through redesign: It's time to shift from small projects to whole systems" (BMJ 2006 Jun 3;332:1286-1287).

The editorial notes, "We cannot accept waiting as inevitable, increased risks to patients at different times of the day or week, or the current levels of hospital acquired infection and errors... Systems and processes of care cannot continue to evolve in an uncontrolled fashion. We must design in quality and reliability and design out waits and delays. As the 100 000 lives campaign and the other quality improvement programmes outlined show, we know how to engage staff and promote improvement through the development of strong clinical champions with a vision that incorporates the pursuit of perfection in patient care. If we can harness this potential with engagement of patients, carers, and staff high quality health services will result."

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