Big hospitals can seem like impossibly complex organisms, but how simple some of these patient-safety improvements are! From Beth Israel Deaconess Medical Center:
BOSTON – Reducing preventable harm in hospitals often starts with small, low-tech steps: brushing the teeth of patients on ventilators; using low-rise beds and socks with safety treads on both sides; completing a surgical time out before mounting a blade on a scalpel.
Those small steps have yielded big results at Beth Israel Deaconess Medical Center – from a 90 percent reduction in ventilator-associated pneumonia since 2006, to progress in reducing patient falls with injury and in helping to avoid wrong site surgeries. They are some of the key lessons learned and implemented after the hospital declared the then “audacious goal” to eliminate preventable patient harm by 2012.
Those safety steps may seem obvious now, but of course, hindsight is always easy. Yes, “after the fact, it seems obvious,” said Dr. Kenneth Sands, the hospital’s senior vice president for health care quality, but “you need to have that ‘Aha’ moment.” Consider luggage, he said; he spent years lugging around bags because no one had thought to put wheels on them. “The good news is that some of these things are very simple and not technological,” he said, “but they are sometimes only obvious in retrospect.”
More from the hospital:
BIDMC has posted a video on its public website that chronicle three stories that represent how the issue is being addressed:
Preventing ventilator-associated pneumonia
Ventilator-associated pneumonia is a problem that can affect between 10 to 20 percent of intensive care patients who need assistance breathing. Bacteria can collect in the breathing tube and work its way into a patient’s lung and contracting VAP can double a patient’s risk of dying.
By implementing a VAP bundle of five specific, seemingly small steps – elevating a bed at 30 degrees, brushing a patient’s teeth daily, preventive treatment against stress ulcers and deep vein thrombosis as well as daily “sedation vacations,” when patients are awakened daily to see if they can come off the vent – BIDMC achieved a 2,000-case reduction of VAP since 2006. Factoring in the $20,000 cost to treat a case of VAP, this translated into $40 million not spent. With so many patients leaving the hospital sooner, the medical center was also able to forego construction of a new $8 million ICU…
A similar back-to-basics approach was applied to reducing falls with injury, some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. In a hospital, a typical fall rate in general and medical-surgical units is four to five falls per 1,000 patient days.
“Over the years we’ve really looked at every fall and looked at if there was something different we could do to prevent that fall and we’ve added many different strategies over the course of the last five years to enhance our fall prevention standards,” says Kim Sulmonte, RN, BIDMC’s Associate Chief Nurse of Quality and Safety.” Those strategies revolve around supplies and equipment, process changes and patient education and communication.”
Sulmonte acknowledges “we’ve not reached our goal. Our goal really is zero falls with injury and we will continue to refine our standard over time and reviewing each case to see if there’s anything we can do differently to prevent falls in the future.”
As a result of these efforts, BIDMC’s total of preventable falls with serious injury has decreased from a high of 10 in 2009 to 3 in 2010, 1 in 2011 and 1 through mid-September 2012.
Instituting a new time out procedure in surgery
The staff-based approach also led to an innovative way to ensure that the “time-out” – a universal safety protocol to prevent wrong site surgery – is taken before every surgical procedure. At the suggestion of a OR nurse, scalpel blades cannot be attached to the handle until the time-out is performed, an extra step of prevention so that an operation cannot begin until the surgical team completes a checklist.