The conference, which drew attendees from as far away as San Francisco, was organized by Southwestern Vermont Health Care and sponsored by SVHC and its partners Dartmouth-Hitchcock and Fletcher Allen Health Care.
Although SVHC has a good record of patient safety and is highly rated by online hospital safety advocates like Leapfrog Group, SVHC spokesman Kevin Robinson says hospitals continually evaluate and improve their care. “What the ratings don’t say is that it can always be better, and we know that,” he said. “That’s what’s motivating us to continue our role as a leader in the health care community by bringing in speakers and people with the expertise in how to do this.”
The keynote speaker at this week’s conference was Johns Hopkins’ Dr. Peter Pronovost, an internationally acclaimed leader in patient safety. Pronovost is an advocate of using the scientific method to analyze patient safety issues and developing checklists to simplify steps necessary to reduce the incidence of preventable infections or injuries.
In his discussion held in Mount Snow’s Grand Summit Ballroom this week, Pronovost offered a story from his own experience in the critical care unit, where infections from catheterization were “astronomical.” About 15% of patients catheterized became infected, and a catheter infection killed a child. “On the year anniversary of her death, her mother came back and asked ‘Can you tell me my daughter would be less likely to die now?’” Pronovost said. “It made me realize what we were doing was like playing whack-a-mole - we had no theory, we had no method.”
Looking for recommendations from the Centers for Disease Control, Pronovost said he found more than 90 recommendations which “were near useless at the bedside.” Pronovost and his team boiled the list down to five of the most important infection prevention steps to be followed with every patient with a catheter.
Instituting the steps proved difficult, however. “I was doing those things about 30% of the time,” he said. When Pronovost investigated further, he found there were circumstances that had become accepted as routine that stood in the way. Equipment used for catheterization wasn’t immediately available in one place. “We found our clinicians had to go to eight different places to get all the equipment they needed, and half the time they weren’t stocked. If someone had to run down the hall to get supplies that’s about 10 minutes they’re not doing something for another patient. And with no downtime for most health care providers, there was nobody to take the initiative to organize the equipment more effectively.”
Pronovost said it was also necessary to change the “culture” of health care to create an atmosphere in which it was not only acceptable, but encouraged to check the work of others, and for nurses to question doctors.
“Our infection rates went to near zero,” he said. “And we’ve sustained that for nearly 15 years.”
Other hospitals that instituted Pronovost’s recommendations and methods for a variety of patient safety issues experienced similar results. At hospitals in Michigan, for instance, not only did infection rates go down, but survival rates for Medicare patients improved. “Medicare patients in Michigan had a 10% lower risk of dying,” Pronovost said. “It’s unheard of to move the mortality rate in a whole state in such a short period of time.”
Robinson says the conference will help reinforce what’s already working at SVHC. “It’s important for our nursing and physician leaders to be exposed to this kind of thinking regularly,” he said. “It becomes part of the way we think about delivering care.”
Robinson says SVHC plans to use the insights gained from Pronovost and other patient safety experts at the conference to focus on hand-washing to prevent the spread of infection, and preventing falls. “Preventing falls is a big challenge in health care,” Robinson said. “When patients are receiving narcotics, a lot of times they feel fine lying down, but if they get up to go to the bathroom, they can become disoriented. We need to implement systems where we have someone there to help them so they don’t fall.”
Why the focus on patient safety? Robinson says there are two reasons. “First, it’s just the right thing to do, and that motivates us in most cases. But if we can make sure we don’t have patients who bounce back into the hospital we can reduce the cost of the care we provide. If people get infections and stay in the hospital longer, get antibiotics, maybe additional surgery, all of those are additional costs to the health care system and to us. It’s in everybody’s interest for care to be as cost effective and efficient as possible.”