I'm working on a feature for the April issue of H&HN profiling a rural health system that has taken a zero-defect approach to medical errors. From top to bottom, eliminating preventable errors has become part of the organization's DNA. It is ingrained in everyone from admission clerks and back-office staff, to nurses, doctors and top administrators. Executive compensation is even tied to error rates. I've been reporting the article for a couple of months and have interviewed a number of people at the health system, as well as several outside experts, and they all reinforce the same theme, which Helen Darling, president and CEO of the National Business Group on Health, summed up pretty well during an interview we did on Tuesday: "Patient safety is fundamental. It isn't just something that is nice to do, it is fundamental to the care process."
Now, that's not really "news." No one goes to work at a hospital wanting to harm a patient, but preventable errors happen. We are all familiar with the groundbreaking work done by the IOM in this arena, which spawned any number of safety initiatives over the past couple of decades. The good news is that some gains are being made. Just this week, the CDC released data showing a 58 percent drop in central line bloodstream infections for ICU patients between 2001 and 2009. Up to 27,000 lives were saved as a result. An estimated 3,000 to 6,000 lives were saved in 2009 alone.
Obviously, the most important fact is that lives were saved, but it's also worth noting that the effort to cut infections resulted in huge cost savings—$1.8 billion in excess medical costs since 2001. Talk about bending the cost curve. Previous work from the CDC shows that health care-associated infections add between $28.4 billion and $33.8 billion to the system annually. In the assessment released this week, the CDC lists a host of steps that can be taken to make further improvements in curbing bloodstream infections. It recommends that the government develop and promote additional guidelines and tools for adopting best practices. It also suggests that providers join On the Cusp: Stop BSI, which is a joint effort between HRET, AHRQ, Johns Hopkins and the Keystone Center in Michigan.
If anything, the CDC data and programs like On the CUSP are evidence that strides can be made, especially when targets are set. That's something the rural health system I'm profiling in April has learned. For instance, one of the system's hospitals set a goal of 100 percent compliance with hand hygiene protocols. Right now, compliance hovers around 95-98 percent. Will they hit 100 percent? No one really knows, but that is the goal everyone is striving to meet. Efforts like these or those taken to reduce CLABSI are certain to become more important in the coming years as payment becomes linked directly to patient care, rather than patient volume. Regardless of what happens in the courts or Congress, the Affordable Care Act makes it clear that providers will be held more accountable for the care they provide. The law institutes payment penalties for hospital-acquired conditions, for instance. And as you've likely heard, CMS any day now will unveil a new national patient safety initiative. Details have been slow to trickle out, but a confidential draft dated Jan. 11 did, of course, find its way to the Internet. It shouldn't come as a surprise that CMS, under Donald Berwick's leadership, would pursue an ambitious patient safety agenda.
For hospital leaders, the issue is making sure that safety becomes part of your institution's DNA. "We find it over and over again," Darling says, "if you look at patient safety or anything that requires significant redesign and reengineering, there is strong executive leadership and insistence that this happens in a very comprehensive way."
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