News

Checklist Saves Lives - Sanjay Gupta Interviews Peter Pronovost

Fri, 19 Mar 2010 11:24:02 -0400

Thousands die from hospital infections annually. CNN's Dr. Sanjay Gupta shows how a simple checklist is changing things.

http://www.cnn.com/video/#/video/health/2010/03/08/saving.lives.money.pt2.cnn

Doctor Leads Quest for Safer Ways to Care for Patients

Wed, 10 Mar 2010 15:15:29 -0500

Dr. Peter J. Pronovost, 45, is medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore, which means he leads that institution’s quest for safer ways to care for its patients. He also travels the country, advising hospitals on innovative safety measures. The Hudson Street Press has just released his book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out,” written with Eric Vohr. An edited version of a two-hour conversation follows.

Q. WHAT GOT YOU STARTED ON YOUR CRUSADE FOR HOSPITAL SAFETY?

A. My father died at age 50 of cancer. He had lymphoma. But he was diagnosed with leukemia. When I was a first-year medical student here at Johns Hopkins, I took him to one of our experts for a second opinion. The specialist said, “If you would have come earlier, you would have been eligible for a bone marrow transplant, but the cancer is too advanced now.” The word “error” was never spoken... Read more at the New York Times website

England's Matching Michigan

Fri, 5 Mar 2010 15:05:15 -0500

Eighty per cent of intensive care units (ICUs) in England are participating in Matching Michigan. This is a patient safety project based on a model developed in the United States which, over 18 months, saved around 1,500 patient lives. It took place at ICUs in Michigan and introduced measures that reduced central venous catheter (CVC) associated bloodstream infections.

http://www.nrls.npsa.nhs.uk/matchingmichigan/

Find out Why we're working to match Michigan from this interview with Professor Peter J. Pronovost of Johns Hopkins University School of Medicine, USA.

January 2010 Newsletter

Fri, 8 Jan 2010 16:04:47 -0500

Download the January 2010 Newsletter

December 2009 Newsletter

Tue, 8 Dec 2009 16:16:39 -0500

Download the December 2009 Newsletter

2008 MacArthur Fellow: Peter Pronovost

Mon, 9 Nov 2009 17:49:25 -0500

A Video Presented by the MacArthur Foundation on Dr. Pronovost and patient safety.

November 2009 Newsletter

Sun, 8 Nov 2009 16:17:10 -0500

Download the November 2009 Newsletter

As Easy as 1-2-3?

Tue, 27 Oct 2009 17:39:25 -0400

As Easy as 1-2-3?
Checklists can reduce infections dramatically. The trick is getting doctors and nurses to use them.

By JACOB GOLDSTEIN
It seemed like a no-brainer innovation: a low-tech way to cut down on a sometimes deadly infection that strikes roughly 80,000 intensive-care patients in the U.S. every year.
Michigan hospitals dramatically lowered rates of bloodstream infections in their patients by following a five-step checklist, according to a study published in the New England Journal of Medicine. But nearly three years after the study appeared, meaningful use of the checklist remains limited.
The list prescribed steps doctors and nurses in the intensive-care unit should take when performing a common procedure—inserting a catheter into a vein just outside the patient's heart, to allow easy delivery of intravenous drugs and fluids.
The steps are simple: washing hands; cleaning the patient's skin with a disinfectant called chlorhexidine; wearing a cap and gown and using a surgical drape during the procedure; inserting the catheter through parts of the body other than the groin, when possible; and removing unnecessary catheters.
The Michigan study, which included more than 100 ICUs, found that putting the checklist in place lowered the rate of bloodstream infections related to catheter use by 66%.
But putting the checklist into practice is more complicated than it sounds.
The Wall Street Journal spoke with Peter Pronovost, the Johns Hopkins intensive-care specialist and patient-safety expert who led the study. Here are edited excerpts:
Culture Clash
THE WALL STREET JOURNAL: What were the main findings of the Michigan study?
DR. PRONOVOST: Prior to this, there was some uncertainty about how many of these infections were preventable versus inevitable. What this study showed was nearly all of them are preventable with some very practical and inexpensive interventions. But it's not necessarily simple, because it's not just the checklist, it's the culture piece.
WSJ: What do you mean by culture?
DR. PRONOVOST: Can we get the nurses to ensure that the doctors actually follow the items on the checklist? When I said that, you would have thought I was causing World War III. That's where the culture came into it.
The nurses said, "That's not my job to police the doctor, and if I do I'm going to get my head bit off." And the doctors said, "There is no way I can have a nurse second-guess me in public. It will make me look like I don't know something."
But nobody was debating the evidence. What they were debating was power and politics and hierarchy.
I pulled everyone together and said, "Would you harm patients?" Everyone said no. Then I said, "Well, how is it possible that you as a nurse would see someone not washing their hands and keep silent? You know they're increasing the risk of being harmed; we need you to speak up."
So then we say to the docs, "If the nurses say these things, they need to know that they're not going to get their head bit off."
When it was presented as a patient area rather than power or hierarchy, conflict melted away.
The Measurement Gap
WSJ: How widely has the checklist spread?
DR. PRONOVOST: Earlier this year, Congressman [Henry] Waxman held a hearing. He surveyed all 50 states and asked them if they were using the checklist.
All of the states said, "Oh yes, we're using the checklist." But only 11 said they were actually measuring infection rates, which is key. It's kind of like Lake Wobegon—everybody's above average, until you measure.
This has been frustrating. Imagine there was a disease that killed between 30,000 and 60,000 per year and researchers at Johns Hopkins found a way to eliminate it.
If that therapy was a drug or a device it would spread throughout the world rapidly. The private marketplace would produce it, its quality would go up, its cost would go down, and everybody in the country would be exposed to it.
WSJ: Why aren't the benefits more widespread?
DR. PRONOVOST: If it was as simple as handing someone a piece of paper that says "Here's a checklist, I've solved your problem," that would be easy. This was a complex intervention. It's feasible, but it takes some effort. It takes commitment to monitor these infections. It takes commitment to do this hard work of culture change.
Right now, these deaths are invisible. If every hospital had to publicly report their rates of infection, I guarantee you this problem would be solved.
Make Your Own Checklist
WSJ: Are there other areas of health care that would benefit from checklists?
DR. PRONOVOST: We're doing this for care of patients with pneumonia. We're doing it for how to diagnose various conditions. We're using it for preventing deep venous thrombosis.
We're using it in the operating room for timeouts before you start the procedure to ensure that all the correct things are done. But if I go one checklist at a time, I'm going to be long dead before I get anywhere. So I'm trying to build a checklist maker.
— Mr. Goldstein is a staff reporter for The Wall Street Journal in New York. He can be reached at jacob.goldstein@wsj.com

Safety Gurus: Penalize Doctors Who Don’t Follow the Rules

Thu, 1 Oct 2009 17:42:27 -0400

Should hospitals start penalizing doctors and nurses who fail to follow patient safety rules?

http://blogs.wsj.com/health/2009/10/01/safety-gurus-penalize-doctors-who-dont-follow-the-rules/

Sorrel King Discusses Patient Safety on the Today Show

Mon, 21 Sep 2009 09:57:16 -0400

Watch video of the interview below

Dr. Pronovost and Sorrel King Talk About Patient Safety On Baltimore’s Public Radio WYPR

Fri, 11 Sep 2009 09:49:05 -0400

Josie's Story: Turning Tragedy to Triumph
Sorrel King has written about her daughter Josie, Josie's death, and all the grief, enlightenment and joy that has come from it. King's book, just published this week, is Josie's Story: A Mother's Inspiring Crusade to Make Medical Care Safe. Dr. Peter Pronovost, director of the Quality and Safety Research Group at Johns Hopkins University, and Sorrel join us in the studio to talk about the book and patient safety today.

Sorrel King will be signing copies of her book Sunday at the Ivy Bookshop.

Web Extra:
Hear the full interview with Sorrel King and Dr. Pronovost

Secretary Sebelius Releases Inaugural Health Care “Success Story” Report

Mon, 13 Jul 2009 11:24:21 -0400

HHS Secretary Kathleen Sebelius today released the first in a series of health care “success story” reports that document innovative programs and initiatives that can serve as models for a reformed American health care system. The inaugural report highlights the Michigan Keystone ICU Project. A joint partnership between the Michigan Health & Hospital Association and the Johns Hopkins University, the Michigan Keystone ICU Project helped dramatically reduce the number of health care associated infections in Michigan, saving over 1,500 lives and $200 million.

“We know there are tremendous examples of efficient, high-quality health care in America today. Our challenge is spreading these good examples across the country,” said Sebelius. “Our reports will showcase success stories like the Michigan Keystone ICU Project and highlight how health reform can improve the quality of care for all Americans.”

Medical errors including health care associated infections claim the lives of nearly 100,000 patients in America every year and patient safety measures have worsened by nearly 1 percent each year for the past decade. The Michigan Keystone ICU Project worked to make patient care safer in over 100 ICUs in the state of Michigan. The project targeted a specific type of infection that ICU patients can get while in the hospital: catheter-related bloodstream infections. To help reduce these infections, the project worked to ensure clinicians used a simple checklist when inserting catheters into ICU patients.

Following the checklist was associated with a 66 percent reduction in these infections throughout the state of Michigan, saving over 1,500 lives and $200 million in the first 18 months alone. This project was funded by a grant from the Agency for Healthcare Research and Quality, and for every dollar invested, approximately $200 was saved.

“Americans don’t expect to get additional infections when they go into the hospital,” said Sebelius. “Stopping health care associated infections and improving the quality of care is one of our top priorities.”

The Obama Administration has already begun work to reduce health care associated infections. The American Recovery and Reinvestment Act (ARRA) included $50 million in grants available for states to help fight health care associated infections across the country. Secretary Sebelius has also called on hospitals across America to commit to reduce Central Line Associated Blood Stream Infections in Intensive Care Units by 75 percent over the next three years by using the same checklist that has shown such success in Michigan.

The President is also working to enact health reform that will emphasize quality care over quantity and makes health care more affordable for American families, businesses and the government.

“When we enact health reform, we can improve quality, help control costs and ensure success stories like the Michigan Keystone ICU Project become the rule, not the exception,” added Sebelius.

Click Here for the official HHS Press Release