Patient Safety Focus

Video Monitoring Saves Lives: Interview with Meghan Dierks, M.D.

In structuring the HVA (Hospital Video Auditing) program at a surgery center in the southeastern United States, Dr. Meghan Dierks, Assistant Professor, Harvard Medical School, has witnessed compliance scores soar from 35% to 90%+...and even more striking, she's seen compliance rates remain there.

Q: In what ways, and to meet which specific goals, is the healthcare facility using HVA?

A: "We applied the technology to tackle a refractory problem in the healthcare compliance arena--the very basic safety protocol revolving around hand-hygiene and getting physicians to modify their safety behavior. The technology was two-fold: first, it would provide us the ability to collect highly reliable data and we hadn't been able to in the past. And, second, by nature of collecting high-quality data and instilling a feedback loop to relay that data to physicians practicing in that environment we could achieve a behavioral change.

We had two goals, both of which were achieved through the use of HVA. First, we needed to be able to collect highly reliable data over a sustained period of time on hand hygiene behaviors--something that has been difficult to achieve using other strategies. Second, in order to achieve a behavioral change, we needed to be able to use this data to provide continuous performance feedback to the healthcare workers practicing in that environment."

Major New Study Works to Reduce Central Line Infections

Huguley Memorial Medical Center (Fort Worth, TX) will play a pivotal part in a major new study that could dramatically reduce the number and severity of central line associated bloodstream infections.

A central line is a catheter placed into a large vein so a patient can be given repeated medicine or fluids or have their cardiovascular system more carefully monitored, and these lines are a regular feature in intensive care units, where patients may be recovering from serious surgery or illness.

These bloodstream infections significantly impact how long people stay in ICUs due to secondary illness, which cost patients their lives--and cost millions of dollars per year to treat. The Centers for Disease Control and Prevention estimate that around 16,000 patients per year get central line-associated bloodstream infections.

According to the article:

"The study could help eliminate a major problem for hospitals and patients, according to Huguley officials.

“It’s profound,” said Christine Sammer, the patient safety officer and administrative director of patient safety and quality at the hospital.

HHS releases new tools with aim to make healthcare safer

The Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality released an array of toolkits designed to help caregivers--including doctors, nurses, hospital managers, patients and others--reduce medical errors.

According to the article:

"The 17 toolkits, developed by AHRQ-funded experts who specialize in patient safety research, are free, publicly available, and can be adapted to most health care settings. The toolkits range from checklists to help reconcile medications when patients are discharged from the hospital to processes to enhance effective communication among caregivers and with patients to toolkits to help patients taking medications.

'These toolkits build on AHRQ's investment in patient safety research over the past 6 years and support our commitment to research that can be put to use in everyday settings," said AHRQ Director Carolyn M. Clancy, M.D. "These toolkits are a major advance toward putting knowledge into practice and saving lives.'

The toolkits were developed through AHRQ's Partnerships in Implementing Patient Safety (PIPS) program. Researchers who developed the toolkits examined best practices in a variety of health care settings, including small rural facilities, large urban hospitals, health clinics, and hospital emergency departments. They also studied patient safety interventions among diverse populations, including children and older patients.

If simple checklists can transform the safety of ICUs, what other areas could they improve?

In an essay featured in The New Yorker, Atul Gawande, asks an astute, if altogether basic, question: If simple checklists can transform ICUs, what else can they do?

After reviewing the piece you, too, might find that more should be asking this very same question. Here are a few paragraphs excerpted from the full article:

"In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections.

On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check.

These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.