Published in the February 2005 issue of Today’s Hospitalist
Officials from the Institute for Healthcare Improvement (IHI) are hoping that the organization’s new campaign to save the lives of 100,000 Americans by 2006 will give many of the nation’s hospitals the impetus they need to jump into the quality improvement movement.
The 100,000 Lives Campaign, which the IHI unveiled in December, aims to enroll 1,600 U.S. hospitals in its bid to reduce morbidity and mortality. The initiative will focus on six areas that include preventing central line infections, ventilator-associated pneumonia and surgical site infections; improving care for acute myocardial infarction and patients who appear to be in decline; and error prevention strategies like medication reconciliation. (See “The six goals of the IHI’s 100,000 Lives Campaign” below, for more information.)
The campaign marks a big step for the IHI, which has earned its reputation by working with a core group of hospitals on many of the projects that are part of the current initiative. The new campaign also promises to raise the group’s profile “and its mission of improving quality in the nation’s hospitals ” among a much larger group.
Joe McCannon, acting manager of the campaign, says he hopes that many organizations who have heard about the IHI’s work in the past will see the campaign as an opportunity to get involved.
“These are best practices that are well-packaged and in line with the strategic goals of a lot of organizations,” he explains. “These are interventions that we know will save lives.”
The requirements of participation
More than 500 hospitals have already signed up for the campaign, and IHI is busy recruiting more. Mr. McCannon says that hospitals that want to participate will be required to contribute in several ways.
For one, hospitals will have to enroll in the program. “By enrolling,” he explains, “we mean publicly saying that you are going to take part in the campaign.”
Second, hospitals that choose to participate in the campaign will have to identify which of the interventions they are going to pursue.
Finally, participating hospitals will have to regularly give mortality data to the IHI. “With that information,” Mr. Mc Cannon says, “we’re going to track the progress of the work.” He adds that he expects many participating hospitals will want to more closely track outcomes associated with each of the measures, but they will have to provide overall mortality data at a minimum.
Mr. McCannon says implementing any of the initiatives won’t require a major overhaul. “We’re talking about interventions that are relatively straightforward and don’t require a lot of additional resources,” he explains. “It’s really about changing and refining existing process, which tends to make it more amenable to people.”
Participating hospitals will receive guidance, both from materials posted on the IHI Web site (www.ihi.org), and by working with hospitals in their area that have already implemented some of these strategies. Mr. McCannon says these groups, known as partners, will function as “campaign managers” to help their local colleagues be successful.
“We are going to be asking our partner organizations to act as the equivalent of field offices to organize the work,” he explains. “They will provide the counseling that hospitals will need to succeed.”
The IHI’s timing in pursuing a large scale quality improvement project is excellent. High-profile groups like the Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services are beginning to look at specific measures used by hospitals to prevent disease. Both organizations are on board with the IHI campaign.
A number of other organizations, from the Veterans Health Administration to the American Nurses Association, have also endorsed the campaign. Blue Cross and Blue Shield of Massachusetts has already pledged $3 million for the campaign, and Mr. McCannon says discussions are underway with other payers as well. (He notes that payers are not asking for any special access to data from the campaign.)
Finally, how did IHI come up with the number 100,000? Mr. McCannon admits the figure is a bit conservative, explaining that the group made calculations on how many lives each of the interventions could save on a national basis. He says if the group can enroll 1,600 hospitals, the 100,000 number is easily attainable.
“If you saw the exact math, you might say that we should be able to go beyond 100,000, which is possible,” he explains. “We thought it was a good number, because we know that there is a lot of mortality every year in the American health care system. We think that would be a significant step to nullifying a lot of that.”
The six goals of the IHI’s 100,000 Lives Campaign
1. Rapid response teams. Allow any staff member, regardless of that person’s position in the hospital’s chain of command, to call on a specialty team to examine a patient at the first sign of decline.
2. Evidence-based care for acute myocardial infarction. Consistently deliver key measures like early administration of aspirin and beta-blockers to prevent death from heart attack.
3. Medication reconciliation. Compile and reconcile a comprehensive list of all patient medications to make sure patients receive the right medications at the right dosages at admission, discharge and before transfer.
4. Central line infections. Consistently deliver five interdependent, evidence-based steps that are part of IHI’s central line “bundle.”
5. Surgical site infections. Consistently deliver the right perioperative antibiotics, maintain glucose levels and avoid shaving hair at surgical sites.
6. Ventilator-associated pneumonia. Implement five interdependent steps, like elevating the head of ventilator patients’ beds.