Published in the June 2005 issue of Today’s Hospitalist
Hospitalists are taking a leading role in patient safety and quality improvement efforts as part of a new consortium of nine health systems in southeastern Michigan.
The consortium, known as Hospitalists as Emerging Leaders in Patient Safety, or HELPS, will disseminate best practices and other strategies to improve safety and quality. The consortium’s principal investigator, Scott Flanders, MD, director of the hospitalist program at the University of Michigan and associate professor of medicine, says that the goal is to identify the best way to improve safety and quality.
“The goal is to present successful and failed implementations,” he explains, “to examine how these hospitalist groups have improved patient safety at their institutions. We want to know if they did something that didn’t work, and we want to know if they did something that was wonderfully successful.”
The project, which is being funded by a grant from the Blue Cross Blue Shield of Michigan Foundation, will focus on nine targets that include the following areas: preventing device-related infections; improving perioperative and intensive care; eliminating medication errors and creating a culture of safety; preventing nosocomial pneumonia and improving antibiotic utilization; and improving safety for geriatric patients by preventing falls and delirium.
Those targets reflect the goals of national organizations like the Joint Commission on Accreditation of Healthcare Organizations and the National Quality Forum, which have called for improvements in inpatient care.
The University of Michigan has been chosen to lead the project because it has extensive experience with these efforts. The other principal investigator for the grant, Sanjay Saint, MD, MPH, a hospitalist at the University of Michigan who leads the university’s patient enhancement safety program, has led initiatives focusing on the prevention of nosocomial infections.
Focusing on manageable goals
The HELPS consortium will regularly bring together two individuals from each of the nine health systems “a hospitalist and a patient safety or quality improvement officer “to attend regular meetings every month or two. After reviewing existing evidence on a topic, participants will discuss their experiences in trying to affect change.
“We’re hoping that after a session on preventing device-related infections, for example,” Dr. Flanders says, “groups will go back to their institutions and try to implement a strategy like an automatic stop for urinary catheters after 72 hours. We’ll look at how they do, what type of data they gather and how they measure the impact of their efforts.”
The initiative will conduct site visits, hold small group meetings to help troubleshoot and identify implementation strategies, and offer research assistance in collecting and analyzing data.
Another important goal of the project, Dr. Flanders adds, is to find projects that are manageable. He says implementing an automatic stop order to decrease the inappropriate use of urinary catheters, an approach that Dr. Saint spearheaded at the University of Michigan, is a good example of an approach that doesn’t require overhauling all of a hospital’s systems.
The HELPS consortium will also focus on projects that work in a range of settings. The group includes hospitalists from an academic hospital, community teaching and non-teaching hospitals, a rural hospital and a VA facility.
“It’s great if a big medical center like the University of Michigan does something and shows that it improves quality and safety,” Dr. Flanders says, “but is that really relevant to a community hospital or non-teaching center? It is far more powerful if you can do something and show that there’s a benefit in a variety of settings. You improve the external validity of what you’re doing if you can show that it’s not specific to a unique medical center.”
A lever for quality
Dr. Flanders admits that many hospitalists may find it difficult to add quality improvement and patient safety duties to an already packed schedule.
“Hospitalists are busy,” he says. “We work a lot of hours and see a lot of patients. In many instances, the time hospitalists spend working on safety and quality is not directly supported by their institutions. While they’re putting in extra time and effort, they’re not necessarily compensated for that work.”
Nonetheless, he thinks quality improvement is important to the future of the specialty. Hospitalists are unique in part because they control the care of so many inpatients, he says, pointing out that the hospitalists in the nine programs in the consortium collectively manage more than 80,000 discharges a year.
“If you’re trying to impact the care of 80,000 hospitalized patients by working with individual primary care physicians,” Dr. Flanders says, “you have to work with a lot of people. By meeting with just two individuals from nine hospitalist programs, the HELPS consortium can, theoretically at least, impact the care of 80,000 patients.”
If the consortium is successful, he adds, he hopes it will do more than disseminate information and actually gather data from participating institutions. This would allow hospitalists to conduct observational research that provides a new level of detail about common inpatient diagnoses.
For many of the inpatient conditions that don’t fall neatly under the domain of one subspecialty, Dr. Flanders says, there are few standards of care or solid data to guide decision-making. As hospitalists take over the care of these conditions, they have an excellent opportunity to create what he calls a “trials collaborative” to collect and share information.
He adds that if the consortium is successful, it will help boost the profile of hospitalists in and beyond Michigan.
“People will see that the hospitalist is a nice lever or fulcrum to improve patient safety,” Dr. Flanders explains. “It will increase the visibility of hospitalists as a key to patient safety and quality improvement.”
Many hospitalists seek career guidance; all seek job satisfaction. Watch for the forthcoming feature: 2008 Hospitalist Salary Survey appearing in October 2008.