Institute For Healthcare Improvement’s 100k lives Campaign

1. Institute For Healthcare Improvement’s100klivesCampaign Clint MacKinney, MD, MS clintmack@cloudnet.com Duluth, Minnesota July 19, 2005

2. Topics for Today • The 100,000 Lives Campaign • Why is the Campaign important • Why rural and why us • The Campaign’s current status • The interventions • Resources to get started • Opportunities and barriers to involvement (discussion)

3. A Flawed System “Between the health care we have and the health care we could have lies not just a gap, but a chasm.” – Crossing the Quality Chasm, 2001 Health care does not yet reliably transfer best-known science into practice, and processes frequently fail, despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, too often does just the opposite – leading to unintended harm and unnecessary deaths at alarming rates. – 100k Lives Campaign folder, 2004

4. Background

5. Six Changes that Save Lives • Deploy Rapid Response Teams* • Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction (Heart Attacks)* • Prevent Adverse Drug Events (ADEs)* • Prevent Surgical Site Infections* • Prevent Central Line Infections • Prevent Ventilator-Associated Pneumonia *Rural-appropriate interventions

6. Healthcare Safety? • < 98,000 deaths per year due to medical errors – Institute of Medicine, 1999 • 195,000 deaths per year due to medical errors – HealthGrades, 2004 • How many is too many?

7. Healthcare Quality? The Quality of Health Care Delivered to Adults in the United States – McGlynn et al Results • Participants received 54.9% of recommended care. • 45% defect rate! Conclusions • The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. NEJM. Volume 348:2635-2645. June 26, 2003. Number 26

8. Healthcare Value? Causes of poor care: Misuse, underuse, overuse, waste – Juran Institute and Midwest Business Group on Health. 2003

9. Why Rural; Why Us? • 30% of Minnesota’s population is rural • The “big” systems have already signed on • Our interest in improvement, and our need for improvement, is no less significant • Our patients, families, and communities are no less cherished • Only interventions that make sense for rural, for our hospitals, and for our communities

10. If not for statistics, then for our future

11. Participation May 2005 • Over 2,200 hospitals enrolled in all 50 states • Nearly 50% of U.S. hospital beds • Thousands on national calls • Unprecedented web activity and new tool development • Related campaigns forming globally • Data collection underway with Pioneer Group; begins for all enrollees 6/14/05

12. Participation May 2005

13. Changes Proven to Prevent Avoidable Death • Rapid Response Teams • Cardiac arrest or shock occurs in 0.6% of medical patients and 0.5% of surgical patients. • Only 17% of patients who experience a cardiac arrest survive to discharge. • Most patients who have in-hospital cardiac arrest have identifiable signs of deterioration prior to arrest. Rural

14. Changes Proven to Prevent Avoidable Death • Improved Care for Acute Myocardial Infarction • 1.1 million experience an AMI yearly. 1/3 die acutely. • Implementation of guidelines reduces mortality. • Yet in AMI, only 61% receive aspirin and only 45% receive beta-blockers. • AMI care included in • CMS’ Hospital Quality Initiative, • JCAHO’s core measure set. Rural

15. Changes Proven to Prevent Avoidable Death • Prevention of Adverse Drug Events • 1,200 hospital deaths in 1993 were due to medication errors. • 6.3% of malpractice claims are due to medication errors. • 46% of all medication errors occur at care transition points. Rural

16. Changes Proven to Prevent Avoidable Death • Prevention of Surgical Site Infection • Surgical site infections (SSIs) account for 14% - 16% of hospital-acquired infections. • Among surgical patients, SSIs account for 40% of hospital acquired infections. • Surgical patients who develop SSIs are twice as likely to die as other surgical patients. Rural

17. Changes Proven to Prevent Avoidable Death • Prevention of Central Line-Associated Bloodstream Infection • 48% of ICU patients have central venous catheters, or 15 million catheter days per year. • There are 5.3 venous catheter-related bloodstream infections per 1,000 catheter days. • Approximately 14,000 deaths per year from venous catheter-related bloodstream infections.

18. Changes Proven to Prevent Avoidable Death • Prevention of Ventilator-Associated Pneumonia • Ventilator-associated pneumonia (VAP) occurs in 15% of patients receiving mechanical ventilation. • Mortality for mechanical ventilator patients with VAP is 46% compared to 32% for those without VAP. • VAP is associate with prolonged mechanical ventilation, ICU stay, hospital stay and associated increased costs.

19. Resources – IHI • www.ihi.org/IHI/Programs/Campaign/ • Platform materials for each intervention • How-to Guide for implementing the change • Presentation with facilitator notes • Annotated bibliography • Campaign activity checklist • Getting Down to Work: Field Operations, Implementation, Measurement, and Next Steps • Customizable press release • Data submission how-to guide • Multiple informational calls, videos, web discussions

20. Resources – Minnesota • Minnesota Node – 60-70 hospitals signed on! • Stratis Health (Minnesota’s QIO) • Acute Myocardial Infarction, Adverse Drug Events, Surgical Site Infections • Institute for Clinical Systems Integration • Rapid Response Teams, Central Line Infections • Minnesota Hospital Association • Ventilator Associated Pneumonia • Contact • Julie Apold, MHA Patient Safety Manager • japold@mnhospitals.org

21. Resources – www.mnpatientsafety.org "Promoting optimum patient safety through collaborative and supportive efforts among health care organizations in Minnesota" The Minnesota Alliance for Patient Safety was established in 2000 as a partnership between the Minnesota Hospital Association, Minnesota Medical Association, Minnesota Department of Health and more than 50 other public-private health care organizations working together to improve patient safety.

22. Some Is Not a Number… Soon Is Not a Time The Number: 100,000 Lives The Time: June 14, 2006 9 am ET