The 100,000 Lives Campaign: Getting Started

1. The 100,000 Lives Campaign: Getting Started Institute for Healthcare Improvement This document is in the public domain and may be used and reprinted without permission provided appropriate reference is made to the Institute for Healthcare Improvement.

2. Campaign Objectives • Save 100,000 lives across the country over 18 months (end date of June 14, 2006). • Enroll as many as 2,000 hospitals to join us in this work. • Build a reusable national infrastructure for change.

3. Campaign Progress • Over 2,800 hospitals enrolled • All 50 states and the District of Columbia represented • Over 1,200 people listening to each intervention call

4. Key Campaign Principles • Some is not a number; soon is not a time. • Welcome anyone at any level. • We do this together. • Let’sget down to work • The Campaign starts with you

5. Campaign Elements • Platform – the six evidence-based interventions that we advocate • Measurement – How we will measure our progress • Field Operations – How we will spread the Campaign across the country and implement improvements successfully • Communications - How we will publicize the Campaign’s progress and your success

6. Campaign Platform • The 100,000 Lives Campaign invites participants to pursue all or several of six improvement interventions. • More interventions may be added in the course of the Campaign. • There are thorough, referenced overviews of each Campaign intervention at www.ihi.org/IHI/Programs/Campaign/

7. Six Changes That Save Lives • Deployment of Rapid Response Teams…at the first sign of patient decline • Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack • Prevention of Adverse Drug Events (ADEs)…by implementing medication reconciliation • Prevention of Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle” • Prevention of Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time • Prevention of Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

8. Deploy Rapid Response Teams • A Rapid Response Team (RRT) – known by some as a Medical Emergency Team – is a team of clinicians who bring critical care expertise to the patient bedside (or wherever it is needed). • The goal: To prevent deaths in patients who are failing outside intensive care settings.

9. Prevent Adverse Drug Eventsby Implementing Medication Reconciliation • Reconciliation: A process of identifying the most accurate list of all medications a patient is taking—including name, dosage, frequency, and route—and using this list to provide correct medications for patients anywhere within the health care system • Requires comparing the patient’s list of current medications against the physician’s admission, transfer, and/or discharge orders

10. Improve Care for Acute Myocardial Infarction • Early administration of aspirin • Aspirin at discharge • Early administration of beta-blocker • Beta-blocker at discharge • ACE-inhibitor or angiotensin receptor blockers (ARB) at discharge for patients with systolic dysfunction • Timely initiation of reperfusion (thrombolysis or percutaneous intervention) • Smoking cessation counseling (The seven care components in the ACC clinical guidelines and measured by JCAHO and CMS) www.acc.org/clinical/guidelines/stemi/index_pkt.pdf ; 2/11/05 11:50 ET

11. Reduce Surgical Site Infections • Appropriate use of antibiotics • Appropriate hair removal • Post operative glucose control (major cardiac surgery patients cared for in an ICU)* • Perioperative normothermia (colorectal surgery patients)* * These components of care are supported by clinical trials and experimental evidence in the specified populations; they may prove valuable for other surgical patients as well.

12. Prevent Central Line Infections • Hand hygiene • Maximal barrier precautions • Chlorhexidine skin antisepsis • Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters in adults • Daily review of line necessity with prompt removal of unnecessary lines

13. Prevent Ventilator-Associated Pneumonia • Elevation of the head of the bed to between 30 and 45 degrees • Daily “Sedation Vacation” and daily assessment of readiness to extubate • Peptic ulcer disease (PUD) prophylaxis • Deep vein thrombosis (DVT) prophylaxis (unless contraindicated)

14. What We Will Measure • Number of hospitals “signing up” (along with demographic information for each facility) • The interventions each hospital pursues • Actual changes in the number and percentage of inpatient deaths

15. Campaign Measurement • The 100,000 Lives Campaign strongly encourages all participants to measure and submit process and outcome measures associated with each intervention. • The Campaign will, however, keep track of the number of organizations involved, the interventions they pursue, and total number of lives saved. • Measurement strategy is available at www.ihi.org/IHI/Programs/Campaign/

16. Use of the Data • We will collect these data in quarterly reports from participating organizations. • Individual participant data will not be released to the public or any other organization (data will only be shared in aggregate). • A national comparative database which identifies each participant will not be developed. • Number of “Lives Saved” based on changes in mortality (inpatient deaths and discharges) within each campaign hospital, adjusting for historical trends in mortality

17. Campaign Field Operations • Campaign field operations consist of two elements: • Enrollment – building awareness and will within your organization and signing up • Implementation – successfully introducing the interventions you select within your facility or system

18. Campaign Field Operations Structure IHI and Campaign Leadership Ongoing communication NODES (approx. 75) *Each Node Chairs 1 Network FACILITIES (2000-plus) *30 to 60 Facilities per Network

19. Enrollment Process • Learn more about the Campaign by: • Reviewing informational materials • Listening to a recording of the January 12 Informational Call • Reviewing slide presentation and video from Don Berwick’s National Forum speech announcing the Campaign All available on the web at: www.ihi.org/IHI/Programs/Campaign/

20. Enrollment Process (cont.) • Raise awareness about the Campaign within your organization • Identify interventions of interest and form teams responsible for implementing each intervention • Enroll by emailing or faxing the form available at www.ihi.org/IHI/Programs/Campaign/

21. Implementation Process • A number of free products and services will support teams as they begin this work, including: • Informational calls on each intervention and Campaign management (recordings available at www.ihi.org) • Downloadable Getting Started Kits on each intervention (available at www.ihi.org) • Intervention web discussions (available at www.ihi.org) • System, state, and regional events

22. Campaign Field Operations Structure Field Operations structure: • Individual hospitals • Networks (groups of 30-60 hospitals organized by geography, business affiliation or affinity) • Nodes (high-leverage organizations responsible for managing each network) • IHI Field Operations (team interfacing intensively with each Campaign node)

23. Campaign Communications • The Campaign will actively seek to publicize the involvement and success of participating organizations. • A customizable press release announcing your organization’s enrollment is available at www.ihi.org/IHI/Programs/Campaign/

24. Key Activities and Milestones All dates and details to be posted at www.ihi.org/IHI/Programs/Campaign/ • Calls on specific interventions (recordings at www.ihi.org) • Hospitals launch their Campagin (ongoing) • Node certification process (ongoing) • 6-month review in conjunction with IHI’s 1st Annual International Summit on Redesigning Hospital Care (materials available on www.ihi.org) • Second data reporting period for participating teams (August)

25. Key Activities and Milestones All dates and details to be posted at www.ihi.org/IHI/Programs/Campaign/ • Ongoing national node calls • Ongoing national field operations calls • Data reporting: October 1, 2005 - October 31, 2005 January 1, 2006 - January 31, 2006 April 1, 2006 - April 30, 2006 June 1, 2006 - July 31, 2006

26. Key Activities and Milestones (cont.) • Coast-to-coast bus tour with hospital visits and node events (October) • 12-month review in conjunction with IHI’s 17th Annual National Forum on Quality Improvement in Health Care (December) • Conclusion/Celebration (June 2006) This represents only a sampling of key events, which will be augmented by local meetings, ongoing electronic communication, activity hosted by Campaign partners, and fee-based resources offered by IHI and other organizations.

27. Next steps • If you are not currently listed on www.ihi.org/IHI/Programs/Campaign/ as a Campaign participant, learn more and enroll. • Join upcoming calls, listen to recordings of past calls, and download Getting Started Kits to learn more about each intervention and how you and your organization can start your campaign work. • Get started on making change and saving lives!