One in every 10 patients is harmed while receiving hospital care in high-income countries, according to the World Health Organization. The WHO also estimates that among countries in the Organisation for Economic Co-operation and Development, including the U.S.,15 percent of hospital expenses come from addressing patient safety failures.
A January 2020 Yale School of Medicine study found 22,000 preventable hospital patient deaths per year in the U.S., and healthcare leaders are working to lower numbers.
Here are what four healthcare leaders told Becker's Hospital Review about their patient safety goals and wins this year.
Note: Responses have been lightly edited for style and clarity.
Question: What patient safety goals have you and your organization set for 2021?
Scott Hayworth, MD. CEO, CareMount Health Solutions (Westchester, N.Y.):
For 2021, one of the broad areas we have focused on [at CareMount] is perioperative care. As we transition lower-risk surgeries and procedures out of hospitals and ASCs and into our office-based surgical suites, we have developed practices to ensure patient safety and comfort. For example, we are integrating the QA processes and standardizing patient care workflows across our 17 office-based surgical practices in order to maintain the same high quality of care at each location.
David Christensen, MD. Senior vice president of medical affairs, Valley Children's Healthcare (Madera, Calif.)
Our board of directors and CEO have mandated that we eliminate all harm to patients. As such, we have set our hospital-acquired conditions goals to zero. We have been working with [the Children's Hospitals' Solutions for Patient Safety Network] and other children's hospitals to incorporate best practices and to learn from each other.
David Lee, MD. Senior vice president and CMO, Virginia Hospital Center (Arlington):
Our 2021 goals for patient safety are to decrease hospitalwide mortality for cardiac and pulmonary conditions, stroke and especially sepsis. Hospital-acquired infections are always a concern, so attention will be on avoiding central line infections and urinary tract infections.
Since the hospital is so busy, throughput is an area of concern — things like emergency department flow, decreasing length of stay and robust home/outpatient care to avoid unnecessary hospitalizations.
Q: Which patient safety goals are you on track to meet or exceed, and what do you attribute that to?
Brian Kaminski, DO. Vice president of quality and patient safety, ProMedica (Toledo, Ohio):
Although our serious safety event rate can ebb and flow over time, in the past 24 months alone, we have reduced our rate by approximately 50 percent, coming off a slight increase the previous year.
Evidence-based practices, data-driven decision-making and the development of care pathways have enabled our system to deliver safe, high-quality care with limited and rapidly changing information. We even went as far as converting an existing hospital to care for only COVID-19 patients, capitalizing on an integrated and highly engaged care delivery model. The results of this model are evident in better-than-expected outcomes of our patients and the continued deployment of many of our methods throughout the various waves and surges in our community.
Similarly, we are adopting an approach to address surgical site infections specifically. A multidisciplinary, evidence-based practice team has been assembled. They have reviewed and synthesized the available literature and identified the "dirty dozen" evidence-based practices that have demonstrated a reduction in surgical site infections based on the best research available. The "dirty dozen" will be deployed through an [enhanced recovery after surgery] platform for specific, high-risk surgical procedures across the system. We hope to see even further reduction in our serious safety events by tackling these infections using evidence-based standards.
Dr. Hayworth: One of the many benefits of being in a multispecialty group is that we are able to leverage expertise among many specialties to inform our clinical policies and guidelines. Most recently, we reviewed and updated our pacemaker policies for CareMount's office-based surgical practices.
A working group from the CareMount departments of cardiology and anesthesiology reviewed our current practices and advised, among other things, that leadless pacemakers should be added to the exclusion criteria because these pacemakers do not have a magnet response, rendering them difficult to manage in an office setting. Leadless pacemakers are a relatively new technology and not yet a common consideration in most noncardiology practices.
Dr. Christensen: We recently went through a 17-month period of zero central line infections for our entire system. Essentially, we have maintained our zero rates in pretty much all hospital-acquired conditions or have met our improvement goals in all categories of HACs this year.
The COVID pandemic did add a layer of complexity to our quality and safety endeavors. Despite this, we have succeeded by making the safety of our patients part of our culture. This has been done through transparency of results, learning from each situation, a nonpunitive approach to improvement and frequent celebrations as milestones are reached.
Dr. Lee: Virginia Hospital Center is on track to meet or exceed our safety goals in many areas.
For mortality rates, we have collaborated with Mayo Clinic to emulate best practices: a multifaceted approach with strong nursing care, good protocols and procedures and leveraging use of the Epic EHR platform to identify patients at risk for deterioration. We have created rapid response teams, in conjunction with hospitalist medical staff, to intervene.
Another initiative we started this year follows patients discharged from the hospital with acute myocardial infarction and heart failure. This can be a challenging population to keep healthy, so we have assigned a nurse to work with the hospitalist physicians to identify patients with these diagnoses. This specialty nurse meets them, coordinates care in-house, and then follows them after discharge. Anything from placement to medication management, physician follow-up, social services and food requirements are assessed and addressed.