A new World Health Organization study shows that hospitals can prevent the spread of infections and improve the safety of a hospital stay by following checklists. We'll see how Iowa hospitals are reacting. We asked the Iowa Hospital Association to suggest two 'success stories' in Iowa.
We then visited a large and a small hospital to find out about infection control. The large hospital they chose was Mercy Hospital, Des Moines, for its connections with the "5 Million Lives" national campaign, and also the "Keystone Surgery Project." The small hospital is Waverly Care Center, a 25-bed institution with an innovative approach to employee flu virus inoculations, as well as embracing protocols from the "5 Million Lives" campaign and the World Health Organization check list.
The two hospitals have chosen different areas to emphasize, both low- and high-tech. But, both organizations have also jumped into the other major adjustment of this century - learning how to improve outcomes for patients by working together in groups.
There are any number of diseases you can give or receive in a hospital – and just about an infinite number of ways to prevent passing them around. So, to help hospitals sort through the 'best practices' they should use, there are some national organizations that make – lists.
We asked the Iowa Healthcare Collaborative, a statewide group that reports hospital infection rates, to recommend one large and one small Iowa hospital that has been successful in using these lists of evidence-based practices.
They suggested the Waverly Health Center, in Waverly, and Mercy Medical Center – Des Moines. We visited both hospitals to ask them what's new in preventing hospital acquired infections and medical errors.
It turns out that one of the main things both of these hospitals have created is: employee groups that focus on change.
Dr. Michael Witte: "The Institute of Medicine many years ago in one of their sentinel studies on health care showed that it takes about 17 years for an evidence-based practice to be applied to the bedside consistently."
In order to cut down the time it takes to adopt proven techniques in patient care, Dr. Witte at Mercy Medical Center has been taking lessons in how to organize teams from the Michigan-based "Keystone Surgery Project."
Dr. Witte: "That Keystone Project – that was a very enlightening program that taught us how to focus and how to bring all the forces to bear on a given project if you want to have real improvement."
Dr. Witte's Keystone group focused on a problem that is particular to patients in an Intensive Care Unit: Ventilator Associated Pneumonia – or VAP.
Dr. Michael Witte: "What we want is to get them off the ventilator quickly, because the longer you're on, the more likely you are to develop an infection. But, there are a lot of other little things that we try to do – and we compiled what we call a ventilator bundle set of orders.
Instead of taking 17 years to standardize these practices, Mercy's group took less than one year. The results have been a 75% reduction in VAP in their ICUs.
"It has saved lives, it's saved resources. And yet, it took a lot of effort from a lot of people, pharmacy, respiration therapists, dieticians, physicians, nurses, and administration to support this.
Waverly Health Center was one of Iowa's first 'critical care' hospitals to incorporate all of the World Health Organization's pre-surgery checklist items into their daily routines.
Dr. Lisa Warne: "All the points of it. The WHO surgical check list, are already in place in our pre-surgical checklist, in our inter-operative checklist, and then we do a post-surgical briefing."
The pre-surgical list includes many common sense items, like talking with the patient prior to surgery to confirm their condition and to let them mark their surgical site, and remind them to take any daily medicines they might need.
Dr. Lisa Warne: "Antibiotics and tubing…"
The conformity of using a check list helps staff order and assemble all the medicines and care items, before the patient arrives.
Dr. Lisa Warne: "warming gown is here to keep the patient warm before surgery…"
Part of the process involves keeping the patient warm and comfortable, with warming gowns and blankets.
Dr. Lisa Warne: "hat, socks, gown. The main goal is to keep the patient warm and comfortable."
Even the IV bags are heated. Evidence suggests that warm blood helps fight infection.
Some other successful efforts include checking a patient's blood sugar – if it's too high, surgery won't heal as well.
Dr. Lisa Warne: "More people are running around on the street that don't know they have diabetes than people who are actually diagnosed."
Besides making sure the surgery goes well, an unintended benefit of glucose testing is discovering undiagnosed diabetes, as often as once or twice a week.
Waverly Health Center has another claim to fame: they have created an annual campaign to inoculate employees against the flu. In the past two years, an impressive 95% of their staff has received flu shots.
Iris Veering, Quality Control Officer: "The idea is protecting the herd – that's the terminology that's used. And, if we as staff and care providers are vaccinated against the flu, we won't give it to patients."
Another recommended practice – having a Rapid Response Team available within the hospital, has been successful in both Waverly and Mercy.
Dr. Lisa Warne: "The goal of a Rapid Response Team is to intervene in the patient's care – before something bad happens. Like, they stop breathing, or their heart stops or they become unconscious.
"So, the RRT comes in before these things happen. Provides oxygen, provides medication, helps to get the patient transferred to the ICU if that's what they need.”
Mercy's new East Wing has another new team effort that has been saving the lives of intensive care patients. It's their new high-tech "eICU."
eICU Nurse: "Good morning."
man: "We're just letting you know he's back from MRI."
eICU Nurse: "Oh…"
Patients' life signs can be monitored by the nurses on each floor, and also at a distance – in this case across the hospital in the "eICU" Command Center.
Nurse "Are you breathing okay now?"
Dr. Michael Witte: "We're aware of vital sign trends, lab values. We can talk to a nurse, we can camera into a room. Evaluate a patient as well as you would at the bedside – other than not being able to do a procedure or physically examine a patient – but we can do a visual exam."
If there are problems, these experienced ICU nurses can alert staff on the floor, consult the eICU doctor, or even call in a 'rapid response team.'
Once again, it's getting care to the patient before things get to the emergency stage that has the biggest impact. And, Dr. Witte says this new service has had measurable results in its first year: a 30% reduction in both the mortality rates and the length of stay in the ICU.
So, not only are patients getting fewer hospital – acquired – diseases, but they're also making some new friends.
eICU Nurse: "I wish you well, Larry."
Larry: "Thanks for the good care!"