Tag: Dr.Peter Pronovost

OM in the News: Quality Control in Intensive Care Units

If you want an example of how the tools of OM can result in major improvements in the field of health care, read The Wall Street Journal (Sept. 11, 2012) article on the use of checklists in hospital intensive care units. A national patient-safety program, sparked by the death a decade ago of an 18-month-old child, reduced the rate of a deadly  bloodstream infection by 40% in hospital ICUs.

The initiative, led by Johns Hopkins’ VP-Quality, Dr. Peter Pronovost,  was implemented in more than 1,100 ICUs in 44 states. It took aim at bloodstream infections associated with catheters used to deliver drugs directly into patients’ major veins. The result of the effort was a reduction in the rate of infections to 1.137 per 1,000 days of catheter use, from 1.903, over the first 18 months that hospitals implemented the program. This cut represented at least 2,000 infections avoided, more than 500 lives saved and $34 million in health-care cost savings.

One professor who helped with the rollout of the program in Rhode Island, said the results are “dramatic.” Though the ideas in the program weren’t new, its developers “figured out how to bundle those best practices and insert them into the daily practice of nurses, physicians and other health-care professionals.”

Mortality for central-line infections in the U.S. is 12% to 25%. The CDC estimated there were around 18,000 of the infections in ICUs in 2009, down from 43,000 in 2001. The entire program is built on checklists like pilots use. Key practices on the checklist include hand washing, properly covering up care givers and patients when a catheter is inserted, and using the right disinfectant at the site of insertion. But equally important, according to Dr. Pronovost, were cultural changes, such as authorizing nurses to ensure that doctors adhere to the lists.

Discussion questions:

1. How else can operations management tools be used in ICUs?

2. Ask students to report on Dr. Pronovost’s book, Safe Patients, Smart Hospitals, which we described in this blog last year.

Good OM Reading: Safe Patients, Smart Hospitals

After reviewing The Checklist Manifesto for our blog a few months ago, I wondered how Dr. Peter Pronovost’s  book, Safe Patients, Smart Hospitals would add to the important role  OM plays in hospital quality. Simple and avoidable errors in hospitals around the world are made each day that cost the lives of patients. Inspired by 2 tragic medical mistakes —  his father’s misdiagnosed cancer and  sloppiness that killed  an 18-month old child at Johns Hopkins– Pronovost has made it his mission, often swimming upstream against the medical culture, to improve patient safety and prevent deaths.

He began by developing a basic 5-step checklist (see Ch.6) to reduce catheter infections. Inserted into veins in the groin, neck, or chest to administer fluids and medicines, catheters can save lives. But every year, 80,000 Americans get infections from the central lines and 30,000-60,000 of these patients die.  Pronovost’s checklist has dropped infection rates at hospitals that use it down to zero, saving 1,000’s of lives and tens of millions of dollars.

His steps for doctors and nurses are simple: (1) wash your hands, (2) use sterile gloves, masks, and drapes, (3) use antiseptic on the area being opened for the catheter, (4) avoid veins in the arms and legs, and (5) take the catheter out as soon as possible. He also created a “central line cart”, where all supplies needed for the procedure are stored.

Provonost believes many hospital errors are due to lack of standardization, poor communications, and a non-collaborative culture that is “antiquated and toxic”. Whereas safety in the airline industry is a science, and where every crew member works as part of the team, he writes: “doctors think they are infallible”.

This is an inspiring book which shows how one person, with small changes, can make a huge difference in patient care. Your students in the health care areas will appreciate the OM insights provided. An interview with Dr. Pronovost appears in The Wall Street Journal (March 28,2011).