By Larry Beresford
Independent journalist
Patient safety improvement and medical error prevention programs in U.S. hospitals often take their inspiration from the aviation industry's long-standing efforts to prevent errors and from Toyota Motor Corporation's "lean" production system, with its celebrated "stopping the line" policy, in which anyone working on the auto production line can stop it until an identified quality problem can be fixed. Two explicit examples from Seattle's Virginia Mason Medical Center and Seattle Children's were described during a panel at the Association of Health Care Journalists annual meeting in Seattle on April 17.
"In our little health system we have 1 million patient visits and 1 million radiology procedures done per year," said Cathie Furman, R.N., M.H.A., senior vice president of quality and compliance at 336-bed Virginia Mason. Little mistakes can have devastating effects, and yet research suggests that the average human being makes six mistakes in a day. "So the key is to provide a system that identifies mistakes before they cause harm," she said.
Virginia Mason's commitment to patient safety traces back to a preventable medical error that caused the 2004 death of patient Mary McClinton at the hospital, 19 days after she was mistakenly injected with an antiseptic cleaning solution from an unlabeled syringe. Under its policy of patient safety alerts, employees who encounter a situation that could harm a patient are required to make an immediate report. Hospital administrators stop what they are doing and report to the problem area to determine if a care process needs to be halted.
Patrick Hagan, M.H.S.A., president and CEO of Seattle Children's, said the U.S. health care system suffers from excessive waste, which is connected to documented widespread variations in treatment practices between regions and facilities. "Waste comes in many forms and often is cleverly disguised as real work," he quipped. It refers to "the things we do in health care that are of no value to any customer – particularly the patient," and which hospital quality improvement programs aim to eliminate.
Hagan said Children's continuous performance improvement program was also adapted from the Toyota production system, and it has enjoyed success at addressing safety problems such as the failure of clinicians to comply with hand hygiene protocols and rates of catheter-associated bloodstream infections in hospitalized patients. "If you increase patient safety, you automatically reduce costs," he said.
Two other approaches to improving patient safety, adoption of quality checklists for the operating room and the use of patient simulator mannikins and safety drills in the training of labor and delivery teams, were described during the panel. Seattle's Foundation for Health Care Quality houses a statewide voluntary program called Surgical Care Outcomes and Assessment Program (SCOAP), in which 40 hospitals have adopted safety checklists, including one based on a checklist of 19 steps to improve safety in the operating room developed by the World Health Organization's Safe Surgery Saves Lives campaign. It has been shown to reduce surgery-related mortality rates in hospitals around the world by more than 40 percent.[i]
SCOAP Medical Director David Flum, M.D., a surgeon and outcomes researcher at the University of Washington, called SCOAP a "grass-roots, clinician-led collaborative" based on applying evidence-based medicine to surgical practices. See a sample of the surgical checklist used in Washington.
Connie Lopez, R.N.C., M.S.N., C.N.S., simulation trainer with the National Risk Management Team at the Kaiser Permanente HMO in Oakland, Calif., described Kaiser's approach of using the computerized patient simulators for labor and delivery teams to drill on emergency delivery techniques once a year. This training, which includes an essential debriefing session afterward in which the team discusses what went right and what went wrong, helps to create more reliable and safe practices, much as flight simulators allow pilots-in-training to practice handling aviation crises, Lopez said.
Larry Beresford is a freelance medical writer in Oakland, Calif., and a frequent contributor on quality and safety issues to Anesthesiology News magazine. He can be reached at larryberesford@hotmail.com.
[i] Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AHS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360 (5): 491-499, January 29, 2009.
