Hospitals cut patient complications and cost of care in push to curb mistakes

Friday, June 3rd 2005, 8:23 am

By: News On 6

TRENTON, N.J. (AP) _ Not one patient on a ventilator at Newark Beth Israel Medical Center has developed pneumonia in the past 13 months, even though there is typically a case of pneumonia every week at busy hospital intensive care units.

The Newark hospital is among hundreds nationwide that are drastically curbing in-house infections. Stung by repeated reports that hospitals make preventable mistakes that kill tens of thousands of patients each year, hospitals are ratcheting up efforts to improve care.

``There are people walking around their communities that wouldn't have seen their daughter's graduation, that wouldn't have seen their next birthday'' but for these efforts, said Dr. Thomas G. Rainey, chairman of the ICU care project at the Institute for Healthcare Improvement.

The Boston-based institute is six months into its ``100,000 Lives Campaign,'' which has signed up about one-fifth of the nation's 5,500 hospitals. It aims to save that many patients each year by focusing on six problem areas, including medication errors.

In one of the most comprehensive reports on the problem, the Institute of Medicine estimated in 1999 that 44,000 to 98,000 Americans die annually because of medical mistakes.

Besides saving lives, preventing complications gets patients home faster and saves money. Patients on ventilators, which make it easier for bacteria or vomit to get into the lungs, spend nearly an extra week in the hospital if they get pneumonia, for example.

``The cost of your care increases by $40,000,'' Rainey said.

His group and officials with Johns Hopkins University have been showing hospitals in New Jersey and Michigan how to prevent pneumonia and blood infections in intensive care patients, among other things. Dr. Peter Pronovost of Johns Hopkins is negotiating similar projects in nine other states.

Already, Pronovost said, about 80 hospitals in Michigan and New Jersey have virtually eliminated ventilator-associated pneumonia and blood infections from neck and groin catheters, which take very potent drugs straight to the heart.

``Morale seems to be way up at hospitals doing this,'' he said. ``Now we're expanding it out to the OR, to the ER, to the other floors'' at some hospitals.

Pronovost and Rainey also are targeting complications such as sepsis, a common blood infection that usually strikes feeble patients, killing 42 percent on average. At 19 hospitals Pronovost has been working with on another project, the sepsis death rate is down to 13 percent.

In New Jersey, 25 hospitals working with Pronovost and Rainey reduced ventilator-pneumonia cases and catheter-related infections by a third between last June and January, and cut the average patient's ICU stay by three-fourths of a day to a total of 3 1/2 days. They followed simple steps such as weaning patients off ventilators more quickly and using a stronger skin disinfectant when inserting a catheter, said Aline Holmes of the New Jersey Hospital Association.

The goal is ``trying to make things as idiot-proof as possible,'' she said.

Newark Beth Israel and seven other New Jersey hospitals in the Saint Barnabas Healthcare System got their complications well below the state average and also reduced infections from urinary catheters, said Dr. John Brennan, the system's head of clinical and emergency services.

``We saved $2 million in direct costs'' for medicines and supplies compared with 2003, he said.

In Michigan last year, 77 hospitals cut the number of catheter-related blood infections and ventilator-associated pneumonia cases so much that hospital officials believe they prevented 73 deaths from pneumonia and four from blood infections.

``It is amazing,'' said Chris Goeschel of the state hospital association.