What We're Doing for Patient Safety and Quality Improvement

What We're Doing for Patient Safety and Quality Improvement

• Involving Patients and Their Families: Recognizing that patients and families can help to improve safety, the Hospital has produced a ten-minute video to encourage their involvement. The video can be viewed on demand in Hospital rooms. In addition, each patient on admission receives a copy of our Partnership Pledge, a document that invites them to take an active role in safety by asking questions, raising concerns, and providing complete, accurate home medication histories, among other steps.
  
  
• Infection Control: Hopkins Hospital intensive-care units have vastly catheter-related reduced bloodstream infections through a program that stresses strict adherence to simple measures, such as frequent handwashing, that are shown to reduce transmission. One Hospital unit’s infection rate dropped 75 percent as a result of this initiative. Hopkins safety experts later oversaw the implementation of this same program in nearly 100 intensive-care units in Michigan, with similar results. New England Journal of Medicine article, 2006
  
  
• Better Care Through Checklists: Many of our efforts to improve patient safety make use of a simple but highly effective tool—the checklist—to help caregivers follow the proper steps in delivering care. These checklists, which incorporate practices that are known to improve patient outcomes, have helped us to reduce bloodstream infections, improve pain management and get better outcomes for patients on mechanical ventilation, among other successes. A New Yorker article recently highlighted our work.
  
  
• Reducing Patient Falls: The frequency of falls at Hopkins Hospital dropped 15 percent between 2004 and 2006, thanks in part to the development of a checklist that allows nurses to rank a patient’s risk of falling down and to take preventive measures based on that ranking.
  
  
• Reducing Length of Stay: It’s well documented that shorter lengths of stay lead to lower infection risk and improved cost efficiency, disproving the notion that longer stays mean better care. Physicians at The Johns Hopkins Hospital cut back on wait times across a dozen departments and, as a result, reduced the average number of days that many patients must spend in the hospital. The Department of Medicine, for example, has reduced its average length of stay from 5.5 days in [date] to 4.9 days in 2007.
  
  
• Multidisciplinary Rounds: In many units, traditional morning “rounds,” in which venerable doctors go from patient to patient, discussing their cases with residents and medical students, has been replaced with a new approach. A team of physicians, nurses and other key caregivers develops a list of short-term aims for each patient, as part of a daily care plan. This approach has reduced hospital stays while improving patient safety and satisfaction.
  
  
• Decreasing Emergency Room Wait Time: Across the country, patients who “walk out”—leave without being seen—are a problem. A new triage system in Hopkins Hospital’s emergency department, implemented in 2006, has decreased by one-third the percentage of walkouts. It also has ensured that patients with the most serious conditions are seen first.
  
  
• Operating Room Briefings and Debriefings: Before a procedure, our surgical teams meet to verify the correct patient, procedure and surgical site, make sure we have the needed equipment supplies and personnel at hand, and discuss any complications that may arise. Then, after your procedure, they discuss your future needs to make sure that the transition of your care is handled smoothly.
  
  
• Rapid Response Teams: In our Children’s Center and in several adult units, we encourage caregivers and patients’ loved ones to seek help at the first sign that a patient is about to have cardiac or respiratory arrest. We believe that this will help reduce the number of arrests, or “codes.” Recent research has suggested that hours before adult patients arrest, a majority show signs, such as slurred speech or hypotension, that should have been heeded.
  
  
• A Program for Safety: Developed at Hopkins by Peter Pronovost, an internationally recognized patient safety expert, the Comprehensive Unit-Based Safety Program is a seven-step improvement process in which unit workers identify problems, organize improvement projects and measure their progress.
  
  
• Simulation: We’re using lifelike, state-of-the-art mannequins to help caregivers improve their technical skills—such as resuscitating patients—and to improve communication and teamwork among care team members. In addition, we bring in professionally trained actors, who mimic key complaints of real patients, to help caregivers and medical students hone their skills in diagnosing illnesses and interacting with patients. A new simulation center, which opened in the Johns Hopkins Outpatient Center in March 2008, has helped push Hopkins to the forefront of this field.
  
  
• Safety Dashboards: Departments keep safety front and center through the use of dashboards, which chart progress in addressing areas of focus, such as reducing improving the timely use of antibiotics. This feedback loop allows units to see the effects of their actions and helps develop a culture that is more sensitive to safety.
  
  
• Borrowing from the Best: Johns Hopkins Medicine has adapted strategies that other high-risk industries, such as aviation and manufacturing, have used to minimize errors and streamline processes.