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Dome - Armstrong Institute Receives $9.4 Million Grant

Dome November 2012

Armstrong Institute Receives $9.4 Million Grant

Date: November 16, 2012

At a recent press conference, Peter Pronovost described how his team plans to improve patient outcomes and reduce costs in the ICU as part of a multimillion-dollar grant from the Gordon and Betty Moore Foundation.
At a recent press conference, Peter Pronovost described how his team plans to improve patient outcomes and reduce costs in the ICU as part of a multimillion-dollar grant from the Gordon and Betty Moore Foundation.

The Gordon and Betty Moore Foundation presented its first award to the Armstrong Institute for Patient Safety and Quality as part of an ambitious new $500 million, 10-year program designed to eliminate all preventable harms that patients experience in the hospital. The Johns Hopkins grant will focus on hospital intensive care units. The goal of improving patient safety relies, in part, on empowering patients and their families to act as an integral part of the care team.

“Despite heroic efforts by clinicians, patients continue to suffer preventable harm, in large part because health care is grossly under-engineered: Devices don’t talk to each other, treatments are not specified and ensured and outcomes are largely assumed rather than measured,” says the institute’s director, Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. “This project will seek to change that by enlisting systems engineers to ensure patients always get the treatments they should, by engaging patients in every aspect of their care and creating a health care system that continuously improves.”

Pronovost says the nationally publicized death of 11-year-old Leah Coufal illustrates how “middleware,” a system that can link a hospital’s existing monitors and devices, could prevent harm. “She died because the infusion pump did not talk to the breathing machine,” Pronovost says, adding that had the two been linked, they could have alerted Coufal’s medical team to the dangerous levels of medication suppressing her breathing. Each year, tens of thousands of patients like Coufal die as a result of preventable harm, and millions are spent on patient readmissions that could be averted.

Ensuring patient and family participation in care is another key focus of the grant. Nicole James, a sickle cell patient from Elkridge, Md., who now comes to Johns Hopkins for her care, knows firsthand how important it is for patients to be full partners in their health care. Like others with the genetic blood disease, the 37-year-old property manager experiences regular “pain crises,” periods of pain so debilitating and intense that they require narcotics, often in a hospital setting. She tells of a time when one such crisis sent her to a local emergency room in the middle of the night. While there, the physicians diagnosed a lung infection using X-ray imaging and immediately started treatment without telling her. Had they talked to her, they would have known that the shadow on her lung shown on the X-ray was scar tissue from an earlier case of pneumonia.

“What should have been a two-day hospital stay turned into two weeks because I wasn’t consulted before being treated,” James says.

Hopkins patient safety experts are exploring ways to empower patients and families. Giving family members a tablet that shows what therapies and procedures the patient should be receiving, and whether they’ve been completed, is one option that Armstrong Institute researchers are considering as part of the new project that’s currently under way.

Integrating patient information for ICU providers in an accessible, easy-to-read format is another key goal, says patient safety expert and ICU attending physician Adam Sapirstein. Sapirstein, implementation leader for the project, says systems engineers from the Applied Physics Lab (APL) are developing and testing prototypes of freestanding display systems that offer nurses and physicians a snapshot of a patient’s care plan and condition.

“We want clinicians to know if they’re meeting target goals and to give them the tools to achieve those goals more consistently,” says Sapirstein. To start, the team will focus on common causes of preventable harm in the ICU, such as ventilator-associated pneumonia and delirium.

Sapirstein says he and others in the Armstrong Institute will also work closely with colleagues from the Berman Institute for Bioethics and School of Engineering throughout the two-year project. It involves pilot sites at Hopkins Hospital and Johns Hopkins Bayview Medical Center, as well as a parallel initiative at the University of California, San Francisco funded through a separate Moore Foundation grant.

—Shannon Swiger

Project goals

  • Enlist systems engineers to ensure that patients receive appropriate treatments.
  • Engage patients in every aspect of care.
  • Create a health care system that continuously improves.