Improving health care quality and safety

The phrase 'first, do no harm” is a guiding principle for doctors, nurses and health care providers the world over. Unfortunately, it isn't always that easy.

Immunity-weakened patients are susceptible to opportunistic illnesses, human error can be compounded in the blur of life-and-death seconds and waiting rooms and hospitals can be campgrounds for germs. The brutal reality is thousands of Americans die from infections acquired while they were in the hospital and many, many more are injured.

Physicians and hospital leaders know we have to do better - and we can do better.

Many hospitals and health systems in Iowa and across the nation have spent the past four years participating in Partnership for Patients, organized by the U.S. Department of Health and Human Services to aggressively and significantly reduce harm to patients. Nationally, the results have been impressive: 1.3 million fewer incidences of patient harm, 50,000 lives saved and $12 billion in avoided health spending.

Closer to home, efforts of the Iowa Healthcare Collaborative (IHC) and the statewide Hospital Engagement Network have spared thousands of patients from having to be readmitted to the hospital or enduring treatment for secondary illnesses, all while saving millions of dollars.

Engagement network hospitals (115 in Iowa, eight in Nebraska and four in Illinois) have reduced adverse drug events by 99 percent, early elective deliveries (which can lead to newborns with serious respiratory and feeding problems, among other issues) by 95 percent and pressure ulcers by 89 percent.

Hospitals also reduced central line-associated blood stream infections by almost 35 percent, surgical site infections by more than 19 percent, falls by 10.4 percent, readmits by 9.7 percent and catheter-associated urinary tract infections by 8.6 percent.

What this means for Iowa is that 4,344 instances of harm were avoided and patients stayed in the hospital for 17,758 fewer days (the equivalent of 48 years) for a cost savings of more than $51 million.

So, are Iowa health care providers ready to declare victory in the campaign against patient harm? Of course not. Data from the Centers for Disease Control and Prevention shows that 2 percent of Iowa hospitals have at least one infection rate worse than the national benchmark. Even though states similar to Iowa have much higher rates (Kansas at 17 percent and Minnesota at 22 percent, for example), Iowa hospitals are determined to do better - to get to zero.

Through efforts like the Hospital Engagement Network, Iowa health care providers are raising the bar - from the person who first takes a sick person's vital signs to the surgeon who operates. This is not easy, because Iowa's health care safety and quality levels have been among the best in the nation for some time.

Still, there is room for improvement - and there is demand for improvement, from consumers, businesses, political leaders and within the health care provider community itself. Local providers are listening and responding with real results that show health care in Iowa is safer and more efficient than ever.

' Tom Evans, M.D., is President and CEO of Iowa Healthcare Collaborative. Comments: evanst@ihconline.org