Spend time with hospitalists and their competitive natures readily emerge. Striving for excellence in clinical care, hospital efficiency, and patient satisfaction, they are their hospitals’ beacons for attracting patients from referring physicians. As hospitalists’ capabilities grow, they hone pathways and procedures, improving their hospitals over time. What would happen if those hospitalists systematically shared their collective knowledge?
That’s what’s happening for hospitalists from nine health systems in southeast Michigan. Transcending their individual pursuits of excellence, they have united as Hospitalists as Emerging Leaders in Patient Safety (HELPS), a unique two-year consortium to improve patient safety regionally. Through large and small group meetings, HELPS is defining and tackling paramount patient safety issues, and collecting and sharing data about what works best.
A $117,000 grant from the Blue Cross/Blue Shield Foundation of Michigan awarded in 2005 to the University of Michigan Health Systems (UMHS) spurred the regional collaboration. Co-principal Investigator Scott Flanders, MD, UMHS’ chief of the hospitalist service and an SHM board member, conceived the project several years ago.
“What galvanized me is when I realized that we are a relatively small number of hospitalists overseeing a large number of patients—between 80,000 to 85,000 admissions annually,” he explains. “Those numbers indicated that we need to share our knowledge, treatment guidelines, and processes if we are to significantly improve patient safety.
—Scott Flanders, MD
“I assumed that many hospitalist groups wanted to improve patient safety,” continues Dr. Flanders. “But we were all working in isolation and were too busy caring for our patients to take the time to collaborate with colleagues in other programs.”
Dr. Flanders and HELPS’ other co-principal investigator, Sanjay Saint, MD, MPH, a hospitalist who heads UMHS’ Patient Safety Enhancement Program, were willing to spearhead a regional patient safety initiative with input from fellow hospitalists and patient safety officers. The Blue Cross/Blue Shield Foundation grant allowed the hospitalists to meet face-to-face periodically, target patient safety concerns, share hospitalist medicine group initiatives, collect data, and disseminate findings and best practices among the participants.
Dr. Saint and his colleagues provided one template for change. By using reminders and automatic order sets to prompt doctors to remove urinary catheters in a timely manner and by using anti-bacterial catheters, the team has shown that it can reduce bloodstream and urinary tract infections among its patients.
Drs. Flanders and Saint outlined a broad range of targets for the consortium hospitalists, including eliminating medication errors, creating a culture of safety, increasing the use of prophylactic medications for surgical patients, improving intensive care practices including pneumonia prevention, and examining end-of-life care practices such as pain management and the use of advance directives. Focusing on the elderly, who often fare poorly during hospitalizations, HELPS is looking for ways to prevent falls and delirium for that patient population. Through regular meetings, the hospitalists are developing techniques and benchmarks for performing quality improvement research and compiling lessons learned.
Nora Maloy, who works for Blue Cross/Blue Shield Foundation and who is Michigan’s senior program officer, positions the hospitalist collaboration as part of her foundation’s broader initiative to improve patient safety in response to the Institute of Medicine’s 1999 “Crossing the Quality Chasm” report that 98,000 unnecessary deaths occur annually in U.S. hospitals.
“We are very excited about the HELPS initiative,” says Maloy. “We hope to see outcomes data and best practices emerge from the nine different systems in the project, and to support a hospitalist consortium that can serve as a national model.”