100,000 Lives Campaign

by Susan L. Marr, M.S.A., Regional Patient Safety/Risk Manager

In this quarter’s article, Susan Marr, patient safety/risk manager in our Southeast Regional Office, discusses the goals of the IHI’s 100,000 Lives Campaign and reports on its progress.

—Robin Diamond, J.D., R.N.; A.H.A. Fellow–Patient Safety Leadership; Vice President, Patient Safety

In December 2004, the Institute for Healthcare Improvement (IHI), founded and led by Donald Berwick, M.D., announced a bold effort called the “100,000 Lives Campaign.” A target date of June 14, 2006, was set, and a target goal was announced: to save 100,000 lives. Some 3,100 of the nation’s 5,759 hospitals—representing 75 percent of all acute hospital beds and an estimated 80 percent of all inpatients—joined the campaign. The organizations that support this effort include the Joint Commission on Accreditation of Healthcare Organizations, the National Patient Safety Foundation, and the American Medical Association.

For purposes of the campaign, a “saved life” is counted as a patient who, had the changes made as a result of the campaign focus not been in place, would not likely have survived his or her hospitalization. Hospitals joining the campaign are asked to implement six evidence-based interventions that are deemed highly feasible as documented in peer-reviewed literature. Those interventions are:

1. Rapid Response Teams (RRTs)
This protocol calls for developing a rapid response team in the facility that consists of clinicians such as physicians, nurses, and respiratory therapists. The call for intervention may be specific or as vague as “my patient is not doing well.” The role of the RRT is to assess, stabilize, assist with communication, educate and support, and assist with transfer as needed. The intention is not to replace code teams with rapid response teams; rather, an RRT’s focus is to reduce deaths by moving intervention upstream prior to actual code status. Code teams still function in the usual way.

2. Acute MI
This protocol seeks to deliver evidence-based care to patients who are post-MI. Even though the American College of Cardiology and the American Heart Association have guidelines on post-MI care and the Centers for Medicare and Medicaid Services use these elements in its hospital quality initiative, the guidelines are not always followed despite clear evidence that they work. The guidelines include items such as timely reperfusion, aspirin use, and beta-blockers.

3. Ventilator-Associated Pneumonia (VAP)
This is another evidence-based protocol designed to prevent patients on ventilators from developing pneumonia by following four steps: raising the head of the bed to between 30 and 45 degrees; daily “sedation vacations” and assessments of readiness to extubate; peptic ulcer disease prophylaxis; and deep vein thrombosis prophylaxis, unless contraindicated.

4. Central Line Infections
This intervention is designed to prevent central line infections by using the five steps developed by the Centers for Disease Control that include hand washing, maximum barrier utilization, use of chlorhexidine antiseptic, catheter site selection (subclavian preferred for nontunneled), and daily analysis of continued need with prompt discontinuation of unnecessary lines.

5. Surgical Site Infections
Surgical site infections can be dramatically reduced through timely antibiotic usage, appropriate hair removal (zero use of razors), perioperative glucose control in major surgery, and temperature control in colorectal cases.

6. Medication Reconciliation
The protocol recognizes that approximately 7,000 deaths each year are related to medication errors, with the errors occurring most commonly at points of transition in care. Medication reconciliation is the process by which a clinician reviews the medication orders for the patient as compared with the actual administration, before and after a transition in care, to assure that the patient is receiving the intended regimen.

Campaign Update

On June 14, 2006, the IHI announced the final tally in the 18-month effort: 122,300 lives saved—an incredible accomplishment. In the area of VAP alone, 20 hospitals reported no VAP deaths for over one year. This is quite remarkable considering that up to 15 percent of patients on ventilators historically develop this serious complication and that it is a leading killer among hospital-acquired infections.

Incredible progress has also been made in providing care for patients post-MI, preventing adverse drug events, as well as reducing infections in surgical sites and central lines.

While the campaign has been widely embraced, it is not without its critics. Skeptics point to the science (or lack thereof) and while noting admiration for its goals, critics have questioned the numbers. The IHI admits there is a need to compare data from hospitals that did not participate in the campaign with those that did, and this is being addressed. Other critics note that there has not been a stringent peer review process, the “results” rely on self-reported data, and there are questions about the reporting methodology. There does, however, appear to be nearly universal agreement that something positive has occurred in the patient safety movement.

The IHI has indicated that it plans to make further announcements for the next stage in this initiative. Look for the IHI’s announcement in December 2006. For more information on the campaign, go to the IHI Web site (www.ihi.org), and click on the 100,000 Lives Campaign link.