Case Study: A Standard Approach

It's been 124 years since caleb Cooley Dickinson, cousin of the poet Emily, endowed the hospital in Northampton, Mass., that bears his name--and he'd barely recognize the modern institution it has become. Cooley Dickinson Hospital has gleaming operating rooms; in April 2007, it will open a large new building. Nonetheless, a few things haven't changed much at the hospital since its benefactor was alive. Take its way of keeping medical records. In the age of smart cards, Cooley Dickinson manages its medication information using paper and pencils. Patients carry wallet-size yellow cards that list their medications, their last vaccinations and their contact information; when they visit doctors, they present their info for updating. The cards are part of a recent overhaul that has focused on deceptively simple, and mostly affordable, ideas. "Sometimes, we get so focused on the latest technology," says director of quality Donna Truesdell, "that it's easy to lose sight of the basics."

Those basics are at the heart of the 100,000 Lives Campaign, a nationwide movement to cut down on medical errors and preventable problems (such as hospital-associated infections) using proven protocols at more than 3,000 hospitals. There's nothing sexy about it, no new cures or therapies. But, as the name suggests, it may end up saving more lives than many pills can. Hospitals are asked to use best practices in six categories--how well they deal with keeping medication lists, acute myocardial infarctions (or heart attacks), surgical-site infections, medical ventilator-associated pneumonia, central-line infections, and how quick their providers are to respond to patients in distress. Then that information is posted on the Web for patients to see, and if they're not satisfied, to question. "You comparison-shop for washing machines," says infection-prevention coordinator Linda Riley. "Why not for your health?"

For too long, says Truesdell, hospitals have been benchmarking against the average rather than striving for perfection. When Cooley Dickinson signed up to participate in 100,000 Lives, that had to change. "There was a day when manufacturers expected a defect rate in their products, and we were thinking that way, too," she says. After the program started, "we made our own internal scoring much more difficult." The staff also carefully examined each case of hospital-associated infection to see if they could decrease the risk. In March, the hospital had its first case of ventilator-associated pneumonia in months. The respiratory staff thought the problem might have been the patient's breathing tube, so it found a new kind with a suction device attached to keep germy fluids out of the lungs. Even though it hadn't had a case of VAP since then, two weeks ago the hospital switched all of its emergency intubations to the new tubes.

Other improvements are easy to see. Cooley Dickinson used to have the "dubious honor" of having more skin irritations per patient than any other hospital in the state, says Truesdell. It hasn't had one in three of the last four quarters, though, partially because patients at risk for them are now identified with large letter P's on their room doors. Physically weak patients also get signs emblazoned with "falling stars"; the fall rate is down 85 percent. Signs with pictures of bacteria--cultured from staff members' own hands--remind doctors and nurses to wash up. Then there are those medication cards. They've been such a hit that hospitals all over the country have called, wanting their own copies.

Of course, not all the changes at Cooley Dickinson have been so inexpensive--the costly new ventilator tubes, for instance. But ultimately, the consequences of errors and infections--code blues, days in the ICU--would have cost more. "Every one of those we prevent, we're saving money," says Truesdell. And, of course, saving lives.