The 100,000 Lives Campaign: Implementation Time

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The 100,000 Lives Campaign Implementation Time

• Donald M. Berwick, MD, MPP
• Institute for Healthcare Improvement
• Reagan International Conference Center
• Washington, DC October 3, 2005
• www.ihi.org

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IHIs No Needless List

• No needless deaths
• No needless pain
• No helplessness
• No unwanted waiting
• No waste
• for anyone

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Our Key Strategies

• Build the Will and Optimism for Change
• Invent Better Care Models with Demonstrated
  Superior Results
• Drive Broad Scale Adoption of Best Practices
• Develop the Next Generation of Change Agents

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(No Transcript)
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Campaign Objectives

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change

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Key Campaign Principles

• Some is not a number soon is not a time.
• Welcome anyone at any level.
• We do this together.

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Six Changes That Save Lives

• Deploy Rapid Response Teams
• Deliver Reliable, Evidence-Based Care for Acute
  Myocardial Infarction (Heart Attacks)
• Prevent Adverse Drug Events (ADEs)
• Prevent Central Line Infections
• Prevent Surgical Site Infections
• Prevent Ventilator-Associated Pneumonia

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1. Rapid Response Teams

• A Rapid Response Team may be summoned at any time
  by anyone in the hospital to assist in the care
  of a patient who appears acutely ill, before the
  patient has a cardiac arrest or other adverse
  event.
• No prior permission is required to call the Rapid
  Response Team.

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The Dramatic Effects of Rapid Response Teams
From Bellomo R, et al. MJA. 2003179283-287.
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2. Reducing Acute Myocardial Infarction Mortality

• Early administration of aspirin
• Aspirin at discharge
• Early administration of a beta-blocker
• Beta-blocker at discharge
• ACE-inhibitor or angiotensin receptor blocker
  (ARB) at discharge (if systolic dysfunction)
• Timely reperfusion
• Smoking cessation counseling

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AMI Reliability McLeod Regional Medical Center
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3. Preventing Adverse Drug Events

• Reliable Medication Reconciliation procedures
  to ensure that patients receive all intended
  medications and no unintended medications
  following transitions in care locations.

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Hackensack University Medical Center Adverse
Drug Events
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4. Preventing Central Line Infections

• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Appropriate catheter site and administration
  system care
• No routine replacement

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Central Line Associated Bloodstream Infections
(CLABs)(from Rick Shannon, MD, West Penn
Allegheny Health System)
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5. Preventing Surgical Site Infections

• Guideline-based use of prophylactic perioperative
  antibiotics choice and timing
• Appropriate hair removal (avoiding shaving)
• Perioperative glucose control

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Mercy Health Center SSI Rate
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6. Preventing Ventilator Associated Pneumonia

• Elevate head of the bed to 30-45 degrees
• Daily sedation vacations
• Daily assessment of readiness to extubate
• Peptic ulcer prophylaxis
• Deep venous thrombosis prophylaxis

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VAP ResultsBaptist Memorial DeSoto
Courtesy of Manoj Jain, MD, MPH
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What We Will Measure

• Number of hospitals signing up (along with
  demographic information for each facility)
• The interventions each hospital pursues
• Actual changes in the number and percentage of
  inpatient deaths

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Baptist-DeSoto HSMR (Hospital Standardized
Mortality Rate)
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Campaign Elements

• Platform The scientific basis for our work
• Measurement How we will measure our progress
• Communications - How we will publicize the
  Campaigns progress and success
• Field Operations How we will spread the
  Campaign across the country and implement
  improvements successfully

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Campaign Field Operations Structure

• Field Operations structure
• Individual hospitals
• Networks (groups of 30-60 hospitals organized by
  geography, business affiliation or affinity)
• Nodes (high-leverage organizations responsible
  for managing each network)
• IHI Field Operations (team interfacing
  intensively with each Campaign node)

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Campaign Field Operations Structure
IHI and Campaign Leadership
Ongoing communication
NODES (approx. 75)
Each Node Chairs 1 Network
FACILITIES (approx. 2000)
30 to 60 Facilities per Network
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Campaign Status

• Over 2,800 hospitals enrolled in all 50 states
• Over 50 of U.S. hospital beds
• Thousands on national calls
• Unprecedented web activity and new tool
  development
• Related campaigns forming globally
• Data collection began with Pioneer Group now
  underway for all enrollees on June 14, 2005

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Extraordinary Support

• Nearly 50 nodes and counting
• Vibrant partnerships (AAMC, AHRQ, AMA, AHQA, ANA,
  Ascension, CMS, CDC, JCAHO, Leapfrog, NPSF, NRHA,
  NC State Hosp. Assoc., Premier, Qualis, SSM, UHC,
  VA, VHA)
• Generous financial backing (BCBS of MA, Moore
  Foundation, Leeds Family, Rx Foundation, Blue
  Shield of CA Foundation, Colorado Trust, Cardinal
  Health Foundation)

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Campaign Participants So Far (a sample)

• American Medical Association, American Nurses
  Association, American College of Physician
  Executives, Association of American Medical
  Colleges, JCAHO, Leapfrog Group, NPSF, Premier,
  University HealthSystem Consortium, VHA
• Leading systems SSM Health Care, Ascension
  Health, Hospital Corporation of America, Tenet
  Health Care
• State Hospital and Nurses Associations MA, NC,
  IL, MI, WA.
• Federal Agencies CMS, CDC, AHRQ, VA
• Scientific Societies ACC, American Heart
  Association, APIC, SCCM, SHEA, SGIM
• Pediatric (NICHQ, NACHRI, CHCA) and rural (NRHA)
  nodes
• AHQA (Quality Improvement Organizations)
• Financial support BCBS of MA, Moore Foundation,
  Leeds Family, Rx Foundation, Blue Shield of CA
  Foundation, Colorado Trust, Cardinal Health
  Foundation
• Over 2,800 hospitals so far And counting

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Extraordinary Commitments in Washington, DC,
Delaware and Maryland

• Washington, DC is home to many national
  organizations that are key Campaign partners
• The regions is reporting wonderful initial
  success
• Delmarva Foundation is doing an outstanding job
  as the local node for DC, DE, and MD
• Delmarva has joined forces with CareFirst to
  bring the Campaign to the region
• CareFirst has generally provided funding to
  sustain the Campaign efforts in the region

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Getting Down to Work

• Enrollment is exciting but insufficient on its
  own. Lets seize the opportunity weve created
• We need to introduce these interventions reliably
  in every participating hospital by engaging
  leaders, front line providers, patients, and
  families
• All Campaign stakeholders IHI, partners, nodes,
  hospitals have to pull together to support
  implementation
• Start with small steps within your organization
  (use the new guide to hospital-wide Campaign
  activity available on www.ihi.org today)

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Supports and Events

• Campaign Progress page at www.ihi.org (see for
  details on all the below)
• Campaign Bus Tour from Boston to Seattle
• Ongoing 100K Live call-in show, next call
  October 4 from 3-5 PM EST
• Next Campaign-wide data submission begins October
  1
• Web ACTION programs on Campaign interventions

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Look. This Is Not Going to Be Easy!

• Technical changes and cultural changes
• Reliability of bundles composites no
  partial credit
• Automation, standing orders, default systems
• Teamwork
• Valuing initiative from everyone (nurses,
  pharmacists, all..)
• Pretend the goal is 3 months away, not 12 months
  away audit in July, 2005
• Are the process changes being made? Really?
• Are deaths decreasing? Really?
• Revisit and redesign implementation accordingly
  by September 1, 2005
• Fail First Learn Then Succeed
• Use the whole Campaign system. You are part of
  something very big, ambitious, and wonderful.
  Use It!

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REALLY?

• We are already doing the six changes.
• REALLY?
• Our care for (heart attacks, surgical sites,
  central lines, ventilator patients, medication
  reconciliation) is highly reliable?
• REALLY?
• Our nurses are empowered to act when they get
  worried, and to get support immediately and
  without criticism.
• REALLY?
• We are connected to the Campaign community, and
  learning from it every day.
• REALLY?
• We are saving lives now that we would not have
  before.
• REALLY?

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THE Question for the Next Three Months

• REALLY?

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For more information...

• www.ihi.org/campaign

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Some Is Not a Number Soon Is Not a Time

• The Number
• 100,000 Lives
• The Time
• June 14, 2006 9 a.m. ET