Safety checklist yields 10% drop in hospital deaths

A safety checklist program that nearly eliminated bloodstream infections in hospital intensive care units throughout Michigan and Rhode Island appears to also reduce deaths by 10%, according to a study from Johns Hopkins University.

Though prior research had already shown a major reduction in central-line bloodstream infections at hospitals using the checklist, this latest study — published in the British Medical Journal — is the first to show that use of the checklist directly lowers mortality.

The checklist is a cockpit-style initiative, and previous research has shown that coupling it with a work environment that encourages nurses to speak up if safety rules are not followed reduced intensive care unit (ICU) central-line infections to nearly zero at hospitals in Michigan and Rhode Island.

“We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” study author Peter J. Pronovost, MD, PhD, stated in a Johns Hopkins Medical Institutions press release. “Thousands of people are believed to have survived because of this effort to reduce bloodstream infections.”

Survival more likely

Pronovost and his team used Medicare claims data to study the hospital mortality of patients admitted to ICUs in Michigan before, during and after what is known as the Keystone ICU Project – an initiative that features the checklist. The Michigan findings were compared to similar data from 11 surrounding states.

The study sample included hospital admissions for 238,937 patients from 95 hospitals in Michigan and 1,091,547 patients from 364 hospitals in the surrounding Midwest region.

Data from Michigan and the other states showed a reduction in hospital deaths of elderly patients admitted to intensive care units during the 5-year period of Oct. 2001 to Dec. 2006. However, the patients in Michigan were “significantly more likely” to survive a hospital stay during and after the Keystone project.

The Keystone project

The authors noted that the findings cannot definitively attribute the mortality reduction to the Keystone project, but they added that no other known large-scale initiatives were uniquely introduced across Michigan during the study period.

“This is perhaps the only large-scale study to suggest a significant reduction in mortality from a quality-improvement initiative,” Pronovost stated.

The Johns Hopkins-developed Keystone ICU Project includes a checklist for physicians and nurses to follow when placing a central-line catheter, highlighting five cautionary and basic steps from hand-washing to avoiding placement in the groin area where infection rates are higher. Along with the checklist, the program promotes a “culture of safety” that comprises safety science education, training in ways to identify potential safety problems, development of evidence-based solutions and measurement of improvements.

The program also empowers caregivers to question each other and stop procedures if safety is compromised.

References:
Lipitz-Snyderman, et al. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: Retrospective comparative analysis. BMJ. 2011; 342:d219 doi: 10.1136/bmj.d219.
www. hopkinsmedicine.org
Disclosure: The authors have reported no financial support for publishing their work.

Follow ORTHOSuperSite.com on Twitter