1. Institute For Healthcare Improvements 100k lives Campaign Clint MacKinney, MD, MS clintmack@cloudnet.com Duluth, Minnesota July 19, 2005

2. 2005 Minnesota Rural Health Conference 2 Topics for Today 1.The 100,000 Lives Campaign 2.Why is the Campaign important 3.Why rural and why us 4.The Campaigns current status 5.The interventions 6.Resources to get started 7.Opportunities and barriers to involvement (discussion)

3. 2005 Minnesota Rural Health Conference 3 A Flawed System Between the health care we have and the health care we could have lies not just a gap, but a chasm. – Crossing the Quality Chasm, 2001 Health care does not yet reliably transfer best-known science into practice, and processes frequently fail, despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, too often does just the opposite – leading to unintended harm and unnecessary deaths at alarming rates. – 100k Lives Campaign folder, 2004

4. 2005 Minnesota Rural Health Conference 4 Background

5. 2005 Minnesota Rural Health Conference 5 Six Changes that Save Lives 1.Deploy Rapid Response Teams* 2.Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction (Heart Attacks)* 3.Prevent Adverse Drug Events (ADEs)* 4.Prevent Surgical Site Infections* 5.Prevent Central Line Infections 6.Prevent Ventilator-Associated Pneumonia * Rural-appropriate interventions

6. 2005 Minnesota Rural Health Conference 6 Healthcare Safety? < 98,000 deaths per year due to medical errors – Institute of Medicine, 1999 195,000 deaths per year due to medical errors – HealthGrades, 2004 How many is too many?

7. 2005 Minnesota Rural Health Conference 7 Healthcare Quality? The Quality of Health Care Delivered to Adults in the United States – McGlynn et al Results Participants received 54.9% of recommended care. 45% defect rate! Conclusions The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. NEJM. Volume 348:2635-2645. June 26, 2003. Number 26

8. 2005 Minnesota Rural Health Conference 8 Healthcare Value? Causes of poor care: Misuse, underuse, overuse, waste – Juran Institute and Midwest Business Group on Health. 2003

9. 2005 Minnesota Rural Health Conference 9 Why Rural; Why Us? 30% of Minnesotas population is rural The big systems have already signed on Our interest in improvement, and our need for improvement, is no less significant Our patients, families, and communities are no less cherished Only interventions that make sense for rural, for our hospitals, and for our communities

10. 2005 Minnesota Rural Health Conference 10 If not for statistics, then for our future

11. 2005 Minnesota Rural Health Conference 11 Participation May 2005 Over 2,200 hospitals enrolled in all 50 states Nearly 50% of U.S. hospital beds Thousands on national calls Unprecedented web activity and new tool development Related campaigns forming globally Data collection underway with Pioneer Group; begins for all enrollees 6/14/05

12. 2005 Minnesota Rural Health Conference 12 Participation May 2005

13. 2005 Minnesota Rural Health Conference 13 Changes Proven to Prevent Avoidable Death Rapid Response Teams –Cardiac arrest or shock occurs in 0.6% of medical patients and 0.5% of surgical patients. –Only 17% of patients who experience a cardiac arrest survive to discharge. –Most patients who have in- hospital cardiac arrest have identifiable signs of deterioration prior to arrest.

14. 2005 Minnesota Rural Health Conference 14 Changes Proven to Prevent Avoidable Death Improved Care for Acute Myocardial Infarction –1.1 million experience an AMI yearly. 1/3 die acutely. –Implementation of guidelines reduces mortality. –Yet in AMI, only 61% receive aspirin and only 45% receive beta-blockers. –AMI care included in CMS Hospital Quality Initiative, JCAHOs core measure set.

15. 2005 Minnesota Rural Health Conference 15 Changes Proven to Prevent Avoidable Death Prevention of Adverse Drug Events –1,200 hospital deaths in 1993 were due to medication errors. –6.3% of malpractice claims are due to medication errors. –46% of all medication errors occur at care transition points.

16. 2005 Minnesota Rural Health Conference 16 Changes Proven to Prevent Avoidable Death Prevention of Surgical Site Infection –Surgical site infections (SSIs) account for 14% - 16% of hospital-acquired infections. –Among surgical patients, SSIs account for 40% of hospital acquired infections. –Surgical patients who develop SSIs are twice as likely to die as other surgical patients.

17. 2005 Minnesota Rural Health Conference 17 Changes Proven to Prevent Avoidable Death Prevention of Central Line- Associated Bloodstream Infection –48% of ICU patients have central venous catheters, or 15 million catheter days per year. –There are 5.3 venous catheter-related bloodstream infections per 1,000 catheter days. –Approximately 14,000 deaths per year from venous catheter-related bloodstream infections.

18. 2005 Minnesota Rural Health Conference 18 Changes Proven to Prevent Avoidable Death Prevention of Ventilator- Associated Pneumonia –Ventilator-associated pneumonia (VAP) occurs in 15% of patients receiving mechanical ventilation. –Mortality for mechanical ventilator patients with VAP is 46% compared to 32% for those without VAP. –VAP is associate with prolonged mechanical ventilation, ICU stay, hospital stay and associated increased costs.

19. 2005 Minnesota Rural Health Conference 19 Resources – IHI www.ihi.org/IHI/Programs/Campaign/ –Platform materials for each intervention How-to Guide for implementing the change Presentation with facilitator notes Annotated bibliography –Campaign activity checklist –Getting Down to Work: Field Operations, Implementation, Measurement, and Next Steps –Customizable press release –Data submission how-to guide –Multiple informational calls, videos, web discussions

20. 2005 Minnesota Rural Health Conference 20 Resources – Minnesota Minnesota Node – 60-70 hospitals signed on! –Stratis Health (Minnesotas QIO) Acute Myocardial Infarction, Adverse Drug Events, Surgical Site Infections –Institute for Clinical Systems Integration Rapid Response Teams, Central Line Infections –Minnesota Hospital Association Ventilator Associated Pneumonia Contact –Julie Apold, MHA Patient Safety Manager –japold@mnhospitals.org

21. 2005 Minnesota Rural Health Conference 21 Resources – www.mnpatientsafety.org The Minnesota Alliance for Patient Safety was established in 2000 as a partnership between the Minnesota Hospital Association, Minnesota Medical Association, Minnesota Department of Health and more than 50 other public- private health care organizations working together to improve patient safety. "Promoting optimum patient safety through collaborative and supportive efforts among health care organizations in Minnesota"

22. 2005 Minnesota Rural Health Conference 22 Some Is Not a Number… Soon Is Not a Time The Number: 100,000 Lives The Time: June 14, 2006 9 am ET