Researchers Report on Success of Patient Safety Program In Michigan

Medical and nursing researchers and social scientists in the United States and the United Kingdom have concluded that a patient safety program, which ran in more than one hundred hospital ICUs in Michigan, dramatically reduced the rates of central line bloodstream infections. Funded in part by the Health Foundation in the U.K., the collaboration between researchers at the University of Pennsylvania, Johns Hopkins University and the University of Leicester has led to a deeper understanding of how patient safety initiatives like the Michigan program can succeed.

The researchers found that one of the Michigan program’s most important features is that it explicitly outlined what hospitals had to do to improve patient safety, while leaving specific requirements up to the hospital personnel.  A critical aspect of the program was convincing participants that there was a problem capable of being solved.

“We knew this program worked. It not only helped to eliminate infections, it also reduced patient deaths,” said program leader Peter Pronovost of the Johns Hopkins University School of Medicine, named one of Time Magazine’s 100 most influential people in 2008 and a MacArthur Fellowship recipient. “The challenge was to figure out how it worked”.

Infection rates were continuously monitored at hospitals participating in the program, making it easier for hospital workers to track how well they were doing and where they needed to improve.The authors conclude that that there are important lessons for others attempting patient safety improvements.  Checklists were an essential component but not the most important component of the Michigan program.

“It was much more than that,” said lead author Mary Dixon-Woods, professor of medical sociology at the University of Leicester. “It involved a community of people who over time created supportive relationships that enabled doctors and nurses in many hospitals to learn together, share good practice and exert positive pressure on each other to achieve the best outcomes for patients.”

The Michigan program, also known as the Keystone study, was designed to minimize the risk of patients getting catheter-related bloodstream infections in intensive care units. Each year, about 80,000 patients in the U.S. get these infections.  Between 30,000 and 60,000 of them die.  During the 18-month period when the Michigan program was implemented in 103 hospital intensive care units, infection rates dropped 66 percent, resulting in estimated savings of 2,000 lives and $200 million.

Bloodstream Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

The number of bloodstream infections in intensive care unit patients with central lines decreased by 58 percent in 2009 compared to 2001, according to a new CDC Vital Signs report. During this time span, the decrease in bloodstream infections represented up to 27,000 lives saved and almost $2 billion in excess health care costs. Bloodstream infections in patients with central lines can be deadly, killing as many as one in four patients who gets one.

A central line is a tube usually placed in a large vein of a patient's neck or chest to deliver treatment in an ICU, elsewhere in the hospital, and during dialysis. A bloodstream infection can happen when germs enter the blood through a central line, often because proper procedures were not used while the central line was placed or maintained. In recent years, studies have proven that health care providers can prevent most bloodstream infections in patients with central lines by following CDC infection control recommendations, which include removing central lines as soon as medically appropriate. In hemodialysis patients, central lines should only be used when other options are unavailable.


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