Slowly the public is coming to realize that hospitals are not always safe places. Since the Institute of Medicine published its landmark study on unsafe medical care more than a decade ago, a grassroots patient safety movement has blossomed. This is the third in a series of posts that will examine what the media are doing to report on patient safety in their communities. The series is archived here.
I have just returned from England, where as a Fulbright Senior Specialist I attended a conference of European health journos and participated in meetings with health care academics and government officials. One of them was from Britain’s National Health Service, the NHS—you know, that so-called socialist organization reviled in some quarters here in the U.S for allowing patients to die on the streets. At the NHS Institute for Innovation and Improvement I learned about some pretty cool stuff that has found its way into UK hospitals and improved care for patients. What’s more, some of these new practices have taken root in Oregon hospitals in a collaborative organized by CareOregon, a health plan that insures some 150,000 Oregonians, mostly those on Medicare and Medicaid. In an interview with the Institute’s marketing and communications officer, Annie Taylor, I learned that some of the simplest changes have made oodles of difference for patient safety.
Since 2007 the Institute has fostered nurse-led innovations to improve care in such areas as patient hygiene, nursing procedures, meals, medicines, and ward rounds that frees up more time to be with patients. Now almost all UK hospitals embrace some of these practices. Positive stats from this “Releasing Time to Care” project show a thirteen percentage point increase in the median time spent on direct care; a seven percentage point increase in median patient satisfaction scores, and a twenty-three percentage point increase in median patient observations. Not a bad showing for a health system that many Americans think is the devil incarnate.
One practice that intrigued me was a way to cut down on errors made by nurses when they give patients their meds. Taylor told me that medication errors are a problem in the UK as they are in the US. Any reporter who has spent time examining hospital or nursing home inspection reports knows how frequent they are. Taylor explained that nurses administering medications too often are interrupted, causing them to lose focus and increasing the chance for a deadly mistake. To solve this problem nurses started wearing red pinafores over their uniforms when they gave patients their medicines. That signaled to others not to bother them. “It’s so simple,” said Taylor.
The NHS innovations so impressed CareOregon CEO Dave Ford that he organized a collaborative of hospitals with which his plan contracts; four decided to participate. “The NHS has done some of the best thinking in the world around large scale complex system transformation,” Ford told me. “It’s some of the most exciting feet-on-the-ground stuff I’ve seen in improvement.” Stats are beginning to tell a pretty tale on this side of the Atlantic as well. Ford called the numbers “startling.”
The time nurses spent with patients rose from around 24 percent to about 54 percent. The rest of the time is consumed by administrative details and interruptions. The number of falls has dropped dramatically thanks to a simple intervention called patient safety crosses. Using a graphic with boxes for each day of the month, hospital personnel on a floor mark the boxes with a green X if there are no falls for the day and a red one if there are. Another visual called a “measles chart” uses red dots to mark the spots on a floor plan diagram showing where most falls occur. Knowing that, the staff can investigate the causes and make corrections. Ford explained that this simple technology has allowed nurses to “visually see their work and create a team and a community on the floor.” In one hospital, nurses were upset when a fall occurred after several months of having none.