Improving the Prognosis for Patient Safety in Hospitals

"Josie's Story" Book"Safe Patients, Smart Hospitals" BookThere’s a newly published book just out on the issue of patient safety in U.S. hospitals that’s quite an interesting read. The book is titled Safe Patients, Smart Hospitals (Hudson Street Press, ISBN-13: 978-1594630644), written by Peter Pronovost, Ph.D, M.D., a professor at Johns Hopkins University School of Medicine, and Eric Vohr, former assistant director of media relations at Johns Hopkins University School of Medicine and an instructor of technical writing at the school. Dr. Pronovost is also Medicaid director for the Johns Hopkins Center for Innovation in Quality Patient Care. (The book is also available in a Kindle edition.)

Instead of presenting us with a dry tome like so many other books on healthcare issues, this volume starts out with a true-life medical case where procedures and protocol at a top-notch healthcare institution were not enough to save the life of a patient.

The example the authors use to introduce us to the issue of patient safety is Josie King, an 18-month old girl who was the victim of accidental scalding by hot water and who was admitted to Johns Hopkins Hospital with second-degree burns. Unfortunately, the little developed a bacterial infection from a central line catheter while in the hospital, which was then improperly treated, leading to her death.

Living not far from Baltimore area, I recall this story as being big news in the local media market back in 2001 when the case occurred. Numerous stories were broadcast along with concerns raised as to how such events could have happened at one of America’s most prestigious healthcare institutions. (The child’s mother, Sorrel King, also wrote a book about the incident – Josie’s Story – published last year.)

Both Dr. Pronovost and Mr. Vohr are intimately familiar with the Josie King tragedy because of their first-hand knowledge of the events at the time. In fact, Dr. Pronovost used the experience to develop a simple set of usage guidelines for central line catheters – reducing a ~120-page thicket of inconsistent, confusing procedures and guidelines down to a five-step checklist. When a test program across 50 intensive-care units in Michigan hospitals used the five-step checklist in lieu of the traditional guidelines, there was a dramatic reduction in the incidence of catheter line infections to near zero, along with saving an estimated 2,000 lives.

In their book, Messrs. Pronovost and Vohr are basically issuing a “call to action” for taking a similar approach to a myriad of other surgical and related procedures at hospitals. But the book also pinpoints significant hurdles the authors believe are standing in the way of action. These range from having a lack of uniform standards from one hospital to another … a propensity for doctors and other medical staff to stick to existing behaviors and protocols even if they have shortcomings … the sometimes insufficient lines of communications between physicians and nurses … and, not least, the unwillingness of some surgeons, as the prima donnas of their hospitals, to taking direction, advice or orders from other medical staff members.

In my line of work, I have the opportunity to interact with healthcare organizations ranging from smaller community hospitals to large regional “destination” health centers. From my experience, I tend to agree with the authors that different hospitals have different protocols, different priorities, and different cultures, which could certainly lead to different patient outcomes in some cases.

Nevertheless, I have never seen a case of wanton disregard for patient safety. From what I’ve observed, I think any problems that might arise would more likely come from the large volume of patients being cared for, along with the constantly evolving technologies and procedures. It’s really too bad that medical staff members aren’t blessed with a 36-hour day, because so many seem to put forth a 36-hour effort within a 24-hour day … day in and day out.

Perhaps for this reason as much as any other, it is interesting – and welcome – to read of practicals way to improve patient safety through using steps such as ones outlined by Dr. Pronovost and Mr. Vohr in their book. For anyone interested or involved in the healthcare industry, it’s a volume definitely a worth reading.

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