September 14, 2012
Hopkins Team to Boost Patient Safety in ICUs
More sophisticated health care technology has improved mortality and morbidity rates in hospitals, but the increasing use of these innovations has also resulted in patient safety and care-quality challenges. APL and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality will address this problem using an $8.9 million grant to design, implement, and deploy an integrated set of interventions to reduce medical errors in intensive care units (ICUs).
The award, provided by the San Francisco-based Gordon and Betty Moore Foundation, will fund a two-year demonstration project at three sites: the Surgical Intensive Care Unit at Johns Hopkins Hospital (JHH); the Bayview Medical Center, a JHH-affiliated community hospital; and the University of California, San Francisco Medical Center.
Roughly four million Americans are treated in intensive care units every year, and studies show that at least one in every five is harmed during their hospital stay. These adverse events range from ICU-acquired weakness and delirium to ventilator-associated infections such as pneumonia, adult respiratory distress syndrome, bloodstream infections, deep vein thrombosis, and pulmonary embolus.
A significant problem is that health care technologies commonly used in ICUs—infusion pumps, ventilator systems, defibrillators, electrocardiogram analyzers—are not integrated or interoperable, resulting in systems that do not share data or functionality, says Alan Ravitz, of APL’s Research and Exploratory Development Department, who is leading APL’s involvement in the project.
Previous improvement efforts have fallen short, Ravitz notes, because they have required manual data extraction, been focused on a single area of patient harm, failed to take into account the needs of patients and their families, or neglected to address cultural and technical barriers to improvement.
“Health care technology is grossly under-engineered,” says Dr. Peter Pronovost, director of the Armstrong Institute. “Devices don’t talk to each other, treatments are not specified and ensured, and outcomes are largely assumed rather than measured. This project will seek to change that by enlisting systems engineers to ensure patients always get the treatments they should, by engaging patients in every aspect of their care and creating a health care system that continuously improves.”
Says Ravitz: “We will demonstrate that a systems approach to the management of patient care can improve both the processes of care and the outcomes of patients, and facilitate the meaningful engagement of patients and families.”
The team will develop a systems approach to improving care and reducing a variety of negative effects, not only those that harm the patient physically but also those that can damage the dignity and respect of patients and their families. For each type of harm, they will create an approach that incorporates three levels of theory: clinical epidemiology; culture and supporting social structure; and organizational, team, and human factors.
In addition to managing the project, APL—which will receive roughly $3.2 million of the funding—will lead the systems engineering component, including the incorporation of human factors engineering to ensure that technologies developed support improving patient outcomes and enhance the effectiveness and efficiency of clinicians.
Other APL/Hopkins Medicine collaborations on health care improvements include a separate effort to improve the design and operations of medical treatment facilities and a safety initiative aimed at improving the safety of infusion pumps. In fact, the Johns Hopkins Systems Institute—based at the Whiting School of Engineering—provided the research and development funding, as well as the technical oversight, for the development phase of this project, says APL’s Mo Dehghani, the director of the Systems Institute.
“Through these early efforts, we’ve learned key lessons that we intend to apply to the demonstration project,” says Ravitz. “System devices need to be more tightly integrated with the larger IT enterprise and more aligned with workflow and the needs of the patient and family to reduce the risks inherent in the design of some the medical devices.”
Work on the new effort is scheduled to start in November and continue for two years.