January / February 2007
5 Million Lives
IHI Launches National Campaign to Reduce Medical Harm
IHI Estimates That 15 Million Incidents of Patient Harm Occur in U.S. Hospitals Each Year
The Institute for Healthcare Improvement (IHI) has announced, with the support of prominent leaders in American healthcare, a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. The 5 Million Lives Campaign will ask hospitals to improve more rapidly than before the care they provide in order to protect patients from five million incidents of medical harm over a 24-month period, ending December 9, 2008. This represents a continuation of the largest improvement effort undertaken in recent history by the healthcare industry.
The Campaign was announced by IHI President and CEO Donald Berwick, MD, MPP, speaking before thousands of healthcare professionals attending the organization’s 18th National Forum, held in Orlando. The new Campaign, which will be sponsored principally by America’s Blue Cross and Blue Shield health plans, builds upon the success of the 100,000 Lives Campaign, in which 3,100 participating hospitals reduced inpatient deaths by an estimated 122,000 in 18 months through overall improvement in care, including improvement associated with six interventions recommended by the initiative.
Joining Dr. Berwick at his announcement were leaders of America’s Blue Cross and Blue Shield health plans, the American Hospital Association (AHA), the American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), each pledging that their organization will act as national champions and clinical advisors for the critical work ahead. Also present on stage was Sorrel King, a patient safety activist whose daughter died from a medical error in 2001.
The 5 Million Lives Campaign will promote the adoption of 12 improvements in care (below) that can save lives and reduce patient injuries, and it aims to enroll even more hospitals than participated in the previous Campaign.
“No one in healthcare can feel comfortable with the magnitude of infections, adverse drug events, and other complications that hospital patients endure. Dozens of organizations and programs are now working to reduce that toll. They deserve encouragement. This Campaign joins those efforts, and seeks leverage and scale that our nation has never had before to make care safe — everywhere,” said Dr. Berwick. “We can, and we will, equip all willing healthcare providers with the tools they need to make the motto, ‘First, do no harm,’ a reality.”
IHI estimates that 15 million incidents of medical harm occur in U.S. hospitals each year. This estimate of overall national harm is based on IHI’s extensive experience in studying injury rates in hospitals, which reveals that between 40 and 50 incidents of harm occur for every 100 hospital admissions. With 37 million admissions in the United States each year (according to the AHA’s National Hospital Survey for 2005), this equates to approximately 15 million harm events annually — or 40,000 incidents of harm in U.S. hospitals every day.
Several preeminent authorities on patient safety and healthcare improvement have reviewed and endorsed this estimate and the Campaign’s aim. These include: Lucian Leape, MD, adjunct professor of Health Policy at the Harvard School of Public Health; Brent James, MD, executive director of Intermountain Healthcare’s Institute for Healthcare Delivery Research; Ross Baker, PhD, professor of Health Policy, Management and Evaluation at the University of Toronto; and David Bates, MD, medical director of Clinical and Quality Analysis, Information Systems at Partners HealthCare System.
IHI defines “medical harm” as unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization, or results in death. (Please consult www.ihi.org for a detailed definition of medical harm.)
“The goal of protecting patients from five million incidents of medical harm in two years is ambitious, but patients and families deserve no less,” said Campaign Manager and IHI Vice President Joe McCannon. “We’re inspired to know that so many courageous hospitals and healthcare leaders share our commitment to addressing this problem. This is the next big step in a major national effort to completely transform the quality of the care Americans receive.”
The 5 Million Lives Campaign aims to enlist 4,000 hospitals, challenging all to adopt up to 12 of the following interventions — six of which were included in the 100,000 Lives Campaign and six of which are new:
New interventions targeted at harm
- Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) infection… by reliably implementing scientifically proven infection control practices throughout the hospital.
- Reduce harm from high-alert medications… starting with a focus on anticoagulants, sedatives, narcotics, and insulin.
- Reduce surgical complications… by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP).›
- Prevent pressure ulcers… by reliably using science-based guidelines for prevention of this serious and common complication.
- Deliver reliable, evidence-based care for congestive heart failure… to reduce readmissions.
- Get Boards on board… by defining and spreading new and leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating the improvement of care.
The six interventions from the 100,000 Lives Campaign
- Deploy Rapid Response Teams… at the first sign of patient decline — and before a catastrophic cardiac or respiratory event.
- Deliver reliable, evidence-based care for acute myocardial infarction… to prevent deaths from heart attack.
- Prevent adverse drug events… by reconciling patient medications at every transition point in care.
- Prevent central line infections… by implementing a series of interdependent, scientifically grounded steps.
- Prevent surgical site infections… by following a series of steps, including reliable, timely administration of correct perioperative antibiotics.
- Prevent ventilator-associated pneumonia… by implementing a series of interdependent, scientifically grounded steps.
There is no cost for hospitals to join the 5 Million Lives Campaign though there is an obligation to adopt at least one intervention and an expectation of regularly reporting hospital profile and mortality data throughout the Campaign.
The 5 Million Lives Campaign is made possible through the generous leadership and support of America’s Blue Cross and Blue Shield health plans. IHI also acknowledges the leadership and support of the Cardinal Health Foundation, and the support of the Blue Shield of California Foundation, the Aetna Foundation, Baxter International, Inc., and Abbott Point-of-Care. This initiative builds on work begun in the 100,000 Lives Campaign, supported by Blue Cross Blue Shield of Massachusetts, the Cardinal Health Foundation, the Rx Foundation, the Gordon and Betty Moore Foundation, The Colorado Trust, the Blue Shield of California Foundation, the Robert Wood Johnson Foundation, Baxter International, Inc., The Leeds Family, and the David Calkins Memorial Fund.
Scientific partners in this work are led by the American Heart Association (and its closely aligned Get-With-The-Guidelines Program), the American College of Cardiology, American Society of Health-System Pharmacists, the Association for Professionals in Infection Control and Epidemiology, the Institute for Safe Medication Practices, and The Society for Healthcare Epidemiology of America. Additional Campaign partners include the Agency for Healthcare Research and Quality, American Health Quality Association, National Business Group on Health, National Patient Safety Foundation, VHA Inc., Premier Inc., National Quality Forum, Leapfrog Group, National Rural Health Association, Ascension Health, Kaiser Permanente, Allina Hospitals and Clinics, SSM Healthcare, the Society of Hospital Medicine, and the American Board of Internal Medicine.
As a result of the 100,000 Lives Campaign, joining other effective improvement efforts in American healthcare, many patients have begun to enjoy a new standard of care. Participating hospitals have also made great headway in delivering reliable care for acute myocardial infarction, preventing adverse drug events, and preventing surgical site and central line infections. Dozens of facilities have reported that they have gone over a year without a ventilator-associated pneumonia, a leading killer among all hospital-acquired infections, demonstrating that this sort of complication is not inevitable. Hundreds of hospitals have also now instituted rapid response teams, a relatively new concept that is saving lives.