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The New Health Dialogue

A Blog from New America's Health Policy Program

QUALITY: Every Patient, Every Time

Published:  August 5, 2009

The term "cookbook medicine" gets thrown around a fair amount these days, especially surrounding stepped up comparative effectiveness research. Most professionals in the health dialogue agree that this information will help improve the quality of care by deepening our understanding of what works for whom, when. But standardization also has its opponents, on the right, the left, and among some physicians.

But if there is one generally agreed upon best way to conduct bypass surgery, and another one that's been found to result in higher mortality, wouldn't you want your family member's physician to follow the cookbook?

The Institute for Healthcare Improvement (IHI) is an unwavering supporter of using evidence to improve and standardize certain processes that are known to improve patient outcomes. They recently hosted a webinar to advertise four collaboratives that they are continuing and recruiting members for this fall: Transforming Care at the Bedside, Improving Perinatal Care, Reducing Readmissions by Improving Transitions in Care, and Reducing Sepsis Mortality.

According to the webinar, about 80 percent of what happens to a patient should happen to all patients the same way. Deviation from this will result in poorer quality care, hence the mantra learned from the event: Every patient, every time. The other 20 percent should be personalized to the patient. We're all different after all; "cookbook" isn't cookie cutter.

And of course, it's a collaborative. Participants are expected to contribute their findings to IHI so that hospitals and clinicians can learn from each other's experiences. They encourage new participants to only focus on one or two interventions so that they don't overextend themselves. We learned this studying the Hill Physicians Medical Group: it's important to build in short term wins to give participants a taste of success.

It's the big wins, though, that are impressive. Using a rounding strategy called "intentional rounding," the VA serving Nebraska/Western Iowa has had zero patient falls for the past six months. Baystate Medical Center in Springfield, Massachusetts has had zero hospital-acquired acute pressure ulcers for the past four months. This is real progress. And it is replicable.

I want to focus on Transforming Care at the Bedside, which aims to increase the amount of time nurses spend with patients. It's a joint initiative between IHI and the Robert Wood Johnson Foundation. One change that has helped improve time at the bedside is to reduce the nurses' "hunting and gathering" role. The solution was to put supplies at the bedside; each patient's room now has many of the tools nurses need to provide care instead of making nurses run around to supply closets at the other end of the hospital. Some sites have also been able to keep medicines by the bedside. A locked cabinet prevents tampering, theft, or self-administration. For a great YouTube on this initiative, click here. It's five minutes -- a little long for a YouTube, but highly recommended.

If you're interested in the other three collaboratives, I encourage you to click the links above and explore the IHI Web site. We've also written on perinatal care here and here, reducing readmissions numerous times, and reducing sepsis here and here.

Medicine is indeed more art than science -- but as we expand the clinical knowledge base, science is becoming a more robust minority partner.

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