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Seeing a Way Forward

Seeing a Way Forward. Peter Pronovost, MD, PhD Johns Hopkins University. Bilateral cued finger movements. Translation Superhighway. Pronovost . The Safety of Healthcare 2000 -2005. Median Improvement : 2000-2005 All Selected Measures (117) 1.9% Heart Disease (n= 16) 5.6%

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Seeing a Way Forward

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  1. Seeing a Way Forward Peter Pronovost, MD, PhD Johns Hopkins University

  2. Bilateral cued finger movements

  3. Translation Superhighway Pronovost

  4. The Safety of Healthcare 2000 -2005 Median Improvement : 2000-2005 All Selected Measures (117) 1.9% Heart Disease (n= 16) 5.6% Cancer (n=15) 3.6% Maternal & Child Health (n=12) 1.5% Safety (n=25) 1.0% Diabetes (n=9) 0.6% National Healthcare Quality Report 2008

  5. Disparities in Healthcare Quality are Staying the Same or Increasing National Health Disparities Report 2008 n=number of core measures

  6. Will you commit to eliminate preventable harm and suffering in your unit, organization, state, or nation?

  7. Are the citizens of Tennessee less likely to harmed? How do we know?

  8. ICU Safety Dashboard Pronovost JAMA 2007

  9. Comprehensive Unit-based Safety Program (CUSP) • Educate staff on science of safety http://www.jhsph.edu/ctlt/training/patient_safety.html • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter and implement teamwork tools Pronovost J, Patient Safety, 2005

  10. Interventions to prevent Blood Stream Infections: 5 Key “Best Practices” • Remove Unnecessary Lines • Wash Hands Prior to Procedure • Use Maximal Barrier Precautions • Clean Skin with Chlorhexidine • Avoid Femoral Lines MMWR. 2002;51:RR-10

  11. Ensure Patients Reliably Receive Evidence Pronovost: Health Services Research 2006

  12. Ideas for ensuring patients receive the interventions • Engage: stories, show baseline data • Educate staff on evidence • Execute • Standardize: Create line cart • Create independent checks: Create BSI checklist • Empower nurses to stop takeoff • Learn from mistakes: review infections • Evaluate • Feedback performance • View infections as defects

  13. Break Through Idea • Technical versus Adaptive • I thou versus I it • Material versus relationship

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