The Johns Hopkins Armstrong Institute for Patient Safety and Quality will work with 750 U.S. hospitals to improve surgical care for patients under a federal contract that could be worth up to $16 million.
Doctors at Johns Hopkins Medicine will share with other hospitals how they provide care to surgical patients in the effort designed to improve outcomes and reduce risks to patients nationwide.
The patient care guidelines already are used widely in Europe and were adopted by Hopkins in 2013. They address care before, during and after surgeries.
The American College of Surgeons will collaborate on the initiative with the Hopkins Armstrong Institute, long a leader in the development and dissemination of checklists and other means for reducing medical errors, a leading cause of death in hospitals. The project is being funded by the U.S. Agency for Healthcare Research and Quality, which awarded an initial $4 million contract for one year with three one-year options worth $4 million each.
"What's a little different about this is that it focuses on safety, preventing harm that happens to patients in the hospital, but it also focuses on quality," said Michael Rosen, an associate professor of anesthesiology and critical care medicine at the Hopkins Institute. "That means making sure after they go in for a surgical procedure that they return to a normal qualify of life as soon as possible."
The method, called "enhanced recovery after surgery," focuses on five common types of surgery, including colorectal surgery. Hopkins found the approach reduced complications on patients who had colorectal surgery, sent them home faster and reduced medical costs.
Hopkins will show other hospitals, recruited by the American College of Surgeons, how to achieve similar results.
The Hopkins Institute will work with the surgeons organization and the federal health care quality agency to help participating hospitals assess their current practices and adopt new ones. All will track the health and satisfaction of patients.
Rosen said participating hospitals will engage better with patients and their families before surgery so they know what to expect and can participate more fully in recovery. Surgeons, anesthesiologists and nurses will ensure all safety measures are taken during surgery. And afterward, the focus will be on getting patients up and moving.
The effort will begin specifically with colorectal surgery patients and later expand to bariatric, orthopedic, gynecological and emergency surgeries. Rolling out the methods separately will allow doctors, nurses and others specializing in specific procedures to compare notes.
Rosen said the difficulty will be in launching such a program at so many hospitals that already have their own procedures, which already may have been enhanced and cemented over the years to improve safety and satisfaction. Often doctors within a specialty have slightly different procedures that they have become comfortable with.
The data from Hopkins and other hospitals in Europe, he said, should help medical staff and administrators at American hospitals see the benefits of embracing the new protocols clinically and culturally. At Hopkins, hospital stays were reduced by a day and a half and costs were cut by $1,500 using the protocols. Complications also were reduced, including a 50 percent decrease in surgical site infections.
The costs to hospitals are minimal, though they may require adding or moving staff to coordinate patient care before, during and after surgery. The units within hospitals that provide each level of care are often accustomed to operating independently.
Hospital recruitment has begun and Rosen said some results may be available by the end of the year.
"We know that patients usually fare better when they recover quickly from operations," said Dr. Clifford Y. Ko, director of the American College of Surgeons' division of research and optimal patient care.
The new protocols, he said, "will set the standard and provide a framework for hospitals across the nation to successfully carry out a program that delivers better outcomes for surgical patients."
Dr. Peter Pronovost, director of the Armstrong Institute and senior vice president of patient safety and quality for Hopkins Medicine, added that patients still are suffering complications and prolonged hospitalizations after surgery even though preventive measures exist.
"This program brings these recommended practices together into one coordinated, unified program where everyone — clinicians, patients and their loved ones — understand what they must do for the best possible outcome," he said.