Hopkins aims to make ICU safer with $8.9 million grant

Johns Hopkins will use an $8.9 million gift to make intensive care units safer for patients, expanding on the institution's past work to reduce medical mistakes that have long troubled hospitals.

The grant is part of a 10-year, $500 million program — called the Patient Care Program — announced Tuesday by the Gordon and Betty Moore Foundation to eliminate all preventable harm to patients in hospitals.

The program seeks to improve health outcomes by eliminating medical error, better engaging patients in their care, and using technology to better coordinate patient care. The foundation plans to fund several projects in coming years.

"It is a start today, but one that we see gaining momentum in years to come," said Steve McCormick, president of the Gordon and Betty Moore Foundation.

Foundation leaders said they are starting their efforts with the ICU because the complexities of cases lead to many errors. They also said they will be able to quickly see if new initiatives work because patients' conditions are ever-changing.

"We think we can use what we learn from the ICU and apply it in other health care settings," Dr. George Bo-Linn, chief program officer for the Patient Care Program, said after an event in Washington where the funding was unveiled.

The foundation chose to work with the Johns Hopkins Armstrong Institute for Patient Safety and Quality because its leader, Dr. Peter J. Pronovost, has already had great success at improving safety conditions in the hospital. Pronovost is well known for creating a simple medical checklist to reduce central-line associated bloodstream infections. The checklist has been adopted by hospitals around the world.

Pronovost said he hopes to create a more efficient and better coordinated ICU. Right now, devices don't talk to each other, meaning doctors and nurses have to check patients from several machines. ICUs contain 50 to 100 pieces of equipment that aren't integrated, made by dozens of designers.

"The best ICUs are not good enough," Pronovost said. "They look the same as they did 30 years ago."

Plans are to look at ways to integrate the newest technologies to bring the ICU into the 21st century.

The medical community began work to curb mistakes in hospitals nearly a decade ago after a report by the Institute of Medicine blamed medical errors for up 100,000 patient deaths a year.

Nationally, one in five patients is harmed during a hospital stay and 60 percent of the incidents are preventable.

As many as 40,500 critically ill patients die in U.S. hospitals with an unknown medical condition that may have caused or contributed to their death, a Hopkins study released Monday found. Diagnostic errors in the ICU claim as many lives as breast cancer, the study found.

The Gordon and Betty Moore Foundation is a 12-year-old organization that works to promote environmental conservation, scientific research and patient care. The new patient care program builds on a nursing initiative the foundation said has improved the care of adult patients in Northern California. Also Tuesday, the foundation awarded $2.1 million for a study led by the University of California, San Francisco of team-based care and patient involvement at ICUs.

Gordon Moore is the co-founder of Intel Corp.

A main focus of the foundation's patient care efforts is to improve patient and doctor communication. Studies have found that when patients are engaged they have better outcomes.

During Tuesday's event, patient Nicole D. James told of a recent stay at a hospital for complications of sickle cell anemia. James' doctor treated the Elkridge resident for pneumonia during her stay, but didn't tell her.

James had a bad reaction to the medicine, turning a one-night stay into two weeks. But what the doctor thought was pneumonia was actually scar tissue on her lungs.

"If he would have talked to me, I would have told him that," James said.

Pronovost hopes to create a checklist method for the ICU, much like he did to combat infections. Pronovost said a patient in the ICU may have multiple conditions that require hundreds of different types of daily treatments, but there is no list of what needs to be done.

Hopkins has already begun some research on improving the ICU model. Last year, it announced a deal with defense contractor Lockheed Martin to develop technology to create a more up-to-date ICU.

Executives at the Institute of Medicine, one of the first to point out the problems with medical errors, praised the efforts by the foundation.

"This is a genuinely significant step in this effort," said Michael McGinnis, a senior scholar with the institute.

The effort will involve working with people from all disciplines, including clinicians, engineers, bioethicists and others.

Proctor Reid, a program director with the National Academy of Engineering, said the medical industry could learn from manufacturers and airlines that already have integrated systems in place.

"Some of this is already being done," he said. "It's a matter of adapting it to health care and health care services."



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