HELPS Really Helps

The Hospitalist. 2006 May;2006(05):

May 1, 2006 | The Hospitalist

Health Systems Participating in HELPS

University of Michigan Health System
Veterans Affairs Ann Arbor Healthcare System
St. Joseph Mercy Healthcare System
Oakwood Healthcare System
Beaumont Hospital
Detroit Medical Center
Henry Ford Health System
Chelsea Community Hospital
Michigan Hospitalists/St. John Health System

At early meetings the hospitalists developed this process for their work together:

Identify a common problem to study;
Present data on the individual hospitalist or hospitalist group’s experience with the problem and a patient safety initiative to correct it;
Create a steering committee and a team to research and present data on the initiative;
Capture and organize data;
Have an on-site visit from a principal investigator who participates in rounds and discusses data collection capabilities;
Present to the group key steps in performing the patient safety initiative;
Implement the initiative in as many of the nine hospitals that want to participate;
Collect data from the larger group and report to the consortium; and
Disseminate results through other regional and national meetings, and peer-reviewed journals.

HELPS’ funding frees participating hospitalists to attend quarterly meetings. Reflecting on their busy professional lives, Dr. Flanders says that groups are participating on different levels.

“We know that some hospitalist groups are stable, and they will propose initiatives, collect data, etc.,” he explains. “Other groups that may have recruiting and turnover issues and are just surviving won’t be able to do so, but their attendance at the meetings is very important. There are also small ad hoc meetings for those working on specific patient safety projects.

Targets for Improvement

HELPS advocates these target areas for improving hospital care

Preventing device-related infections;
Eliminating medication errors;
Creating a culture of safety;
Improving usage of preventive medications for surgical patients;
Managing pain;
Using advance directives in end-of-life care;
Preventing falls and delirium in older patients; and
Developing techniques and measures of data collection to assess the effects of patient safety efforts.

Took the Challenge

Bobby Lee, MD, director of inpatient medical education at the 600-bed Oakwood Hospital and Medical Center in Dearborn, Mich., eagerly joined the consortium when he realized that a large number of patients were being managed by a small number of hospitalist physicians.

“Scott [Flanders] and Sanjay [Saint] were very inclusive of hospitalists from different programs,” says Dr. Lee. “They articulated what’s important to us as hospitalists—that we bring something special to a hospital, to make it a safer place than when we got there.”

Sharing an Idea

Dr. Lee’s initiative, “Preventing Failure to Resuscitate,” addresses the issue that—on average—between 66% and 70% of patients outside the ICU on whom a code blue is called have alterations in their vital signs six to eight hours before the code. Dr. Lee’s solution was a rapid response team (RRT), developed after process analysis and data collection. And he has shared the initiative with HELPS.

“We did a literature review and then collected historical data on code blues at Oakwood,” explains Dr. Lee. “I took the data to our director of accreditation, an RN, and we felt that we could do better.”

After conducting several small pilot projects on different units to determine optimal staffing, equipment, and medications necessary for a quick response to a code, Dr. Lee presented his findings to Oakwood’s senior management, who committed the necessary resources. That includes a CCU nurse, respiratory therapist, either a hospitalist or intensivist, and a medical service resident—four teams in all for 24/7 coverage.