Facilities, Research Projects Home in on Patient Care
Providing high-quality patient care does not happen by accident. Rather, it is the result of researching the best ways to manage illness, developing guidelines that correspond with these findings, and then implementing protocols in a consistent, thorough manner. Evidence-based medicine, or the concept of providing health care that is clinically proven to be as safe and effective as possible, provides a framework to manage new information about health and disease.
As with other areas in medicine, the transfusion and cellular therapy communities are trying to provide the best care based on the most updated evidence and suited to patients’ particular needs.
“In our fields, there is a current shift toward outcomes-based research. It is more of a priority to identify patient populations who would benefit from transfusions versus those who wouldn’t, and which patients would benefit from certain types of transfusions,” said Aryeh Shander, MD, chief of anesthesiology at Englewood Hospital and Medical Center in Englewood, N.J. He added that he hopes to see this trend grow in the future.
Mayo Clinic anesthesiology professor Gregory Nuttall, MD, agreed that protocols have to strike a balance between ensuring that all people receive uniformly high-quality care and accounting for individual differences among patients.
“Transfusion guidelines pretty much concur, although there are differences. The Society of Thoracic Surgeons and Society of Cardiovascular Anesthesiologists guidelines are predominantly looking at heart surgery patients, while the American Society of Anesthesiology guidelines are broader, for use in anyone undergoing surgery and anesthesia.”
In the patient care and outcomes arena, there are some medical centers and research projects that are pushing the envelope. One such example is Intermountain Healthcare, a system of hospitals, surgery centers, doctors and clinics based in Utah and southeastern Idaho that has received national press and praise from President Barack Obama for being on the forefront of quality improvement.
Some feathers in Intermountain’s cap include a more than 50 percent drop in ventilator-associated pneumonia — a condition that occurs when patients are intubated and placed on ventilators — from 2004 to 2006. In obstetrics, the facility has decreased the number of elective inductions — when labor is induced for a nonmedical reason — performed on women less than 39 weeks pregnant from nearly 30 to 5 percent while nationwide the number of elective birth inductions has increased. Administering specific protocols for patients with bronchiolitis — an inflammation of the airways that most frequently occurs in infants — yielded faster recoveries and shorter hospital stays. A key element of producing good outcomes at Intermountain has been reducing discrepancies among patients’ treatment, said Brent James, MD, MStat, executive director of Intermountain’s Institute for Health Care Delivery Research, a program that aims to improve quality and reduce cost of health care services.
“Variations from one doctor to another, or one nursing unit to another … [were] endemic — it didn’t matter which specialty or subgroups of health care professionals you looked at,” James said. “We began to address this by asking ourselves the question, ‘Why does this variability exist and how do we know what is really best for patients?’”
To reduce variation and improve upon its services, Intermountain developed courses to instill a shared culture of safety and quality care. The organization also has a 20-day advanced training program in clinical practice improvement focused on quality control geared toward senior leaders, managers and health care professionals. Another course teaches physicians how to recognize when system failures can create errors.
“We decided to make clinical quality a business strategy and started to build core infrastructure within Intermountain for that specific purpose,” Brent said. “The reason we could do it, arguably, is because we had enough graduates of the advanced training program scattered through Intermountain. In a sense, it provided us with the intellectual foundation.”
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