100,000 Lives Campaign adds 1,700 hospitals ... and counting.

Sorrel King knew something was wrong with her 18-month-old daughter, Josie, but no one would listen.

Josie, who was recovering at Johns Hopkins Children's Center from burns she received after scalding herself with hot water, seemed extremely thirsty.

When King gave Josie a sponge bath, the brown-haired, brown-eyed toddler grabbed the washcloth and began sucking on it feverishly. Josie begged for sips from every cup she saw. As the hours passed, the toddler grew pale and weak.

King told the nurses that Josie needed water, but they insisted she would just throw it up. King asked the nurses to call the doctor but everyone assured King that Josie was fine. Then, as King was rubbing her daughter's toes, Josie stopped breathing.

"I just screamed bloody murder. Then 30 people came, with tables and boxes of medicine and they stuck me out in the hall," says King, who recently told the story of Josie's death to kick off the Institute for Healthcare Improvement's ambitious 100,000 Lives Campaign.

Had the campaign existed in February of 2001, when Josie was hospitalized, she would still be alive today, King believes.

Two days later, after being transferred to the pediatric intensive care unit, Josie "died in our arms on a snowy night in what's considered to be one of the best hospitals in the world," King says.

But what was worse is that Josie's death was entirely preventable. Josie died not from her burns, but a chain of tragic human error that Johns Hopkins later admitted.

The toddler, who just days before crawling into the bathtub where she was burned had learned to jump on the trampoline and say, "I love you," was severely dehydrated.

King also believes her daughter was improperly medicated, although Johns Hopkins disputes that point.

King and her family, who reached an undisclosed settlement with Johns Hopkins, say they were so grief stricken and angry about Josie's death, they vowed to do something to stop it from happening to someone else.

Since then, King and her husband, Tony, have become crusaders for medical reform. They even used a portion of their financial settlement to fund patient safety programs at Johns Hopkins.

Counting lives saved

In December, King was invited to tell Josie's story to help launch IHI's 100,000 Lives Campaign, which seeks to prevent 100,000 patient deaths within an 18-month time span.

As part of its campaign, IHI is hoping to get 2,000 hospitals to commit to enact at least one of six steps it believes will prevent patient deaths. So far more than 1,700 hospitals have agreed to participate.

The steps range from empowering floor nurses to deploy rapid response teams to prevent patients from going code blue--the step King believes would have saved Josie--to standardizing hygiene to prevent infections.

"It started because we were feeling a serious sense of urgency around trying to rapidly and broadly improve patient care in the U.S.," says Joe McCannon, the campaign manager for IHI. "We felt a lot of the errors and harm and mortality are avoidable and inexcusable."

The campaign, which ends at 9 a.m. on June 14, 2006, is the largest undertaking ever made by the organization. The organization usually works with 50 to 100 hospitals to improve a specific area of care.

The 100,000 Lives Campaign is different from similar initiatives like the Leapfrog Group's patient safety effort. While both focus on specific steps to reduce medical errors, Leapfrog is led by corporations and consumers of health care who are applying outside pressure to hospitals. The IHI campaign is an effort to get hospitals to fix the problems from within.

While the campaign seems like a noble cause, some quality experts, like David B. Nash, MD, MBA and chair of the Department of Health Policy at Thomas Jefferson University Hospitals in Philadelphia, question whether it will succeed.

Nash says one problem IHI might have is living up to its promise of tracking the number of lives saved. He says it's easy to count lives lost, but much harder to count lives saved. Also, individual hospitals might have problems explaining the campaign to patients.

"The challenge will be helping the public understand what this is all about. How would you like it if you were a patient, or going to be a patient, and you learned the hospital you were planning to go to had just joined this (campaign?)," Nash asks.

"Patients might legitimately ask, 'Are you kidding? Why do we need a special national program for this? Isn't this already being done?'"

But Jonathan Small, IHI's director of communications, says he believes the public will applaud the hospitals' efforts. He also says that IHI plans to do its best to provide hard data. He says IHI is in the process of developing a baseline. Once that is established, IHI will begin tracking the number on a daily basis on its Web site.

He says the numbers will not be of scientific precision. Still, he believes it will be an accurate representation of the lives saved.

"Finding someone whose life we saved is a challenging thing to nail down. The way we are approaching it is we know when the interventions are put in place, it results in these lives saved," Small says.

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Gaining momentum

The campaign has been gaining momentum. In addition to the 1,700 hospitals that have pledged to be a part of the campaign, several key medical associations have joined as partners, including the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services. (ACPE is also a supporter.)

One big hitter, the American Hospital Association, however, has not joined the campaign. The AHA, however, did issue a statement saying it applauds IHI's efforts.

Nancy Foster, vice president for patient safety and quality policy at AHA, says her organization has not joined as a partner because it is already committed to several other efforts to make hospitals safer.

"We felt we wanted to stay focused on those efforts that we had already promised our support to," Foster says.

The IHI campaign requires participating hospitals to track mortality rates and report them to IHI. The numbers will only be released as an aggregate number, McCannon says.

The six steps, developed by IHI after reviewing case studies that showed such actions reduced hospital deaths, are:

* Deploy Rapid Response Teams -- by allowing any staff member, regardless of position in the chain of command, to call upon a specialty team to examine a patient at the first sign of decline.

* Deliver Reliable Evidence-Based Care for Acute Myocardial Infarction -- by consistently delivering key measures--including early administration of aspirin and beta-blockers--that reduce patient deaths from heart attack.

* Prevent Adverse Drug Events -- by implementing medication reconciliation, which requires that a list of all of a patient's medications be compiled and reconciled to ensure that the patient is given the right medications at the correct dosages.

* Prevent Central Line Infections -- by consistently delivering five steps collectively called the "Central Line Bundle."

* Prevent Surgical Site Infections -- by reliably delivering the correct perioperative antibiotics, maintaining glucose levels and avoiding shaving hair at the surgical site.

* Prevent Ventilator-Associated Pneumonia -- by implementing five steps collectively called the "Ventilator Bundle"--such as elevating the head of the hospital bed by 30 degrees--thereby dramatically reducing mortality and length of stay in the intensive care unit.

All Children's Hospital in St. Petersburg, Fla. is among those that have agreed to participate in the campaign.

All Children's has pledged to make an effort to prevent central line infections and develop a rapid response team, says Judi Vitucci, administrative director of quality and outcomes.

"I like the idea of a national campaign where everyone is trying to change the same thing so you can actually quantify national improvement. The other thing I liked is it's very well planned for the participants so when you commit to participating, you already know what the goal is," Vitucci says.

"You know what's going to be measured and how it's going to be measured. In a lot of other national efforts, you waste a lot of time trying to figure out what changes are going to be made and how you are going to measure it."

National effort

Vitucci says the campaign could help standardize care not just within a given hospital, but across the country.

"There is some regionalization of care. If you are in the Northeast, for example, treatment may be a smidge different than in the South or California. What IHI did was look at the evidence, this is the best evidence we have for treatment, pulled it out and wrote it down so everybody is using what's in the literature, not just what their lead physician says is the best way to do it."

She says selling the idea to her hospital was easy because it was already planning to make a concerted effort this year to reduce central line infections and establish rapid response teams.

But she says she can understand why some hospitals might be leery about joining. Some might be afraid of the time commitment. Others might be afraid it would be hard to sell the concept to physicians, who might not want to follow a standardized protocol. Still, other hospitals, she says, might be afraid their efforts to reduce mortality rates might be misconstrued by the public.

"Some people will say if it gets into the press that we're working on it, it implies that we're not the best we can be," Vitucci says.

Forest Park Hospital in St. Louis, Mo., is among the hospitals that have joined the campaign and has no qualms about publicizing it, says Laurence Kinsella, MD, president of medical affairs at Forest Park.

Kinsella says he saw the campaign as a way to show the public that the newly purchased, 450-bed hospital is committed to quality health care.

"We saw it as a wonderful opportunity to not only improve the quality of care, but also the added benefit of public relations and community relations," Kinsella says.

Kinsella's hospital has pledged to enact all six steps, although the hospital had already begun putting some of the steps in place prior to the campaign. He says they are most excited about the rapid response team, which they are in the process of testing in a portion of their hospital.

Forest Park's rapid response team consists of a critical care nurse, respiratory therapist and a resident physician, who agree to respond to a page within two minutes.

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"Once the heart stops or respiration stops completely, it's very hard to impact the patient positively. The goal is, and what we try to teach our nurses, is to identify what the subtle changes are and what the criteria is to get intervention. Get that patient some help before he spirals down to that resuscitation event."

The rapid response concept was first tested in 1999 with great success at Austin Hospital in Australia. In August of 2003, Baptist Memorial Hospital-Memphis began testing it.

The 736-bed hospital started with a 10-day pilot and had immediate success, says Kathy Duncan, RN and director of critical care at the Memphis hospital. In the past 16 months, hospital deaths have dropped by 7.5 percent, Duncan says.

Another advantage, Duncan says, is that more patients are now coding within ICU. She says that demonstrates that the patients are being identified early enough to be moved to an area where they are at least afforded the best help available. Prior to the rapid response team, 65 percent of the codes were outside ICU, she says.

"We've had some phenomenal results. It really does seem to affect hospital survival," she says, adding that it not only has saved lives, but it also has boosted morale.

"I really believe our nursing culture has changed," she says. "We really are working together--ICU and non-ICU nurses--to take care of the patients."

Dr. Kinsella says he, too, has seen positive results.

"Last night we had two calls. The nurse noted a patient in trouble. The rapid response team came by and saw the patient's blood sugar was low. They gave her some glucose and she responded right away," he says.

"Another patient was getting a transfusion. She became short of breath and uncomfortable. She had pulmonary edema, too much fluid in the lung. Treating her very early prevented the woman from having respiratory arrest," Kinsella says.

King says she, too, is excited about the rapid response team concept. She says she believes a team, like the one at Forest Park, would have saved her daughter's life.

"Had that been in place when my daughter was in the hospital, I think I can say with 100 percent of my heart that she would be alive today," she says. "I think some nurse would have pushed the button."

King says she is hopeful that more hospitals will join the growing number of efforts, like IHI's, to prevent medical errors. She says the key to the efforts is communication and a mutual respect for everyone's opinion.

"The medical community must be open to the possibility that short-comings do exist, and you must be prepared to make the necessary changes," King says.

Twila Davis is a freelance writer and former reporter for the Los Angeles Times.