But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Friday, April 13, 2007

I want to be proud, but I am not

I had hoped never to have to say such a thing. BIDMC is a wonderful hospital, full of warm, well-intentioned, and competent people who achieve excellent clinical results and even the occasional miracle. But I saw numbers recently that make me cringe. So it is time to let you know -- and to let my staff know -- that enough is enough.

I am talking about hand hygiene. I have raised this topic before and have referred to the national problem. Medical staff can't seem to remember that germs can be carried from one room to another, and one patient to another. OK, they know this, and they believe it. But they can't seem to toss off bad habits and adopt ingrained behavior to make sure they practice proper hand hygiene.

I like to think that things have improved from the 1840s:

Ignaz Philipp Simmelweis, while working as a doctor in Vienna from 1844 to 1850, determined that ... childbed fever was being spread in maternity hospitals by dirty hands. He proved that a chlorine hand wash reduced deaths from 18.27 percent to 1.27 percent. His superiors scorned his findings and eventually he lost his position. In the city of Pest, he repeated the hand washing measures, reducing mortality due to childbed fever to an average of 0.85 percent while elsewhere the death rate was 10-15 percent. Despite acceptance of his work by the young medical students and by the government of Hungary, and being published in medical journals of the time, his work was disdained by the academic authorities of the time.

But, maybe they have not improved. How else to explain the lack of compliance with well established principles of hand hygiene.?

So why am I upset? After months of intensive effort and various education and other campaigns, our compliance with hand hygiene has risen from 52% on our medical-surgical floors to 57%. Sure, it is great to see it rising, but does this result provide confidence to anyone out there that the message has sunk in? And, some floors remain at or below 40%. The results are better in the ICUs, rising from an average of 60% to 71%. But, in the words of our Quality and Safety staff, "opportunities remain for performance improvement and sustainability of improvement."

The results on one particularly noncompliant floor have prompted one of our Chiefs to write to his physicians:

It is bad patient care.
It increases our post op infection rate.
We should be setting the example for the students and nurses.
I have asked [the nurse manager] to have the nursing staff call attention to any physician, resident, staff, PA, med student, fellow, etc) on the ... service who does not wash his or her hands. This is meant to remind you. If I hear of anyone reprimanding a nurse for such a reminder, you will hear from me and it won't be a friendly call. I have no problem with you reminding the nursing staff if you see a lapse as well. Together we must achieve 100% compliance. There is no reason not to.

There is no reason not to. Dear BIDMC, please make me proud.

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