New York Hospitals Take Time Out to Avoid Preventable Complications

Monday, May 19th, 2008
This post was written by Melanie Matthews

Staffers at 11 New York hospitals are taking time out to wash hands, put on hairnets and complete procedure-specific checklists in order to reduce the number of serious infections that afflict hospital patients, according to a story in today’s New York Times.

As a result, hospital-acquired infections in the Big Apple have dropped dramatically since 2005, according to statistics released last week by the city’s Health and Hospitals Corporation (HHC), which administers the city’s 11 hospitals.

In late 2005, the HHC adopted a series of simple, standardized protocols based on those developed by Dr. Peter J. Pronovost, a crusader against preventable hospital deaths and a professor of anesthesiology and critical care medicine at Johns Hopkins University. Dr. Pronovost calls his protocols a checklist, and that is pretty much what they are.

A red binder at the nursing station at Woodhull contains dozens of forms, labeled “Central Venous Catheter Insertion Checklist,” which instruct doctors to, first of all, make sure that they have the right patient and are planning the right procedure. The 14-item list goes on to include washing hands; putting on caps, masks, sterile gowns and gloves; draping the patient from head to toe; preparing the patient’s skin with chlorhexidine antiseptic; maintaining a sterile field; and applying a sterile dressing.

One person, usually a nurse, acts as the referee by calling, “Timeout!” and checking off the “completed” or “not completed” columns on the list as each step is called out and performed.

Beginning in October, Medicare, the federal insurance program for the elderly, will no longer cover the additional cost of eight preventable complications: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three “never events”: objects left in the body during surgery, air embolisms and blood incompatibility.

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