18. Simple Sense

We are in an era of elaborate medical technology, complicated medical procedures, sophisticated medications, detailed medical regulations, etc. That is reality. It makes this next point quite striking: simplicity is saving lives.

We first came across the utility of checklists in January. By February the powers-that-be declared them to be useful.

Here are some more examples.

Look-alike, sound-alike medications are a problem. Think Heparin. What’s the solution? Make the adult and child containers look as different as possible so providers never mistake the difference. Makes sense. But Paul Levy on Running a Hospital provides an example of an idea that makes Simple Sense:

Our head of pharmacy, Frank Mitrano, likes to say that he wishes that all drugs were packaged in exactly the same sized containers, with covers and lids of the same color, and with simple black lettering on a white background in the same font. Why? Because it is human nature to assume that a vial of medicine with a green cap and green lettering is, in fact, the medicine you were looking for, even if it is something quite different. And, also, the more layers of safety protection information systems and other technology that you have in place, the more likely you are to assume that you have the correct drug and the less likely you are to read — in detail — what the label actually says before administering the drug to a patient. On the other hand, if every vial were to look exactly the same, a human being would actually have to carefully read what is in it before administering a drug.

The Health Blog shares the story of New York City public hospitals and their ability to reduce ICU infections. “But if you find yourself in intensive care in one of New York City’s public hospitals, your chance of catching some nasty infections is way down. And you can thank some pretty simple measures for the improvement.” Simple Sense. Here’s the explanation:

“It’s not rocket science,” Alan Aviles, the hospital system’s CEO, told Health Blog. “It is really four or five or six relatively simple practices that need to be followed every time.”

One kind of hospital-acquired infection — ventilator-associated pneumonia — plummeted by 78% between 2005 and 2007 at the New York City Health and Hospitals Corp., the organization said. Another, central-line infections, fell 55%. Surgical-site infections fell as well, but not as dramatically.

Another way to look at it: The country’s biggest public hospital chain — with 11 facilities and 30% of its patients uninsured — has averaged 5.2 months without a central-line infection, and 5.8 months without a case of ventilator-associated pneumonia.

Mr. Aviles says the hospitals focused on specific “bundles” of precautionary measures to tackle each kind of infection: elevating the heads of ventilator patients and giving them periodic respites from sedatives that can worsen infection risks.

Or, to prevent central-line infections — blood infections acquired when doctors insert a catheter deep in the body — the hospital emphasizes hand-washing, deciding each day whether a patient really still needs a central line, and using drapes and other barriers to isolate the catheter’s entry point from other areas of the body that may be colonized by bacteria.

Birth can become a complicated medical procedure quite quickly.  Fierce Healthcare summarizes a USA Today story in which Premier research says that three of every 1000 infants are injured at birth—and that 80% of those injuries could be prevented.  They are using Simple Sense:

The project, backed by healthcare alliance Premier Inc., is designed to address the major sources of birth injury identified by the Alliance, including failing to recognize when a baby is in distress, failing to perform a timely C-section, failing to properly resuscitate a baby, inducing labor inappropriately with drugs, and using vacuums or forceps inappropriately.

Hospitals participating in this project have committed to following a set of guidelines proven to reduce harm to infants and mothers in each of these situations. Not only that, hospitals are drilling their staff on how to respond, with Harris Methodist Fort Worth Hospital, or example, offering staff the chance to practice with computerized simulators named “Mama Noelle” and “Baby Hal.”

Teams are also taking the time to develop clear plans ahead of time for how to deal with dangerous situations. For example, doctors and nurses are creating agreements on how many attempts to make before using a vacuum device to deliver a baby. While developing such strategies is time consuming, hospital leaders and Premier officials believe that the time spent will pay for itself in reduced expenses and fewer lawsuits.

Principle #18: Simple Sense makes sense.  We are on a mission of constant innovation and reducing complicated processes to their simplest, most effective possible iterations is an ongoing necessity.  Simplicity saves lives.  We need more of it.  our own system is committed to Simple Sense.