Championing Patient SafetySince taking the helm of UCSF Medical Center seven years ago, Laret has championed a culture of care and safety. The medical center has engaged the entire leadership, including department chairs, service chiefs, nursing managers and others leaders involved in clinical care, to focus on quality and safety through consistent communication as well as annual retreats. Progress in maintaining the highest standards of care is reflected in accreditations, rankings and activities. Recently, UCSF Medical Center:
- Received full accreditation from the Joint Commission, a nonprofit agency that evaluates and accredits health care facilities nationwide.
- Ranked No. 7 among the nation's top 10 hospitals in the 2007 annual ranking by US News & World Report.
- Ranked in the top 10 out of the nation's premier academic medical centers in overall quality in a study by the University Health System Consortium (UHC).
Reporting ResultsSetting the standard for patient safety is ever more important in today's era of accountability and transparency, in which accreditation and government agencies are raising the standards and patients and the public at large are demanding consistent, high-quality care, Laret says. Increasingly, that demand is driving the proliferation of web-based report cards which publish hospitals' quality and satisfaction scores and outcomes, so that consumers and purchasing organizations can make informed health care choices. Ring says that patients should consider many factors when reviewing these online surveys. When were the data compiled? Is the information current? Academic medical centers like UCSF Medical Center often care for the most seriously ill patients, as well as newborns and the elderly, who are transferred from community hospitals that don't have the resources and expertise to care for these patients. Some patients come to UCSF for its nationally renowned palliative care program. Do the surveys take into consideration these factors when evaluating hospitals?
Cecelia Glennon, a clinical research nurse for the UCSF Clinical and Translational Science Institute Pediatric Clinical Research Center, treats a patient at UCSF Children's Hospital.
Leading the WayOne way that UCSF has led the nation in improving patient safety is by employing hospitalists, the doctors who coordinate the array of treatments a hospitalized patient may receive. Hospitalists are well-positioned to see where errors begin and how to correct them, says Robert Wachter, professor of medicine, chief of the Medical Service and chair of the Patient Safety Committee at UCSF Medical Center. "At UCSF, we were the first to recognize the potential value of hospitalists," says Wachter, who coined the term in 1996 with Lee Goldman, former chair of the Department of Medicine. "Last year, we looked at what other patient populations would benefit from the enhanced quality and safety of care, and put hospitalists in the bone marrow transplant unit and neurosurgery." Wachter says that today, an internist-hospitalist is helping co-manage dozens of patients on the neurosurgery service who have medical problems like diabetes, infections and heart failure. It is really a critical position, since most neurosurgeons spend a huge amount of time in the operating room. Now, the hospitalist manages emergencies, tries to anticipate and prevent problems, and provides early response treatment when necessary. From its hiring of two hospitalists in 1995, UCSF Medical Center now employs 38. Today, more than 20,000 practice in hospitals across the nation, making the hospitalist field the fastest growing specialty in the history of American medicine, Wachter points out. "We have really pushed our hospitals - and those across the country - to not only focus on providing terrific care to individual patients, but also to be leaders in making their hospital system work better," says Wachter, who wrote a best-selling book on patient safety, Internal Bleeding, and recently published the field's leading textbook, Understanding Patient Safety. "It's no coincidence that hospitalists so often emerge as the leaders in areas like patient safety and quality." Wachter also believes improved human interaction among practitioners is making a big difference in patient safety. "Placing a greater emphasis on interdisciplinary collaboration is pretty unique. Hospitalists recognize that providing high-quality, safe care is a team sport," he says. Recently, the Medical Service hosted a program supported by a grant from the Gordon and Betty Moore Foundation to the UCSF schools of nursing, pharmacy and medicine to train 400 nurses, doctors, pharmacists, social workers and others in teamwork and collaboration. Feedback has been very positive from this experience and has led to improved communication and collaboration, Wachter notes. UCSF also hosted the second annual Interprofessional Education Day on Sept. 19 to bring students from all four professional schools, physical therapists and dietetic interns from the medical center together to learn about the importance of teamwork. Recently, the medical center implemented an electronic medical records system. As part of that system, UCSF Medical Center also developed a sign-out module for better transition of care between shifts of health care providers. The module, called Synopsis, provides a practical, up-to-date summary of the condition of each patient, such as what medications were last given or what his or her temperature was, but also communicates to the next shift what antibiotics to give if a patient develops a fever or when to call a family member. Next, UCSF will implement even more advanced clinical information systems for provider order entry and prescribing drugs in the inpatient setting, and will bring electronic medical records into the outpatient setting in clinics across the clinical enterprise. All told, the medical center's investment in information technology will top $100 million. Among other efforts, the medical center has improved the process and protocols of transferring patients from their hospital rooms to other departments, such as radiology, to better ensure their safety while en route, and continues to stress the importance of hand washing to prevent the transmission of germs, including bacteria, viruses and infections. Lastly, the medical center has appointed Joy Pao, a seasoned quality leader from Kaiser Permanente, as the new director of Quality Improvement for the medical center. Pao is responsible for implementing programs and initiatives as outlined in the UCSF Performance Improvement Plan; improving systems and meeting standards for all quality reporting; and maximizing integration among the inpatient, outpatient and home care quality programs. Pao is also directing staff to provide expert support to the quality and safety committees and clinical departments within the medical center. "All of these efforts will help UCSF Medical Center continue to put the quality, safety and care needs of our patients first in everything we do," Laret says. Photo by Susan Merrell
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