Johns Hopkins receives $10 million to open patient safety institute

Johns Hopkins plans to use a $10 million gift to launch an institute for patient safety, aiming to reduce medical mistakes that have long troubled health care facilities around the nation.

The Armstrong Institute for Patient Safety and Quality will conduct research and develop methods for use at Hopkins and other hospitals around the globe that could prevent infections, misdiagnoses, improper treatments and other errors. It may be the first of its kind in the country, Hopkins and patient advocates say.

"Fewer things are more important in health care right now than improving patient safety and the quality of health care," Dr. Edward D. Miller, dean and chief executive of Johns Hopkins Medicine, said in a statement. "All of us acknowledge these imperatives, but few of us have taken the steps to formally erect a framework that will tackle these issues head on."

The donation came from C. Michael Armstrong, chairman of Johns Hopkins Medicine's board of trustees. He is the retired chairman of Comcast, AT&T, Hughes Electronics and IBM World Trade Corp.

Armstrong said in his 21 years working with Hopkins, the focus has been on patient care, yet patients were still being harmed. He said in an interview Thursday that it had become clear to him that a center was needed to focus rigorous scientific research and bring about the culture change needed.

"This industry's business is life, and when you're in the business of life, zero defects is not an inappropriate objective," he said.

The medical community put a focus on patient safety more than a decade ago, when the Institute of Medicine released a report blaming medical errors for up to 100,000 patient deaths a year. Patient safety researchers and advocates say little has been done to prevent those errors, and they now believe the number of mistakes is much higher.A study in the April issue of the journal Health Affairs estimated as many as a third of patients suffer from a medical mistake.

Hospitals have instituted various programs, including sharing best practices and increasing quality measurement and reporting, said Matt Fenwick, a spokesman for the American Hospital Association. Many states, including Maryland, now require some reporting.

Hopkins gained notice in the field of patient safety from a safety checklist developed by Dr. Peter Pronovost, professor of anesthesiology and critical care medicine in the medical school. Pronovost was unavailable for comment.

The checklist has since been adopted at most Maryland hospitals and at facilities across the country. A recent study found the program reduced deaths in Michigan hospitals by 10 percent and nearly eliminated bloodstream infections, the deadliest and most costly health care-associated infections.

The U.S. Centers for Disease Control and Prevention and the National Institutes of Health recently updated their guidelines for health care providers for preventing bloodstream infections. And hospitals now must report such infections from central lines to the federal government. The results, the CDC reported this year, show that there was a 58 percent decrease among intensive-care patients in 2009 compared with 2001. In 2009, the reduction saved up to 6,000 lives and $414 million.

The improvements in bloodstream infections show that stopping errors is possible, said Dr. Sean Berenholtz, an associate professor of anesthesiology and critical care medicine at Hopkins.

Berenholtz, who will be part of the new institute, has been a patient safety researcher for about a decade. Until recently, he said, there has been investment in basic science to make discoveries and in clinical science to turn it into better medicine. But then, he said, "we do an abysmal job getting those effective therapies to actually reach patients."

That patient safety and quality aspect hasn't been taken seriously as a science, Berenholtz said. Partly that's because rigorous science has to be done in a different way — there can't be randomized trials in which a group doesn't get the medicine, for example.

And the funding has also been short, he said. For every dollar spent on basic and clinical science, about 2 cents is spent on health care delivery science, Berenholtz said. That means a patient's chances of getting the proper therapy is now about 55 percent, he said.

"Far too many patients suffer preventable harm," he said. "And as a society we need to refocus our efforts to improve patient outcomes."

To Sorrel King, there's not a lot more important than stopping those errors. Her 18-month-old daughter, Josie, died in 2001 of severe dehydration and incorrect medication at Johns Hopkins Children's Center.

Now a patient advocate at the Josie King Foundation, King said she was encouraged by the new institute. She said it's a recognition that there is a serious problem that needs to be addressed with resources and research, as well as encouragement for providers.

She said during her travels around the country, she still hears from nurses who fear reporting mistakes or near mistakes.

"It's been 10 years since that IOM report, and are we any safer?" she asked. "There's been a lot of talk, and now we need to turn words into action and create programs. I think this [institute] is progress. It's a big deal."

Lisa McGiffert, director of Consumers Union's Safe Patient Project, an education and advocacy program, agreed and said there is a "laundry list" of research that has been proposed and not done. She said the institute could step up the pace of study and more quickly turn science into practice.

She said lack of rigorous science has been a "roadblock" because practitioners are wary of changing their ways without it.

"It's a grim picture," she said of the number of preventable deaths. "And we have a health care system that has the capacity to prevent this kind of harm. Johns Hopkins has shown it's a leader in changing the culture."

Hopkins plans to name a director of the new institute and organization in coming weeks.

Source: By Meredith Cohn, The Baltimore Sun