Changes may have saved thousands, Harvard doctor says

Three thousand US hospitals that improved care in six specific areas, including administering proper antibiotics before surgery and activating ``rapid response teams," saved an estimated 122,300 patients who would have died from errors and poor care, said a Harvard physician who oversaw the 18-month project.

Dr. Donald Berwick, a Harvard Medical School professor who is chief executive of the Institute for Healthcare Improvement in Cambridge, made a splash in December 2004, when he announced plans to enlist hospitals in a campaign to save 100,000 lives by providing them with checklists to improve patient care.

More than 3,000 hospitals joined the project, including 61 in Massachusetts. Yesterday, Berwick said the campaign had created a new standard of care, and, by his organization's calculations, had saved more lives than predicted.

``This campaign has helped propel something in this country in healthcare that I have never seen before," he said.

``The hospitals have come together to extend life and reduce suffering," he added.

But even as hospital executives and physicians applauded the effort, some said that there is no way to know for sure whether the campaign did indeed save the number of lives that were claimed.

The institute calculated the number of lives saved by comparing patient mortality at participating hospitals before and during the campaign, and adjusting those numbers for the severity of patients' illnesses.

But it made those adjustments based on national changes in the severity of patients' illnesses, rather than on changes at participating hospitals.

And because hospitals have been implementing a variety of quality improvement programs at once, Berwick acknowledged that it is not possible to know the specific impact of the ``100,000 Lives" campaign.

``I don't think anyone will criticize the numbers right now, but over the next year you will see questions about the methodology as people have time to understand it," said Dr. Evan Benjamin, who is a vice president for healthcare quality at Baystate Health System in Springfield.

Benjamin added: ``This is a transformational change, and we definitely want to be celebrating it."

Benjamin also said that joining the campaign had helped Baystate Medical Center to improve care.

The hospital already was focused on providing better care to heart attack patients and on reducing infections.

``But the campaign accelerated our involvement," Benjamin said. The hospital gave aspirin and beta blockers to all heart attack patients within hours of admission, and before they were discharged.

Studies have found that this measure, along with others recommended by the institute, reduce s mortality.

For surgery patients, Baystate began administering antibiotics within an hour of surgery and clipping, rather than shaving, hair around an incision site, to reduce the number of infections.

According to the Institute for Healthcare Improvement, patients who develop infections at the site of their surgery are twice as likely to die as other patients.

At Baystate, death rates from heart attacks fell by 30 percent to 3.5 percent, and surgical site infections dropped by 50 percent to 1 percent in the past 18 months, Benjamin said. The numbers have not been adjusted for the severity of patient conditions, but he said he does not expect those adjustments to change the results dramatically.

Hospitals that are part of Partners HealthCare System, also joined the program. ``If someone wants to be negative, there are plenty of ways to poke holes" in the Institute for Healthcare Improvement's report, said Dr. Thomas Lee, president of Partners' physician network.

``Whether it saved 10,000 lives or 122,000 lives, I don't know," Lee said. ``But they used a device to try to drive improvement."