How changing patients’ socks could save lives

October 10, 2012

At Beth Israel Deaconess Medical Center in Massachusetts, health reform means testing out new payment models and delivery systems. It also means changing the socks that patients wear. 

About six years ago, the health care system set a goal: It would aim to end preventable harm in its hospitals by 2012. It has just now released the results of that effort, which included "hundreds" of small changes--such as having patients wear socks with treads that could prevent falls.

While the hospital has not eliminated preventable harm, it has seen such incidents cut in half--and might have a few lessons for hospitals elsewhere in the country.

Beth Israel launched the plan back in 2008, after a two-day board retreat. "Our governance group, they came with a feeling that we needed a more ambitious program," says Ken Sands, Beth Israel's chair for health care quality. "They felt like we needed to have this audacious goal of eliminating preventable harm."

That's seems especially ambitious when you think about how much harm happens in hospitals right now. American surgeons operate on the wrong body part as often as 40 times a week, Johns Hopkins University's Marty Makary noted recently. He adds that "Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind." If medical errors were a disease," Markary writes, "they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer's."

Beth Israel wanted to change that. Executives knew they couldn't eliminate every harmful event; some would be out of their control. But they did want to root out any that could be prevented.

The hospital defined a "preventable harm" as one of two situations: A harm resulting from a provider deviating from a list of best practices or a harm caused by a some defect in a best practices protocol.

"The idea was, if we can change the current standard way that we would deliver care, to prevent the harm from happening in the future, that would be a preventable event," Sands says. 

Armed with a definition, Beth Israel started implementing changes. This is where the socks come in: Beth Israel looked at what patient harms were happening, and how they could be avoided. Back in 2006, they saw 10 patients each year suffer an injury due to a fall. The staff thought about what they could do to take that number down.

They purchased chair alarms, that would let them know when a patient was getting up--a flag to health care providers to remain alert. The hospital began using beds set at a lower height, lessening the potential for a fall to cause injury. Lastly, the socks: The hospital switched to slipper socks that have treads on both sides. 

Beth Israel only had one injury from a fall in 2011, and one so far in 2012.

(Not all sock interventions have, however, proven successful: My colleague Lena Sun reported on one such effort, where the hospital only stocked a large size. Patients with smaller feet began slipping.)

In the surgical setting, one nurse came up with an idea: Requiring the surgical team to go through a "time out"--where the providers double-check they have the right patient for the right procedure--before the blade would be mounted on a scalpel.

The hospital saw its rates of ventilator-associated pneumonia--caused by bacteria in the breathing tube--drop by 90 percent after it began implementing some small changes, like elevating patients' beds at a 30 degree angle and brushing patients' teeth daily.

"There are a hundred things were doing differently. It's really not so much about each individual project," says Beth Israel CEO Kevin Tabb. "It's about a wholesale change in culture. And we think constantly about how do we improve our quality of care and how do we reduce any kind of harm to our patients."

Sand notes they have not met their goal of eliminating preventable harm by 2012, but they have reduced it by 50 percent.

"You could call it a failure, because we didn't eliminate harm, or a success for the decrease," he says. "In terms of raising consciousness though and making substantial progress, it's been an unqualified success. The leadership has decided we need to keep going on this as a long term aspiration mission to eliminate preventable harm. We're still keeping that as a keystone goal."

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