A Word from the President: Best Practices for Better Care: Leading Change to Improve Health
At the end of last month, we marked the one-year anniversary of the passage of the Affordable Care Act (ACA). During my recent travels to AAMC-member institutions, I have seen just how hard our constituents are working to get ready for the changes that the law is bringing. A significant component of our preparation for health care reform implementation is taking a serious look at what we, as a community, can do to improve health care quality and safety. That is why the AAMC recently launched Best Practices for Better Care (BPBC), a unique new collaboration that focuses the three mission areas of academic medicine—medical education, patient care, and research—on the challenge of improving the quality and safety of patient care.
As of March 30, 2011, more than 200 medical schools, hospitals, and health systems have joined the effort by committing to implement five initial best practices to improve health and health care at their institutions. Although seemingly simple, putting these best practices in place broadly will make a significant and immediate impact by making care safer when patients are in the hospital, helping keep patients from unnecessary readmissions to the hospital, allowing the medical profession to replicate what works best, and teaching these lessons to the next generation of doctors, who will take them wherever they practice medicine.
Here is a closer look at the initial BPBC goals and commitments.
Teach quality and patient safety to the next generation of doctors.
First and foremost, BPBC seeks to expand the culture of safety in medical education by integrating proven quality and safety practices into the training of new doctors from day one. Although quality and safety are included in most medical schools’ curricula, institutions participating in BPBC will establish formal curricular requirements related to quality and safety, report on the teaching models used to incorporate quality improvement, and share the results of student and resident self-assessments of their preparedness to improve quality and safety.
Ensure safer surgery through use of surgical checklists.
Developed in teaching hospitals, surgical checklists lead to better outcomes. Particularly when operations are complex, surgical checklists provide a routine approach for all members of the operating team to communicate more effectively with each other and with patients about their respective roles before, during, and after an operation. Under the BPBC initiative, institutions will create policies requiring the use of surgical checklists in all operating rooms for all procedures, document the use of checklists in patient charts, report compliance rates, and demonstrate that medical students and residents understand the importance of standard processes and improved communication.
Reduce infections from central lines.
Some of the sickest patients need special IVs, known as central lines. While these patients are also the most susceptible to infection, the use of central line “bundles”—a series of protocols developed at teaching hospitals—has been proven to reduce rates of infection dramatically. Intensive care units that have implemented similar interventions have shown the significant impact these safety measures can have, both on improving care and reducing costs. As such, the BPBC initiative requires the use of central line bundle protocols and chart reviews to monitor compliance. Medical students and resident physicians also will need to demonstrate competency in these protocols.
Reduce hospital readmissions for high-risk patients.
Hospitals work to ensure that patients are not discharged prematurely. Even so, making sure patients understand how and when to get the right follow-up care after a hospitalization can be challenging, especially for teaching hospital patients, who are often sicker and have more complex conditions. Research shows that follow-up with patients after they have been discharged can significantly reduce readmission rates. The BPBC institutions are committing to contact high-risk patients within 72 hours to review discharge instructions, confirm they understand their plan for follow-up care, and counsel the patients as needed. Institutions also will document these follow-up efforts and report on the results.
Research, evaluate, and share new and improved practices.
It is not enough to develop and implement best practices. As the leaders of true health care reform, we must also disseminate the lessons learned from our efforts. As part of BPBC, participating institutions will collect, analyze, and report the impact of interventions on patient quality, safety, costs, and educational outcomes so that all health care providers—including physicians, nurses, and students—can easily access the results and learn from them, as well as shorten the time it takes for best practices to become standard in patient care.
The campaign went “live” on March 30 with information about the initiative distributed to federal policy leaders, a print advertisement appearing in the Washington Post and Wall Street Journal, and the launch of a Web site, www.aamc.org/bestpractices, which provides more information and resources for each of the commitments, as well as a comprehensive list of participating institutions.
Over the next year, the AAMC will work with BPBC institutions and other organizational partners to develop additional tools and resources for participants, and establish a reporting mechanism to track institutional results and aggregate them so they can be publicly reported. We expect to issue regular reports on our progress beginning no later than spring 2012 and to add additional commitments in subsequent years.
As the places where medical teams discover the cures that save lives, where every doctor and health care provider is trained, and where advances in medicine and practice make the best care even better, medical schools and teaching hospitals are the natural leaders in true transformation of the health care system. In Best Practices for Better Care, the nation’s medical schools, teaching hospitals, and their physicians and scientists are working together to lead changes in health care quality and safety that will improve the health of their communities, the patients they serve, and, ultimately, our nation’s health.
Darrell G. Kirch, M.D.
AAMC President and CEO