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ALWAYS EVENTS? by David Torchiana, MD

We want to control healthcare spending and improve the quality of the care delivered at the same time – the challenge is how to do it. The Chief of Surgery at MGH recently sent out a departmental email describing what he called “always events” that pertain to inpatient care.

• Always record an accurate list of the patient’s prior medications within 24 hours of admission.
• Practice appropriate hand hygiene using Cal Stat, an alcohol based skin cleanser before entering a patient’s room and after leaving it – every time.
• Always use an electronic medical record and electronic prescriptions to document patient care.
• When discharging a patient from the hospital to a non-acute care facility, always give the next provider a full set of critical information about that patient (we have defined a minimum of seven agreed-upon elements that should be communicated).

We don’t do all of these things 100% of the time yet, but by setting the goal at always, Dr Warshaw has defined a clear target.

Over the last two years, we have successfully brought our institution’s hand hygiene rate up to 90% before and after patient contact on our inpatient units and have seen a sustained reduction in new infections with antibiotic resistant bacteria as a result. Presumably, a rate closer to 100% would be even better. The other elements on the list are equally fundamental; if we can get them as near as we can to always, medication errors will decrease and so will the associated costs. There are a variety of ways to do these things more reliably, but a simple place to start is to measure them and consider anything less than always to be a target for improvement.

David Torchiana, MD
Chairman and CEO
Massachusetts General Physicians Organization

This program aired on November 20, 2007. The audio for this program is not available.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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