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