Friday, January 16, 2009

Need a champion for your next quality improvement project? Try your local fire chief!

Although strong evidence favoring therapeutic hypothermia to improve neurologic outcomes after cardiac arrest has been out there for over six years hospitals in the U.S. have been appallingly slow to adopt it, all but ignoring the data. Among the reasons is the fact that hospitals, motivated by money, pride and shame, are focused, to a distraction from matters of real import, on publicly reported core performance measures.

Any quality maven will tell you that if you really want to go beyond the core measures with your project you need a champion. Enter the fire chief. From a piece last month in the New York Times:

Starting on Jan. 1, New York City ambulances will take many cardiac arrest patients only to hospitals that use a delicate cooling therapy believed to reduce the chances of brain damage and increase the chances of survival, even if it means bypassing closer emergency rooms.

The move by the city’s Fire Department and Emergency Medical Service, after a year
of preparation, indicates a shift away from the prevailing view among emergency workers and the public that how fast critically ill patients reach the hospital is more important than which hospital treats them.

That’s right---ambulances transporting cardiac arrest patients will be diverted away from hospitals that don’t have a therapeutic hypothermia protocol in place! Predictably the public attention and real money at stake has New York City hospitals, few of which were providing therapeutic hypothermia, scrambling:

Since the Fire Department sent letters to hospital chief executives this week informing them of the impending change, about 20 of the 59 hospitals with emergency rooms have said they will have cooling operations ready by the Jan. 1 deadline.

The fire chief, who has no money at stake and isn’t a slave to public core measures, is the perfect champion. According to the New York Times piece this fire chief as champion strategy has been tried in a few other cities but we’re a long way from widespread adoption. If it takes hold nation wide the cooling protocol may finally get the attention it deserves.

By the way, although it requires institutional commitment, organization and staffing you don't need a lot of expensive equipment. I previously reviewed the practical aspects here and here.

Image source Wikipedia.

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