Increasingly, viability for physicians and hospitals requires physicians working together and with other disciplines to agree on best practices, implement and document them, then audit our performance to make sure we are using the best practices. While any successful protocol allows us to alter the process at times, because algorithms cannot address the complexity of our patients, significant changes should impact a small number of patients.
For example, we routinely give aspirin to patients having MIs, but 1-2 percent are excluded for various reasons. A huge help is patient registries, which are making a difference and will be more important as we move forward. You can’t sustainably improve what you don’t measure. When the evidence does not show a significant difference in outcomes between practices, we end up practicing in the most cost-efficient way. That is the expectation of CMS, the public and insurance companies.
There are notable successes with the team approach. During the past 18 months, our critical care physicians worked with nurses and respiratory therapists to standardize care for intubated patients. Those changes resulted in a major drop in the hospital’s ventilator-associated pneumonia incidences here. Similar efforts reduced central-line associated bloodstream infections and catheter-associated urinary tract infections. The work continues and you should also see a nurse-driven Foley catheter removal protocol in the near future.
Many efforts that are taking place now involve physicians and staff from each hospital in Yale New Haven Health System. Bridgeport Hospital physicians are critically important to the success of many system-wide initiatives. We need you to stay engaged as we look to offer better care. If you can participate in an initiative, please do. Remember, these are collaborative efforts, which often require compromise by all involved. I can promise you it will be an interesting process and your voice will be heard.
Cross-system groups have looked at antibiotics, chemotherapy regimens and glucose control, improved care and costs. Similarly, obstetricians did an excellent job collaborating on various complicated issues. Other procedural specialties are moving in this direction. We are working on standardizing supplies and will do more on supplies as well as on other aspects of peri-procedural care. I think real changes were made during the past few years and the pace should increase in the coming months.
Michael Ivy, MD
Chief Medical Officer