WASHINGTON, DC—The National Quality Forum (NQF), with the support of the Agency for Healthcare Research and Quality, has endorsed 30 evidence-based safe practices that will reduce the risk of harm in hospitalized patients. These practices cover a range of areas, including intensive care unit (ICU) staffing, and include strategies for preventing infection and venous thromboembolism (VTE).[1]

Evidence suggests that 50,000 hospital deaths each year could be avoided if it were a universal practice to staff all ICUs in the United States with physicians certified in critical care. “Care-related complications and nosocomial illnesses could be substantially lessened if safer care were provided,” explained Kenneth W. Kizer, MD, MPH, President and Chief Executive Officer of the NQF. According to the report, physicians certified in critical care should be present in the ICU a minimum of eight hours per day, seven days per week. Dr. Kizer believes that having these physicians available will also ultimately reduce costs, “because illnesses would be diagnosed earlier, complications prevented, and unnecessary tests not performed.” Hospitals may not see the reduction immediately, though, he acknowledged, because there may be some additional costs initially.

PRACTICES SHOULD NOT BE MODIFIED

“In general, these practices have been widely embraced by NQF’s nearly 200 member organizations,” said Dr. Kizer. For hospitals concerned about cost, Dr. Kizer suggested that implementation of the practices be done incrementally so that they can be incorporated into the budgeting process. He stressed, though, that supporting these practices should be a high priority. Dr. Kizer also pointed out that many of the practices should be relatively easy to execute and cost little or nothing. For example, documenting a patient’s VTE risk in his or her chart, or having nurses repeat back verbal orders is easy and should have minimal cost. Similarly, handwashing or using a disinfectant to prevent catheter-related and other infections should be the norm already. “Cost should not be a reason for not moving forward on these lifesaving, evidence-based safe practices,” added Dr. Kizer.

Facilitating compliance with the practices may be a “culture” issue since it involves changing some of the norms that hospital staffs are used to. “Any time you propose change in health care, it is resisted,” Dr. Kizer explained “[but] these recommendations should have high priority.” Many hospitals already have procedures in place for infection control and prevention of VTE that are similar to the practices in the report; however, “some of the staff may be following the procedures only some of the time,” stressed Dr. Kizer. “When compliance is not consistent, it needs to be,” he added.

WILL THE PRACTICES BE MANDATED?

According to Dr. Kizer, the practices in the NQF report are “voluntary consensus standards, and as such they have a certain legal status.” In other words, hospital compliance is currently voluntary, although the federal government is obligated to consider the endorsed practices when setting standards for performance. Dr. Kizer expects that the set of practices will be revised in two years, at which time the number of practices that providers will be asked to observe will likely increase. Overall, the practices are expected to improve patient care and reduce morbidity and mortality. When followed consistently, they should significantly lower ICU costs as well. When these practices are used, “hospitals will become safer places and have fewer adverse outcomes,” Dr. Kizer concluded.

—Tamara Gibb

Reference
1. The National Quality Forum. Safe Practices for Better Healthcare: A Consensus Report. Washington, DC: The National Quality Forum; 2003.

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