ANN ARBOR, MI - Their hospitals may compete fiercely for patients, but the doctors at nine southeast Michigan health systems will be working together for patient safety, under a new program that starts this month.

The first of its kind in the nation, the project combines two of today's top trends in medicine: efforts to protect hospital patients from errors and oversights, and the increasing number of hospitalists, or doctors who specialize in hospital-based care.

Led by the University of Michigan Health System and funded by a $117,000 grant from the Blue Cross Blue Shield of Michigan Foundation, the new project will allow hospitalists from around the region to share tips, tools and techniques.

It will also help doctors put proven safety ideas into motion at their hospitals, and measure how well this pooled effort can prevent such problems as medication errors, hospital-acquired infections and dangerous falls.

“Patient safety relies on every member of the hospital staff to do the right thing and to speak up when something's not right. But the buck stops with the physician who leads the inpatient team – and increasingly, that physician is a hospitalist,” explains Scott Flanders, M.D., chief of the hospitalist service at UMHS, clinical associate professor of medicine and member of the board of directors of the Society of Hospital Medicine.

Hospitalists, Flanders explains, are usually general internists who base their entire medical practice inside a hospital. Unlike doctors in private practice, who have to juggle caring for their patients both in and out of the hospital, hospitalists can focus entirely on managing the complex needs of patients while they're in the hospital.

“Health systems are hiring more and more hospitalists, in an effort to maximize the benefit of a patient's hospital stay while making it more efficient, coordinated and cost-effective,” says Flanders. “It makes sense that we should make it safer, too.”

Flanders will lead the project along with co-principal investigator Sanjay Saint, M.D., MPH, a hospitalist who heads the Patient Safety Enhancement Program at UMHS. Saint and his colleagues have already shown that they can reduce bloodstream and urinary tract infections among hospital patients by using reminders and automatic orders to prompt doctors, and by standardizing the use of anti-bacterial catheters. This effort alone has saved U-M hospital patients untold pain and risk, and has saved UMHS money in the long run even though the catheters cost more initially.

Now, Flanders and Saint will lead the region's hospitalists and hospital patient safety officers in an effort to repeat this success in nine different areas of medicine.

Those areas are:

• Techniques for performing quality-improvement research, so that doctors can accurately assess the effects of their efforts;
• Preventing device-related infections;
• Eliminating medication errors and creating a culture of safety;
• Improving the use of preventive medications for surgical patients;
• Closing gaps in care between different services in the hospital and gaps that exist as patients are discharged from the hospital;
• Improving intensive-care practices, including pneumonia prevention;
• End-of-life care, including pain and advance directives;
• Safety for older patients, including prevention of falls and delirium, and
• Learning lessons from patient safety efforts.

The project, called Hospitalists as Emerging Leaders in Patient Safety or HELPS, will pool the knowledge of hospitalists from nine of the area's largest health systems:

• U-M Health System,
• VA Ann Arbor Healthcare System
• St. Joseph Mercy Healthcare System
• Oakwood Healthcare System
• Beaumont Hospital
• the Detroit Medical Center
• the Henry Ford Health System
• Chelsea Community Hospital and
• Michigan Hospitalists, who practice throughout the St. John Health System.

Several of these health systems have multiple hospitals where hospitalists care for patients.

“We'll be sharing information about safety tactics that work, instead of allowing that knowledge to stay within one hospital or health system,” says Flanders. ”Linking these key hospitals, where hospitalists care for so many patients, will really make a difference for people in southeast Michigan.” In all, the hospitalists in the new consortium care for about 80,000 patients each year.

Hospital medicine is the fastest-growing specialty in all of medicine, with an estimated 12,000 nationwide. There are 47 hospitalist groups across Michigan, according to the Society for Hospital Medicine, taking care of more patients every year.

Flanders notes that U-M's hospitalist practice has grown rapidly, and now cares for half of the adult patients admitted to the internal medicine services of University Hospital – nearly all of those who don't need minute-to-minute care by a specialist such as an oncologist or cardiologist. U-M hospitalists are pioneering co-management of surgical patients with orthopaedic surgeons, and U-M also has a team of pediatric hospitalists who care for patients at the C.S. Mott Children's Hospital.

In addition to participating as one of the hospitals in the project, UMHS will also provide the expertise in patient-safety research and statistical analysis that will boost the project's impact. The team hopes to publish its data about safety-enhancing practices that show the most promise — and about how to persuade and remind doctors to use safety-enhancing practices.

The bottom line, Flanders says, is that hospitalists represent an important group of doctors for patient safety improvement. “It would be extremely difficulty to reach the thousands of community-based doctors who spend part of their time caring for their patients at hospitals across the region,” he says. “But by reaching the doctors who spend all of their time focusing on hospital patients, we have the advantage of ‘one-stop shopping' – we can help patient-safety efforts spread and protect patients across the region.”

Written by Kara Gavin

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