Best practice: lessons from US on patient safety

Does the NHS make medical errors, do we make prescribing errors and do people suffer needless pain? Are people admitted unnecessarily, do we lack good communication across multiple providers in primary, secondary and tertiary care and do we fail to involve patients and their families in their treatment plans?

If the answer to one or more of these questions is yes, then I suggest it is worth taking some time to watch the series Remaking American Medicine, available on DVD from Amazon.com.

Of course, the US system of healthcare is different from the NHS. It is divided in two. First, there are public sector providers Medicare and Medicaid who together make up America's largest healthcare insurance provider. Then there are a huge number of other providers - insurance companies, hospital and healthcare providers, not-for-profit organisations and charities.

Setting aside the structure, the problems facing the US health system appear to be identical to those facing staff in the NHS.

There is a serious problem with healthcare-acquired infections, medical errors, prescribing errors, rising levels of long-term conditions, spiralling healthcare costs, increased mortality rates from diseases such as diabetes and so on.

Remaking American Medicine looks at some of these issues and the steps that have been taken to address them over the past five years. There are four hour-long episodes entitled: Silent Killer, First Do No Harm, The Stealth Epidemic and Hand in Hand. Little in this documentary will be.new to those who work in the NHS but, like the US, we are doing much of it only very patchily.

Tackling 100,000 needless deaths

The first episode follows the King family, whose 18-month-old daughter Josie scalded herself. Having got away from her parents for a few minutes, she had climbed in to a bath and turned on the hot water. The family called the emergency services, who transported her to Johns Hopkins Hospital in Baltimore.

She survived the burns but, within days of her being discharged, her parents noticed she was starting to deteriorate. They brought this to the attention of staff, yet Josie died of dehydration.

The episode goes on to cover the changes made in hospitals such as.Johns Hopkins, and Shadyside in Pittsburgh, following the campaign by the King family to ensure such an event could not and would not ever happen again.

It shows staff discussing the formation of rapid-response teams, and their contribution to the Institute for Healthcare Improvement's Saving 100k Lives campaign. The name of the campaign refers to the.estimated 100,000 people who die in the US every year because of medical errors. This film makes it clear that Josie died needlessly, and that there are very basic things that can be done to ensure that this does not happen to others.

Johns Hopkins put in place rapid-response teams that could be called in by nursing or other clinical staff. At Shadyside, this was taken to the next level by allowing patients and their families to call the teams if they felt something was not right. Staff were, of course, worried that patients would call for frivolous reasons. But the chief executive responded: 'Trust that when you give people authority, very rarely do they abuse it.'

The programme at Shadyside brought together patients, clinicians, patients' families and front-line staff to ensure that everyone involved knew of steps they could take if they felt clinical care or safety were being compromised.

Are superbugs good for business?

Episode two is largely set in Pennsylvania's Alleghany medical centre. It covers healthcare-acquired infections and prescribing errors. In partnership with the Center for Disease Control, the Veterans Administration and the County Health Board, Alleghany set out to reduce the transmissions of such infections between organisations.

It highlights a perversity of the US healthcare system -.indeed, of any payment-for-treatment system. Hospitals in the US are paid to treat people. If a patient gets an infection, the hospital can bill an insurer for the treatment of it. This would suggest at a superficial level that it is not in the hospitals' interest to prevent infections. This is demonstrated by the chief financial officer in the programme, who wants a business case before investing in bio-packs to improve infection control.

Dr Richard Shannon at Alleghany General Hospital put together a business case to demonstrate that preventing infections is worthwhile and does not result in financial loss. The results are astonishing. There is a loss in terms of income but the average loss on a patient's length of stay, after an operation resulting from infection, is $17,000 per case. Following this research, Alleghany set a target of zero infections for intensive care.

Spiralling diabetes and obesity

Episode three covers diabetes and the impact of rising obesity rates on the US healthcare system. Innovative solutions are covered, some of which were pioneered in the UK. The main focus is on public health clinics for people with diabetes in the Los Angeles metropolitan area. These clinics are free and nurse led. They provide assistance and advice to patients without health insurance,[and?].patients who are on Medicare or Medicaid.

The programme points out that in the US the uninsured, who have the.least access to healthcare, are in some instances getting the best care. This is because providers are having to develop innovative solutions to cater for looming public health problems.

I doubt there is anything in this episode that is not being done somewhere in the UK. However, such services are not available everywhere in the US and they are certainly not available everywhere here. What the episode demonstrates is the excellence and innovation that is possible when an organisation sets its mind to the task.

Satisfied customers

This series culminates with Hand in Hand, an episode focusing on the Georgia medical centre. It is a fantastic example of what an organisation can achieve, relatively quickly, if it wants to. This is primarily a teaching hospital, where patients historically took a back seat to the teaching of medicine. Over the past decade, the hospital has gone from the bottom end of the league in terms of customer satisfaction to the top end.

A huge number of factors have contributed to this but, at the heart of almost every change, is the involvement of patients and their families. Nowhere is this demonstrated more clearly than at the paediatric centre, where children with serious conditions have a voice through a programme called Kids Art. They are consulted on menus, facilities and other developments at the centre. Parents are encouraged to stay with their children in intensive care and are kept up to date on every new step.

While there are pockets of brilliant practice within the NHS, we face exactly the same problems as the ones illustrated in the documentary - and that makes it compelling viewing.

To see the value in the documentary, it is essential to look past the differences between the UK and the US healthcare systems. The underlying problems are the same. The series makes it abundantly clear that patient care can and must be delivered differently if we are to continue to provide healthcare that is the envy of the world.

Andrew Castle is service improvement consultant at the NHS-funded South West London Improvement Academy.

Remaking American Medicine, by PBS Home Video, is available as a region 1 DVD on Amazon.com, priced $26.99.

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