"Every member of the health care team plays an important role in assuring exceptional outcomes for patients and families. Quality care and patient safety need to be top-of-mind. Everything should in some way contribute to better care."

—Linda Q. Everett, RN, PhD, FAAN

In looking ahead to the next five years, the physicians and staff at University of Iowa Hospitals and Clinics have agreed to embrace a "spirit of improvement" where measurement and comparative analysis are used to make sure each patient receives the safest, most efficient, highest quality care possible.

This commitment to continuing improvement includes the use of outcomes data as a road map to excellence and the application of data-driven business concepts to enhance operational efficiencies. It relies on evidence-based medicine, where caregivers use insights from health care research literature to support each patient care decision.

"The only way to continually improve is to follow the straight and narrow path," says Linda Q. Everett, RN, PhD, FAAN, a designated strategic plan "champion" for exceptional outcomes. "Assume even the best practices can be improved in some way."

Exceptional outcomes champion Linda Q. Everett, PhD, RN

Embracing a spirit of improvement

Saving Lives

When a 37-year-old patient receiving inpatient care in a cardiac unit suddenly took a turn for the worse, every minute became a matter of life and death.

That's why a Rapid Response Team was summoned to his bedside. The team includes three clinicians—a physician, a nursing supervisor, and a respiratory care supervisor—who are on alert to bring critical care expertise to the patient's bedside,

In this case, the patient had been hospitalized but wasn't sick enough to require highly specialized care in the Cardiovascular Intensive Care Unit (CVICU).

All that changed when he developed symptoms of critical heart failure.

Fortunately, Cheryl Irland, RN, recognized the symptoms and called the Rapid Response Team. After assessing the situation, the team immediately transferred the patient to the CVICU, where he not only recovered but soon returned home.

"This intervention almost certainly saved the patient's life," says John Fieselmann, MD, co-leader of the UI Hospitals and Clinics Rapid Response Team initiative. In the first stages of the initiative, he says, the hospital used the team an average of 15 times per month, with a remarkable 82 percent discharge survival rate.

"Our goal is to prevent deaths in patients who are failing, specifically those who are not already receiving care in our intensive care units," he says. "We think the results speak for themselves."

Rapid Response Teams save patients' lives by providing critical care expertise on a moment's notice. This team includes Nora Royer, MD; Justin Kuhn, RRT, and Jane Harp, RN.

"As these new standards of care become common practice, we will continue to save lives and improve health outcomes in the future."

—John Fieselmann, MD,
co-leader, UI Rapid Response Team initiative

A National Mentor
The Rapid Response Team initiative at UI Hospitals and Clinics was so effective that the hospital was named a mentor institution for the "100,000 Lives" campaign, the first national attempt to save a specified number of patient lives by a certain date.

Mentor hospitals offer advice in their areas of expertise to other hospitals.

By jointly implementing six evidence-based changes proven to improve patient care, the campaign aimed to save 100,000 American lives by June 14, 2006.

While the national campaign was directed by the Institute for Healthcare Improvement, the Iowa portion was coordinated by the Iowa Healthcare Collaborative, a statewide initiative by doctors and hospitals to improve quality care. UI Hospitals and Clinics played a leadership role, with JohnFieselmann heading the Collaborative's Rapid Response Team initiative, and Charles Helms, MD, chairing the Collaborative's board of directors.

Rapid response teams were key factors in the outcome.

"The deployment of rapid response teams both here and at many institutions nationwide has had a dramatic effect," Fieselmann says, adding that the campaign's success assures these changes will become permanent.

"As these new standards of care become common practice, we will continue to save lives and improve health outcomes in the future," he says.

"Please express our deep gratitude to all who helped turn our family crisis into celebration. Lily's hospitalization will soon be another dot in the statistics of UI Hospitals and Clinics, but we see it as a high mark in western civilization that can build, staff, and equip such a fine hospital, and then offer care with compassion. The people of Iowa should be proud!"

—Dr. Bob Cooper
Lexington, KY

‘One of Nation's Safest'

The UI Obesity Surgery program is a national leader in collecting, analyzing, and applying data to measure obesity patient care outcomes for safety and effectiveness.

"Outcomes research helps our program evaluate its approach to patient care and find ways to improve," says Isaac Samuel, MD, the program's director. "Our very low complication rates match—sometimes exceed—the best published national series in the field, making us one of the nation's safest programs."

The UI Obesity Surgery program emphasizes pre-operative patient education and post-operative rigorous long-term follow-up to ensure patient compliance, maximum weight loss, and great outcomes.

These outcomes reflect the program's history of clinical excellence. UI Hospitals and Clinics is known as "the birthplace of bariatric surgery" because the world's first such procedure was performed here in 1966 by Edward Mason, MD.

In addition, the UI Obesity Surgery Program has been identified by Wellmark Blue Cross and Blue Shield of Iowa as a Bariatric Surgery Center of Excellence and is a Blue Distinction CenterSM for Bariatric Surgery, a national program established by the Blue Cross and Blue Shield Association.

These designations underscore the program's excellence in patient education and outstanding clinical outcomes. UI Obesity Surgery is the first clinical program at UI Hospitals and Clinics to achieve this national BCBS distinction.

Sorrow Leads to Hope

The accidental drowning of 2-year-old Nick Hulshizer shows how—even in the face of tragedy—positive outcomes are possible.

Nick died in 2001, five days after being taken to University of Iowa Hospitals and Clinics. After his passing, his mom and dad, Erin and Doug Hulshizer of St. Anthony, Iowa, agreed to donate his organs.

Two children and two adults benefited immensely from that decision.

One of them was a three-month-old girl from Tennessee named Brianna. She received Nick's heart. While it was difficult initially to make contact because of confidentiality regulations, the Hulshizers have kept in touch with Brianna's family.

They even traveled to Tennessee for Brianna's second birthday.

"It was a wonderful thing," Erin says. "Before we left, I got to hold her and remembered that I tried to feel her heartbeat, knowing it was Nick's heart."

Nick's miraculous gift would not have been possible without an effective organ donation program. By compassionately discussing the organ donation option with the grieving family, hospital social workers and the Iowa Donor Network helped turn a deeply sorrowful event into a healing experience.

Furthermore, the hospital's high organ donation rate of 95 percent of eligible donors in 2005 led to the receipt of an award from the U.S. Department of Health and Human Services. The Organ Donation Medal of Honor recognizes hospitals that achieve organ donation rates of 75 percent or higher in a 12-month period. Included in the count was a procedure in which eight organs were obtained from a single donor for first time in Iowa history.

"Our hospital has always had a strong relationship with the Iowa Donor Network, and our historically high rate of organ donation demonstrates that," says Sue Witte, a social work specialist at UI Hospitals and Clinics. "The Medal of Honor recognizes the strength of our partnership even as we continue to improve our results."

Erin and Doug Hulshizer lost a 2-year-old son but gained a sense of healing when his donated organs benefited two children and two adults.