<p begin="00:00:00.795" end="00:00:03.712" style="s2">(slow-paced music)</p>
<p begin="00:00:17.847" end="00:00:19.874" style="s2">- [Voiceover] Our<br />responsibility is to do no harm</p>
<p begin="00:00:19.874" end="00:00:22.207" style="s2">and to protect the patients.</p>
<p begin="00:00:24.083" end="00:00:25.330" style="s2">- Well, we started to see a trend</p>
<p begin="00:00:25.330" end="00:00:28.233" style="s2">in central line insertion complications.</p>
<p begin="00:00:28.233" end="00:00:30.151" style="s2">Along with that, we were also seeing</p>
<p begin="00:00:30.151" end="00:00:33.651" style="s2">some increases in central line infections.</p>
<p begin="00:00:34.584" end="00:00:38.576" style="s2">- Patients were staying longer in the ICU.</p>
<p begin="00:00:38.576" end="00:00:42.743" style="s2">They were having to have<br />multiple tries at access.</p>
<p begin="00:00:44.187" end="00:00:46.938" style="s2">- There's an occasional<br />patient that was dying,</p>
<p begin="00:00:46.938" end="00:00:50.188" style="s2">and dying with diseases that should not</p>
<p begin="00:00:53.707" end="00:00:57.275" style="s2">have lead to death, and we as a community</p>
<p begin="00:00:57.275" end="00:00:59.162" style="s2">of doctors here decided that we'd</p>
<p begin="00:00:59.162" end="00:01:01.849" style="s2">put an end to that, and our goals</p>
<p begin="00:01:01.849" end="00:01:06.016" style="s2">were not directed towards<br />just reducing the rates,</p>
<p begin="00:01:07.042" end="00:01:09.209" style="s2">but reducing them to zero.</p>
<p begin="00:01:17.911" end="00:01:20.804" style="s2">5% of the people that walk into a hospital</p>
<p begin="00:01:20.804" end="00:01:22.738" style="s2">in the United States develop some sort</p>
<p begin="00:01:22.738" end="00:01:25.080" style="s2">of hospital-acquired infection.</p>
<p begin="00:01:25.080" end="00:01:28.953" style="s2">That 5% translates into a lot of deaths.</p>
<p begin="00:01:28.953" end="00:01:31.115" style="s2">It translations into a lot of disability</p>
<p begin="00:01:31.115" end="00:01:32.827" style="s2">and a lot of cost.</p>
<p begin="00:01:32.827" end="00:01:34.177" style="s2">- But those percentage points,</p>
<p begin="00:01:34.177" end="00:01:36.851" style="s2">even going up or going down,</p>
<p begin="00:01:36.851" end="00:01:39.025" style="s2">is somebody's mom, somebody's relative,</p>
<p begin="00:01:39.025" end="00:01:40.996" style="s2">somebody's grandparent, somebody's child.</p>
<p begin="00:01:40.996" end="00:01:43.458" style="s2">So we've got to get it right.</p>
<p begin="00:01:43.458" end="00:01:44.566" style="s2">- I did a series of debriefings</p>
<p begin="00:01:44.566" end="00:01:46.674" style="s2">with our internal medicine<br />and our family medicine</p>
<p begin="00:01:46.674" end="00:01:50.205" style="s2">residents, and they actually were the ones</p>
<p begin="00:01:50.205" end="00:01:52.588" style="s2">who brought up their concern</p>
<p begin="00:01:52.588" end="00:01:54.692" style="s2">with our central line placement,</p>
<p begin="00:01:54.692" end="00:01:56.129" style="s2">and they felt like they didn't have</p>
<p begin="00:01:56.129" end="00:01:59.608" style="s2">the knowledge and the<br />skills to do it safely,</p>
<p begin="00:01:59.608" end="00:02:02.017" style="s2">and so we took that information,</p>
<p begin="00:02:02.017" end="00:02:03.269" style="s2">then we started looking at our numbers</p>
<p begin="00:02:03.269" end="00:02:05.263" style="s2">and started talking with the rest</p>
<p begin="00:02:05.263" end="00:02:07.414" style="s2">of the doctors and really putting together</p>
<p begin="00:02:07.414" end="00:02:08.866" style="s2">the big picture of what it meant</p>
<p begin="00:02:08.866" end="00:02:11.699" style="s2">to place central lines in east LA.</p>
<p begin="00:02:14.105" end="00:02:16.991" style="s2">- Our goal was to<br />standardize the procedure.</p>
<p begin="00:02:16.991" end="00:02:19.510" style="s2">We make sure everybody is following</p>
<p begin="00:02:19.510" end="00:02:22.684" style="s2">the five steps in the IHI bundle,</p>
<p begin="00:02:22.684" end="00:02:25.990" style="s2">and then the sixth step, which is to use</p>
<p begin="00:02:25.990" end="00:02:28.740" style="s2">the ultrasound for vein location.</p>
<p begin="00:02:29.953" end="00:02:32.403" style="s2">Sonosite was instrumental in helping us</p>
<p begin="00:02:32.403" end="00:02:34.163" style="s2">develop that program.</p>
<p begin="00:02:34.163" end="00:02:35.079" style="s2">- Sonosite was a great partner</p>
<p begin="00:02:35.079" end="00:02:36.667" style="s2">because not only did they help us</p>
<p begin="00:02:36.667" end="00:02:38.603" style="s2">with the equipment side of it,</p>
<p begin="00:02:38.603" end="00:02:41.825" style="s2">but they also helped us<br />make the IHI bundle real</p>
<p begin="00:02:41.825" end="00:02:44.300" style="s2">for our physicians and helped us develop</p>
<p begin="00:02:44.300" end="00:02:47.948" style="s2">our educational modules, really helped us</p>
<p begin="00:02:47.948" end="00:02:50.379" style="s2">identify what measurements<br />we needed to track</p>
<p begin="00:02:50.379" end="00:02:51.987" style="s2">so that we'd know whether or not we were</p>
<p begin="00:02:51.987" end="00:02:53.998" style="s2">really making a difference, then helped us</p>
<p begin="00:02:53.998" end="00:02:56.072" style="s2">analyze our outcomes.</p>
<p begin="00:02:56.072" end="00:02:57.083" style="s2">- That's what helped changed the culture,</p>
<p begin="00:02:57.083" end="00:02:59.862" style="s2">Sonosite's passion to help us</p>
<p begin="00:02:59.862" end="00:03:03.029" style="s2">have the tools and change the culture.</p>
<p begin="00:03:04.349" end="00:03:06.565" style="s2">- The nurses are patients' advocates,</p>
<p begin="00:03:06.565" end="00:03:10.319" style="s2">and if they see a doctor<br />isn't washing his hands</p>
<p begin="00:03:10.319" end="00:03:13.308" style="s2">or her hands, they see that they're not</p>
<p begin="00:03:13.308" end="00:03:16.058" style="s2">donning on the gown the right way</p>
<p begin="00:03:17.909" end="00:03:20.288" style="s2">and using proper sterile technique,</p>
<p begin="00:03:20.288" end="00:03:22.944" style="s2">we have empowered them with the ability</p>
<p begin="00:03:22.944" end="00:03:24.876" style="s2">to stop the procedure.</p>
<p begin="00:03:24.876" end="00:03:26.924" style="s2">- As chief of staff, he<br />looked at them and said,</p>
<p begin="00:03:26.924" end="00:03:27.757" style="s2">"You know what?</p>
<p begin="00:03:27.757" end="00:03:29.411" style="s2">"If you stop any doctor<br />from doing something</p>
<p begin="00:03:29.411" end="00:03:30.622" style="s2">"that you think is unsafe</p>
<p begin="00:03:30.622" end="00:03:33.262" style="s2">"and he or she gives you a hard time,</p>
<p begin="00:03:33.262" end="00:03:36.128" style="s2">"you call me, and I will back you."</p>
<p begin="00:03:36.128" end="00:03:40.128" style="s2">(optimistic instrumental music)</p>
<p begin="00:03:41.906" end="00:03:43.692" style="s2">- In our hospital, we<br />have reduced mechanical</p>
<p begin="00:03:43.692" end="00:03:45.065" style="s2">complications to zero.</p>
<p begin="00:03:45.065" end="00:03:49.036" style="s2">- In 2012, here at White Memorial<br />in our critical care unit,</p>
<p begin="00:03:49.036" end="00:03:53.190" style="s2">we had a zero infection<br />rate for central lines.</p>
<p begin="00:03:53.190" end="00:03:54.426" style="s2">The more days here in the ICU,</p>
<p begin="00:03:54.426" end="00:03:56.363" style="s2">the more it costs and the more</p>
<p begin="00:03:56.363" end="00:03:59.665" style="s2">the hospital may or may not be reimbursed</p>
<p begin="00:03:59.665" end="00:04:03.095" style="s2">for that care, so I<br />think what's really been</p>
<p begin="00:04:03.095" end="00:04:05.940" style="s2">important for us is having a good</p>
<p begin="00:04:05.940" end="00:04:08.426" style="s2">central line program in our hospital</p>
<p begin="00:04:08.426" end="00:04:12.647" style="s2">that limits the<br />complications for patients.</p>
<p begin="00:04:12.647" end="00:04:16.482" style="s2">- As we meet with our<br />colleagues in other facilities,</p>
<p begin="00:04:16.482" end="00:04:19.602" style="s2">often time we share our infection rate,</p>
<p begin="00:04:19.602" end="00:04:22.925" style="s2">and I think they're a<br />little jealous of us.</p>
<p begin="00:04:22.925" end="00:04:26.394" style="s2">- Well, last year when Leapfrog released</p>
<p begin="00:04:26.394" end="00:04:29.305" style="s2">the hospital ratings, we came in at a B.</p>
<p begin="00:04:29.305" end="00:04:31.372" style="s2">Not real happy with a<br />B, but I'll take a B.</p>
<p begin="00:04:31.372" end="00:04:34.126" style="s2">So this year when they<br />released the hospital ratings,</p>
<p begin="00:04:34.126" end="00:04:36.230" style="s2">we had moved from a B to an A,</p>
<p begin="00:04:36.230" end="00:04:38.734" style="s2">so I looked into the details behind why,</p>
<p begin="00:04:38.734" end="00:04:40.849" style="s2">and a lot of them are right around</p>
<p begin="00:04:40.849" end="00:04:43.633" style="s2">those safety indicators, one of them being</p>
<p begin="00:04:43.633" end="00:04:46.959" style="s2">our bloodstream infections<br />and those complications</p>
<p begin="00:04:46.959" end="00:04:50.425" style="s2">associated with those type of procedures.</p>
<p begin="00:04:50.425" end="00:04:52.013" style="s2">I think one of the great things</p>
<p begin="00:04:52.013" end="00:04:53.692" style="s2">about having a project like this</p>
<p begin="00:04:53.692" end="00:04:55.398" style="s2">is it changes your fundamental belief</p>
<p begin="00:04:55.398" end="00:04:58.038" style="s2">about what's acceptable<br />and what's unacceptable.</p>
<p begin="00:04:58.038" end="00:05:00.040" style="s2">And now, for us at White Memorial,</p>
<p begin="00:05:00.040" end="00:05:01.673" style="s2">central line infections and complications</p>
<p begin="00:05:01.673" end="00:05:03.595" style="s2">are not acceptable.</p>
<p begin="00:05:03.595" end="00:05:05.815" style="s2">- Anybody and everybody in health care</p>
<p begin="00:05:05.815" end="00:05:08.588" style="s2">really has to believe<br />that anything's possible.</p>
<p begin="00:05:08.588" end="00:05:12.088" style="s2">You'll never get the outcome<br />that you're expecting</p>
<p begin="00:05:12.088" end="00:05:14.050" style="s2">if you never start to try to think</p>
<p begin="00:05:14.050" end="00:05:17.075" style="s2">about the possibilities<br />of changing your process.</p>
<p begin="00:05:17.075" end="00:05:20.088" style="s2">And change is hard and difficult,</p>
<p begin="00:05:20.088" end="00:05:23.755" style="s2">but if you never start,<br />you'll never finish.</p>