When it comes to protecting patients, the more brains on the case, the better. That's the idea behind the Duke Infection Control Outreach Network (DICON), which is helping community hospitals across the state put their heads together with safety experts, industry, and each other to improve patient safety.

Founded in 1997, DICON was originally designed to help its member hospitals reduce nosocomial (hospital-acquired) infection rates. But when the Institute of Medicine issued its startling 1999 report on patient safety—revealing that up to 98,000 hospital patients die every year as the result of medical errors—"It really motivated us to think beyond infection control," says DICON co-director Dan Sexton, MD, an infectious diseases specialist at Duke. "The DICON approach has been very successful in reducing nosocomial infections in community hospitals, and we thought it could quite naturally be extended to broader issues of patient safety."

For the past six years, the network has been using advanced surveillance techniques and statistical methodology to help its 22 member hospitals collect data on
hospital-acquired infections, identify trends and areas for improvement, and resolve infection control problems. A key advantage of the program is that it gives community hospitals a confidential way to judge how they're performing relative to similar hospitals, as well as to share ideas and 'best practices' with others within the network. It's an effective approach: from 2000 to 2002, rates of various nosocomial infections at DICON hospitals have dropped by up to 33 percent.

Now, DICON is applying its proven methods to patient safety. The safety pilot program began early this year at Durham Regional Hospital and Alamance Regional Medical Center, with Albemarle Hospital joining in April. "Our goal is to complement hospitals' existing safety programs," says program coordinator Connie Clark, a specially trained nurse practitioner who acts as a safety consultant to community hospitals. "We help them identify best practices, increase awareness of error prevention through staff education, and ensure compliance with JCAHO {Joint Commission on Accreditation of Healthcare Organizations} and other safety regulations."

A central feature of the program is Patient Safety Walk Rounds, which Clark helped introduce at each hospital. Every month, a group of caregivers and administrators make the rounds on a hospital unit with the sole purpose of sniffing out potential threats to patient safety—before they cause problems. Simple as the rounds are—the group spends a morning interviewing staff and collecting specific safety-related data—they're already reducing risk, say administrators.

"The process brought safety issues to the forefront of people's minds in a constructive, 'no-blame' atmosphere that helped focus attention on getting problems fixed," says Wanda Morris, a patient safety officer at Albemarle Hospital in Elizabeth City, NC. "For example, on our first rounds, a nurse suggested that the location of outlets in patient rooms was a problem—the cords were frequently plugged in at the foot of patient beds and trailed into the walkway, which could cause someone to trip or fall. We discussed the safety issue with staff and had everyone begin using the outlets by the headboard."

Other hospitals have also made improvements based on the rounds, says Clark. In one hospital, staff reported to the visiting Safety Team that they were unable to hear pages for codes because the overhead call system was inaudible from inside the patient room. The vice president asked the unit manager and Engineering Department to determine if any additional rooms on the unit had the same problem—and staff found that overhead pages could not be heard from a number of rooms. Engineering also reported that the current paging system and existing facility infrastructure could not be modified sufficiently to ensure that all overhead pages were heard. As a result, a new paging system was ordered and is now being installed.

Along with participating in the rounds, Clark helps collect and analyze data from across the network to provide benchmarking data and to trend information. In addition, she also helps participating hospitals educate staff on safety issues, and coordinates a monthly safety newsletter. "We're able to share safety issues and solutions across the DICON system, networking to improve safety across the board."

In recent months, DICON has also been working with the textile and chemical manufacturing company Milliken to incorporate industrial safety strategies into its hospital safety programs. "Milliken is a national leader in workplace safety, and we believe we may be able to transpose some of their methods into health care systems to protect employees," says Keith Kaye, MD, DICON co-director. DICON and Milliken are currently developing a program and curriculum to help participating hospitals implement safer work practices and educate their employees in workplace safety.

Such broad educational efforts are critical, Sexton points out. "Safety is not just a series of preventive efforts—it needs to be a culture, something that everyone from the CEO to the front-line staff is responsible for," he says. "For a long time patient safety has been the gorilla in the living room—everyone knows it's important, but it's often easy to ignore as something we don't have a lot of time to invest in. That is now changing. We want to build on lessons learned here and at other hospitals, and do all we can to help community hospitals ensure the safety of patients and staff."

For more information visit dicon.mc.duke.edu or call 684-4596.