Dr. Sanjay Saint and his colleagues at the Veterans Affairs Medical Center in Ann Arbor, Mich., are turning the inpatient service there into a laboratory, trying to create the ideal hospital experience for patients.
The project, called the “Gold Service,” began over the summer and is a small part of Dr. Saint’s decade-long quest to curb hospital-acquired complications and infections.
Dr. Sanjay Saint
Dr. Saint, a professor of internal medicine at the University of Michigan, said he strives to bring the same type of prevention focus that general internists bring to the outpatient setting to the most vulnerable patients in the hospital. “I wanted to apply that framework to those patients who are so sick that if they actually get a complication under our watch, that could tip them over and it could mean that either they die or they never go home,” he said.
For the last 9 years, Dr. Saint has served as director of the Patient Safety Enhancement Program at the Ann Arbor VA Medical Center and the University of Michigan Health System. In this latest project, he is working to create an inpatient service that is highly efficient and effective, achieves a high level of safety, and keeps patients satisfied, while also fulfilling the research and education missions of the VA and the University of Michigan.
The overall goal, Dr. Saint said, is to provide the type of care that physicians would want for their own family members.
In practice, that means translating research into practice more quickly, providing appropriate oversight of residents and medical students, and improving communications across disciplines. On his service, they provide reading lists to learners, encourage better communication between nurses and physicians, and conduct multidisciplinary rounds.
Dr. Saint also urges the hospitalists and attending physicians to practice what they preach. For example, physicians can talk about the importance of preventing nosocomial infections, but if they don’t wash their hands before and after touching the patient, it doesn’t matter what they say. “Learners see that,” he said.
Although there are no data to report from the project so far, Dr. Saint said they plan to measure their progress on several metrics and compare them to those of other services. Specifically, they hope to examine mortality, readmission rates, nosocomial infection rates, hand hygiene adherence rates, length of stay, patient and nurse satisfaction, and teaching evaluations.
The project is just getting off the ground, but Dr. Saint said they have already encountered challenges. One issue is overcoming the “outdated” mindset that physicians, nurses, and social workers should operate in separate silos, he said, rather than functioning as a true health care team. Ultimately, he hopes physicians and nurses will spend less time worrying about what’s in their job descriptions and more time figuring out how to make the patient “the central focus,” Dr. Saint said.
Another challenge is balancing some of the trade-offs between quality and resource utilization. For example, keeping patients in the hospital slightly longer could increase their satisfaction and potentially decrease readmission rates, but increasing the length of stay has other drawbacks. “We have to look at all these things not in a vacuum, but at how they interrelate,” he said.
If he and his team are successful in improving patient care through the Gold Service, Dr. Saint hopes to see the lessons picked up by all kinds of hospitals, not just in the United States, but in countries all around the world. Since the research is being done at a VA facility, which is part of a large, centralized system, other countries with centralized health care systems like Canada, England, Italy, and France may be able to make similar changes, he said.