New IOM Report Calls for Team Care
The Institute of Medicine, which in 1999 released a "controversial" report on the frequency of fatal medical errors, today will release a "sweeping" new report that calls for team-based care as one solution to the nation's "fragmented" health care system, USA Today reports (Appleby/Davis, USA Today, 3/1). The report, titled "Crossing the Quality Chasm: A New Health Care System for the 21st Century," will be released at a press conference today at 11 a.m. EST. The hour-long conference will be broadcast live on the National Academy of Sciences Web site at http://national-academies.org, and an archived version of the Web cast will be posted on the site about one hour after its conclusion. At that time, the report also will be available on the Web site. The conference will feature William Richardson, president and CEO of the W.K. Kellogg Foundation and chair of the committee that wrote the report; Donald Berwick, president and CEO of the Institute for Healthcare Improvement; and Molly Coye, senior fellow at Institute for the Future and president of the Health Technology Center (National Academy of Sciences release, 2/28).
In the report, the IOM proposes that intensive care units adopt a team-based system to reduce medical errors and improve patient care. A typical team would contain members from different specialties, such as an intensivist (intensive care medicine specialist), a pharmacist, a social worker, a nutritionist, a nurse, a respiratory therapist and a chaplain. Using provider teams yields several advantages, including a wider breadth of knowledge, USA Today reports. For example, psychiatrists can inform physicians of the psychological impact of certain treatments or procedures, whereas a physician acting alone might not be aware of such risks. "We all keep each other up to date," Dr. Christopher McGregor of the Mayo Clinic, which has "long been recognized" for its team approach, said. Dr. Joseph Fontana, an intensivist at Suburban Hospital in Maryland, added, "It's good to have people with differing backgrounds and opinions looking at the same problem. It makes a huge difference, because small problems that can turn into big ones are headed off early." At Suburban, which operates on a team system, team-based care has reduced medical errors, improved communication between families and staff and reduced the amount of time patients spend in the ICU, USA Today reports.
Several obstacles hinder hospitals and medical centers from adopting team-based systems, USA Today reports. According to Dr. Tom Rainey, medical director for critical care services at Suburban, only 10% of the nation's ICUs follow a team model. Physicians, who are "used to being autonomous," might not want to lose their power or income to intensivists, USA Today reports. Furthermore, the cost of implementing team-based care also is an issue for some hospitals, especially those in rural or inner-city areas. Changing to a team-based system costs between $20,000 and $35,000 per hospital for an initial year of training, plus $5,000 to $12,000 per year for additional education. But emergency rooms that use team-based care can save $4 to $10 per patient visit, and also can cut medical errors by more than 50%, according to Robert Simon, chief scientist for Dynamics Research and teacher of teamwork skills for emergency room workers.
Despite such obstacles, a growing number of hospitals are switching to team-based systems, and many insurers and business groups have backed such changes, USA Today reports. The Leapfrog Group, a coalition of large businesses, is "pushing" employers to contract with insurers who promote team care. Solucient, a research and health data tracking firm, says that teams led by intensivists could help save the nation $1.5 billion annually on intensive care treatment. Kaiser Permanente, Group Health and other health insurers have begun to contract with teams to treat beneficiaries with chronic illnesses (USA Today, 3/1).