Critical Care Physician Honored as a MacArthur Fellow

Visit www.iamsccm.org for more insiprational member stories.

Society of Critical Care Medicine member Peter J. Pronovost, MD, FCCM, was honored as a 2008 MacArthur Fellow, pushing forward an agenda to improve patient safety and creating another opportunity to put critical care in the spotlight.

The $500,000 “no strings attached” grant is given to 25 recipients each year to recognize those who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction. MacArthur Fellows must be exceptionally creative, show a promise for important future advances based on a track record of significant accomplishment, and display potential to facilitate subsequent creative work. Pronovost exemplifies all these characteristics in his efforts to bring scientific evidence to the bedside and motivate healthcare professionals in large health systems – including hospital administrators, intensive care specialists, residents, nurses, and other healthcare professionals – to change the culture of their institutions.

“I was humbled and honored by the award, but for me, the real reward is knowing that we make a difference in people’s lives,” he said, while also recognizing his colleagues. “I have an amazing team of researchers; together we are much wiser than we are apart. I’ve brought the lessons I’ve learned about the value of the ICU multiprofessional team to my research team. The disciplines are different, but the concept is fundamentally the same.”

The MacArthur Fellows Program is intended to encourage people of outstanding talent to pursue their own creative, intellectual and professional inclinations. In keeping with this purpose, the Foundation awards fellowships directly to individuals rather than through institutions. “It is a unique grant in that they trust your ingenuity. They want to support creativity and let it flourish,” Pronovost explained. While Pronovost hasn’t yet decided how he will use the funds, he has several long-term projects in mind. One project includes expanding and duplicating his work in reducing the risk of medical errors and hospital-acquired infections. One of Pronovost’s most notable contributions to date resulted from his focus on bloodstream infections from central venous catheters. Pronovost culled lengthy guidelines into a simple checklist of five precautionary steps and tested its efficacy through a cohort study conducted in intensive care units (ICUs) throughout Michigan. This checklist intervention yielded a significant and sizable decrease in rates of infection and is currently being replicated by hospitals across the United States and Europe. Pronovost also hopes to develop similar checklist approaches to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.

Another project includes the development of a “checklist maker,” a software tool that would harness knowledge, make it easily accessible and ensure that it is adaptable to specific practices– such as resource-limited or clinician-based environments. Physicians would no longer have to wait years for guideline development and updates. “So much of what we do is based on experience, intuition or gut,” he explained. “That is valuable information, but we don’t have a good way of sharing that knowledge. I’m longing for a way to tap more efficiently into both empiric and tacit knowledge.”

By doing the technical work behind the checklists, he hopes hospitals will be encouraged to take action based on their needs and resources. “It is not efficient or effective for all hospitals to do the technical work themselves. Measuring infection rates requires developing a database, data collection forms and many other aspects. We can standardize the evidence and how to measure it, but we can’t standardize how to put a program into practice – that has to be locally modified.” Other efforts under way include the development of a Web-based ICU safety reporting system, methods for minimizing the incidence of aspiration pneumonia and acute lung injury in patients receiving ventilator assistance, and quality care measures for patients suffering from severe sepsis.

In all these approaches, Pronovost understands the need for teamwork. “No one is going to solve this alone,” he said. “We need to partner with consumers, providers, insurers and regulators because in the end, we all want the same thing – high-value healthcare that we can afford. For too long, these groups have been working at odds, but we have started to pull them all together.”

Pronovost also was named as one of TIME magazine’s 100 Most Influential People of 2008 for patient safety efforts in Michigan. While his research is well known throughout the medical community, the high-profile recognition helps bring critical care awareness to the general public. With profiles in the New York Times, The Washington Post and several other national newspaper and television outlets, the focus on patient safety and the role of the critical care physician may pique the interest of patients, families, the general public and young medical professionals. Noting the shortage of critical care professionals, he expressed hope that his work would illuminate the rewarding career path of intensive care. He also encouraged researchers not to stop their clinical practice. “I am fundamentally, at my heart, a clinician and an intensivist; continuing my clinical practice has made my research more effective. The ICU is my learning lab. I practice there, and then I reflect on things that are broken and think about how to make them better.”