"Above All, Do No Harm"

Daniel J. Amorino

The Hippocratic Oath is one of the most widely known tenets of a health care provider's code of conduct The code requires a new health care provider to swear to uphold a number of professional ethical standards. One of the most popular phrases of the oath is “Above all, do no harm.” In its groundbreaking report To Err Is Human, the Institute of Medicine (IOM) (1999) estimated that 98,000 patients die each year because of preventable medical harm. This death rate is equivalent to the death rate from three jumbo jets crashing every other day.

As a result of the sobering data brought to light by the IOM's 1999 report on medical errors, health care organizations have made reducing patient harm a key focus in quality improvement initiatives. Geisinger Wyoming Valley Medical Center (GWV) is one such organization that has undertaken a long and hard-fought journey to reduce patient harm. This case study focuses on GWV's efforts to reduce preventable harm by reducing fall rates.

Geisinger Health System and Geisinger Wyoming Valley

GWV is part of Geisinger Health System (GHS), a physician-led, integrated health care system that spans forty-four counties in Pennsylvania, serving over 2.6 million residents. As of the end of fiscal year 2011, GHS employed over 14,000 individuals, including over 1,300 doctors and advanced practitioners. In that same year the system had over 2.3 million outpatient visits and over 85,000 emergency room visits, and had total revenues of $2.7 billion (Geisinger Health System, 2011). Geisinger physician offices are strategically located in small and large towns and cities throughout the region, enabling patients to have close proximity to their providers.

In addition to nearly forty community practice sites, there are a number of hospitals, ambulatory surgery sites, and other Geisinger-affiliated programs or partnerships such as the Henry Hood Center for Health Research, Marworth Alcohol & Chemical Dependency Treatment Center, and the Life Flight® (air ambulance) program.

GWV has 243 licensed beds and features a state-of-the-art critical care building, the region's only freestanding heart hospital, a transplant and organ donation program, and various specialty programs in medicine and surgery. There are several nursing units with varying levels of acuity such as a labor and delivery unit, pediatrics unit, progressive care unit (PCU), intensive care unit (ICU), cardiac step-down unit, and several medical-surgical units.

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