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Finding Opportunities to Save Lives Through Better Quality of Care

.Antonio Velardi, MD

..

"Nobody wakes up saying, 'Today, I am going to screw up,'" said Antonio Velardi, MD, Chief Quality Officer for Orlando Health-Health Central Hospital, his voice still carrying hints of his boyhood home in Milan, Italy. All the same, mistakes are inevitable, even in medicine. It is Dr. Velardi's job to discover when mistakes have happened, to investigate why they happened, and to help figure out what can be done to prevent them from happening again.

"The most important thing people should know," said Velardi, "is that every hospital is doing everything it can to improve, and that each hospital has people whose only job is to ensure the safety of every patient who enters its doors."

For the hospital staff, it is essential they feel comfortable reporting mistakes when they happen.

"We must have a culture in which people know they are not going to be punished for reporting mistakes," said Velardi. "If you are afraid of repercussions, you tend to hide what you did that was wrong. If the organization is focused on improving its policies and procedures instead of punishing people, we have a much more open working environment."

As a simple example, Velardi described the process of transporting a patient from his hospital room to the imaging department for an x-ray. A series of checks must be performed every step of the way, with physicians, nurses, transporters, and technicians double checking instructions and procedures. "Moving a patient from Point A to Point B is relatively simple if all we do is to put a patient onto a gurney or into a wheel chair. But quality and safety procedures surround the patient to make sure the right patient is taken to the right place, and the right tests are performed."

While, it sounds like quality control is focusing on mistakes that get made, it also involves finding opportunities to make improvements. Velardi cited the problem of sepsis in hospitals. Sepsis is a condition that arises when an infection someone already has--in the skin, lungs, urinary tract, or somewhere else--triggers a chain reaction throughout the body. If not treated rapidly, sepsis can lead to tissue damage, organ failure, and even death.

In 2013, the mortality rate for our patients who developed sepsis was about 25 percent. At Orlando Health-Health Central that rate has been cut in half to 12.5 percent. In large part, that improvement was the result of improved procedures, including early recognition and treatment through the institution of a Rapid Response team.

"When the nurse suspects the patient might by septic, the nurse calls a 'Sepsis Alert,'" said Dr. Velardi. That alert immediately summons a team of medical professionals to the patient's bedside to begin aggressive treatment.

You get the impression that while cutting the mortality rate for sepsis in half is a significant improvement, Velardi isn't satisfied. "The results are significant, but they still are not optimal."

Velardi's interest in medicine started when he was very young. As a boy in post-war Italy, he suffered from asthma, and a local doctor made house calls to treat him. "I remember this doctor coming to our house and making me feel better." It was the idea that a professional could visit a sick person and do something that could help them get better that stuck in the young boy's imagination.

It was also the age when spectacular advances in medicine were just beginning. Velardi remembered reading as a teenager about the first heart transplants happening. He was especially inspired by news coverage in Italy of Dr. Denton Cooley, the Texas surgeon who performed the first implantation of an artificial heart into a person in 1969. "I remember reading in the Italian version of People Magazine that he said, 'No one should die for the mere failure of a pump!'" That sparked an initial interest in cardiothoracic surgery and his eventual admission to the School of Thoracic and Cardiovascular Surgery at the University of Milan.

In addition to a love for medicine, Velardi had a love for the United States that had begun with stories told by his mother of Americans liberating southern Italy during World War II. "To me this country is the greatest country in the world."

While at the University of Milan, he met an American student, Carol, and an entirely new kind of love began. They married while in Italy, but soon decided to settle in the United States, where Mrs. Velardi could finish her PhD at Stanford University and Dr. Velardi could pursue his studies. He shifted career paths from surgery to internal medicine and became a Fellow in Critical Care Medicine at St. Louis University in St. Louis, Missouri.

Velardi's path eventually brought him and his family to Florida, where he founded what would become one of the largest hospitalist groups in Central Florida. After establishing the first Leapfrog-compliant critical care medicine service at Dr. P. Phillips Hospital in 2007, Velardi joined Orlando Health-Health Central in 2012 where he has held more than a half dozen leadership roles and received the Physician Colleague Award in 2014.

"I love what I do. I love this hospital and I love the community," said Dr. Velardi. "I hope that when I do leave the hospital eventually, that people will remember me as a person who has made a difference."



 
 
 
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