IMPACT members have proven that breakthrough improvement is possible. For example:

• St. Joseph Hospital (Orange, California, USA) has improved their overall composite score from 91 percent (1Qtr.04) to 98 percent (2Qtr.05), and their all-or-none reliability from 83 percent (Jan 2005) to 96 percent (May-Jun 2005) respectively, by implementing AMI pathways in the Emergency Department, enhancing triage for atypical presentations, expediting Cath Lab call-back process flow, using redundancy checks for evidence-based therapies, and creating default counseling for first- or second-hand smoking cessation. These results were achieved through the Designing for Reliability in Clinical Processes Learning and Innovation Community.

• Henry Ford Hospital (Detroit, Michigan, USA) implemented a Rapid Response Team to reduce inpatient mortality on a medical-surgical unit, decreasing their inpatient mortality rate by 20 percent and reducing pulseless cardiac arrests by 40 percent from baseline. These results were achieved through the Reducing Hospital Mortality Rates Learning and Innovation Community.

• Lee Memorial Health System, Cape Coral Hospital (Fort Myers, Florida, USA) reduced ventilator-associated pneumonia by 50 percent over a nine-month period by engaging a multidisciplinary team to utilize evidence-based practices and conduct multiple small tests of change. These results were achieved through the Implementing an Idealized Model for Critical Care Learning and Innovation Community.

• Baptist Memorial Hospital-Memphis (Memphis, Tennessee, USA) improved performance on acute myocardial infarction (AMI) core measures, specifically targeting smoking cessation advice/counseling and timeliness of door-to-PCI, by using a three-tier model to design reliability into care processes and by developing a culture of collaboration and improvement. These results were achieved through the Designing for Reliability in Clinical Processes Learning and Innovation Community.

• Henry Ford Hospital (Detroit, Michigan, USA) sought to improve the safety and quality of their care by reducing central line complications, focusing on bloodstream infections in particular. These results were achieved through the Implementing an Idealized Model for Critical Care Learning and Innovation Community.

• The Intensive Care Unit of Owensboro Medical Health System (Owensboro, Kentucky, USA) experienced eight consecutive months with a zero ventilator-associated pneumonia rate after implementing the Ventilator Bundle. These results were achieved through the Reducing Hospital Mortality Rates Learning and Innovation Community.

• Baptist Memorial Hospital-Memphis's Intensive Care Unit team set out to reduce sepsis mortality by improving the identification of sepsis and implementing sepsis bundles in November, 2005. Improving the identification of severe sepsis and implementing the Sepsis Resuscitation and Sepsis Management Bundles led to a reduction in sepsis mortality. For the 89 patients with completed data through December 2006 in the Surviving Sepsis Campaign database, there was over a 40% reduction in mortality compared to baseline rates.  These results were achieved through the Implementing an Idealized Model for Critical Care Learning and Innovation Community.