Best Care – Best Way – Every Patient – Every Day
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Transcript of Best Care – Best Way – Every Patient – Every Day
Improving Harm Across the Board
St. Francis HospitalAngela King, BSN, CPHQ, CPHRM
Administrative Director, Patient Safety and Quality
Best Care – Best Way – Every Patient – Every Day
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Cut “harm across the board” by 37%
1Q10 2Q10 3Q10 4Q10 1Q1 2Q11 3Q11 4Q11 1Q12 2Q12153
203
253
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353
403 Total Harms by Quarter
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2012 Breakthrough in Readmission: From 246 to 144
1Q10 2Q10 3Q10 4Q10 1Q1 2Q11 3Q11 4Q11 1Q12 2Q1292
112
132
152
172
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212
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252
272Readmissions
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Reduced 30 Day Readmission RateFrom 9% to 5%
1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 4Q11 1Q12 2Q120.00
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0.02
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Readmissions
Drivers of safety that produce these results include:
• Patient and family engagement - Caught You Washing” cards
- “Turn” signals throughout hospital- Joint Camp/Heart Camp
• Physician led improvement efforts. • Empowering staff to “speak up” in the
interest of safety leads to a culture of safety.
Pearls
Pearls (continued)Development of best practice protocols and
checklists. This can lead to recognition for disease specific certifications.
Providing data to direct caregivers and involving them in developing improvement plans. For instance, stratifying why patients are non-compliant leads to process changes that impact their care. For example: The Heart Failure patient readmitted because they do not have funds to fill prescriptions or do not have a private physician to follow up with for care.
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Defining Moment In Our JourneyA landmark was reached with VAP compliance
when we went 884 days with ZERO VAP cases!Staff realized they could get to zeroStaff realized they could reduce harmWe began tracking on our Intranet in real
time – this was a commitment to transparency
Risk Profile: The Areas of Risk We Are Committed To ControllingAnnual discharges: 10,756 HAC risk opportunities/discharge:
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HACs Estimated annual number of patients at risk in each area Number of Opportunities
ADE # of inpatients: 10,756
CAUTI # pts in IP units with catheter in place: 1,613
CLABSI # pts in IP units with central lines: 6,445
Falls # of discharges: 10,756
Ob AE # of women with deliveries: 0
Pr Ulcer # of discharges: 10,756
SSI # of applicable surgical pts: 9,013
VAP # of patients on a ventilator: 1,310
VTE # of inpatients: 9,013
EED # of women with elective deliveries 0
TOTAL Risk opportunities for harm across the board 59,662
Readmit # of inpatients at risk of readmit: 10,756
Our improvement journeyImprovement Scale:The stages we move
throughIDEAL: level represents zero harm
At Target: level represents meeting improvement target
Progress: level shows movement but not yet at target
Opportunity: level is an opportunity to launch aggressive action
Number of risk areas (0-9) at
each stage_____4_____
_____2_____
_____0____
_____3_____
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Improving Harm Rates (per discharge)HACs Baseline Rate
[2010]Target Rate
ADE 0.004 0.003CAUTI 0.003 0.002CLABSI 0.001 0.000Falls 0.012 0.011Pr Ulcer 0.003 0.002SSI 0.004 0.003VAP 0.000 0.000VTE 0.010 0.009Total 0.037 0.030
Readmit 0.066 0.056
• Areas of strength at the beginning were CLABSI and VAP
• Areas that represented biggest challenges were all others
Improving Harm Rates (per discharge)HACs Baseline Rate
[2010]Target Rate Current Rate
[Q1 – Q2 2012]Improvement Status
ADE 0.004 0.003 0.006 OpportunityCAUTI 0.003 0.002 0.000 IdealCLABSI 0.001 0.000 0.000 IdealFalls 0.012 0.011 0.013 OpportunityPr Ulcer 0.003 0.002 0.000 IdealSSI 0.004 0.003 0.002 At TargetVAP 0.000 0.000 0.000 IdealVTE 0.010 0.009 0.011 OpportunityTotal 0.037 0.030 0.032
Readmit 0.066 0.056 0.047 At Target
Our Hospital Risk Score CardOur Safety Mandate
Annual Volume (Discharges) 10,756Total risk: annual harm opportunities 59,662
Risks per patients (Total Opportunities)/Discharges)
5.55
Number of Risk AreasNumber of PfP Risk Areas Applicable (0 – 11) 9Number of PfP Risk Areas Applicable & Adopted 9
Our ProgressNumber of PfP Areas with Improvement Opportunity
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Number of PfP Areas at Improvement Target 2Number of PfP Areas at Progress 0Number of PfP Areas at Ideal 4
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Hospital CEO and Safety Team
Next Big Step to Reduce Harm
Hardwiring safety tools to impact daily operations
Teamwork training utilizing proven patient safety methodologies
Training in clinical processes to impact patient safety and quality, creating greater efficiency and reliability