Quality Corner
October Highlights of Performance Improvement at SHC
Quality Improvement and Patient Safety Committee [QIPSC],
chaired by Joseph Hopkins, associate chief of staff
A clear sign of a mature and successful program is change, and in the case of our quality initiatives, this means we fix problems and then move on to deploy our resources to solve new challenges.
Our goal is to bring initiatives to levels where we can “call off the cavalry,” sending the strike force elsewhere while taking care to leave behind a police force. In this analogy, the persons responsible for continuing to maintain and improve quality on the units are primarily the committed people who work there regularly. So “Dodge City” is safe. It is not abandoned. It is receiving the attention it deserves.
We have achieved equilibrium in three areas of concern that we had designated as priorities for 2009: IAP (iatrogenic pneumothorax), Delirium and DVT, have been “sunsetted” as initiatives in our quality program. In addition, our success, driven in part by our recent conversion to the Epic electronic health record (EHR), has enabled us to “sunset” Clinical Documentation as an initiative and manage it going forward as a quarterly report.
So the troops, our multidisciplinary team of physicians and nurses and other professionals cross-trained in quality issues, are moving on to tackle new challenges. Currently, we are adding four new initiatives to our list of priorities for 2010. Our targets include Diabetes Control, Anticoagulation Issues, Medication Reconciliation, and Surgical Site Infections. Such a list is not necessarily good news, obviously, because designating initiatives as quality improvement priorities is recognition that we have problems that we need to fix. Similarly the continuation in 2010 of Hand Hygiene and Sepsis from the 2009 priority list to our 2010 list is recognition that issues aren’t solved immediately and sometimes need to remain on the table. Also, a 2009 Collaborative Team Building initiative has been retooled to become a Hand Off (clinical transition) initiative. This retooling is both progress and recognition that issues still need to be solved.
When I started about a decade ago in a version of my current role, it often seemed as if all I could see were quality and safety problems that needed fixing. At this point, I personally take some cautious satisfaction in knowing that we can really get to a point where problems have evolved from being issues needing a task force to address them, to becoming health care issues that we can solve with alert and routine vigilance in the course of our normal practice. For those involved in the care of our patients in the hospital, I’m sure that seeing the kindly sheriff replacing the cavalry is a welcome sign. Those of you who work on units are a large part of the reason these transitions can occur.
Here is additional positive news:
The quarterly Utilization Management Report disclosed in October that we have successfully reduced length of stay (LOS) in six DRGs by more than 20 percent, including one lowered by 30.5 percent. LOS in an additional five DRGs was lowered from between 3.5 and 20 percent. The record of these 11 DRGs is good news in an era when hospitals are under continued pressure to reduce costs both for the institution’s health and survival and for the need to reduce costs for our patients and those who pay their bills. Much of the improvement in LOS can be attributed to continually improved practice strategies that more efficiently help patients recover more quickly. But a significant contributor to reduced LOS is the thoughtful and diligent work of our case managers, who create win-win scenarios by identifying and arranging placement and follow-up care for patients ready to make the move from an acute care setting to an appropriate environment that is almost invariably less costly but usually more appropriate for their post-inpatient well being.
Improved patient survival is among the best news we ever can get, and the report from our Emergency Medical Response Team has disclosed that the hospital discharge survival rate for patients suffering cardiopulmonary arrests averaged 30 percent, compared with a national average of 18 percent.
Satisfied nurses are surely central to a successful hospital, and we are above benchmarks of the National Database of Nursing Quality Indicators (NDNQI) for 2009. Our indicator score for nursing satisfaction is 61.29, compared with a Magnet Hospital (American Nurses Credentialing Center) benchmark mean of 58.91 and an American Medical College mean of 56.17. This is a long way from where we were 10 years ago, even though we weren’t rigorously measuring such satisfaction at that time. On this measure, as on so many, we have room for improvement, and continued progress will be a challenge. But we are light years away from the tales of woe that my colleagues and I have brought to you in the past. Progress is palpable.
