Kathy McGowanDirector/Hospital Engagement NetworkVice President, Quality & Safety, GHA

August 14, 2014

Center for Rural HealthQuality in Georgia

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My Inspiration . . . . . .

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Hospital Engagement Network

Partnership for Patients (P4P) continuation:

By the end of 2014, reduce preventable • all-cause harm rates by 40% • readmissions by 20%

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Aim for Safety across the Board

All preventable harm must be addressed to reach the goal but these are the areas of focus to begin:

– Reducing Preventable Readmissions– Adverse Drug Events (ADE)– Catheter-Associated Urinary Tract Infections (CAUTI)– Central Line Associated Blood Stream Infections (CLABSI)– Injuries from Falls and Immobility– Obstetrical Adverse Events (First: Early Elective Deliveries) – Pressure Ulcers– Surgical Site Infections– Venous Thromboembolism (VTE)– Ventilator-Associated Events (VAE)

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Safe Care is Not Only Important to Our Patients…. but Crucial to Hospital Success

Payment for care is now based on quality not volume• Value Based Purchasing

– Medicare payment incentives/penalties to promote:• Achievement of high quality care• Annual Market update increased or reduced beginning October

2102 up to 2% by 2017– Payment based on quality measures and Patient satisfaction

(HCAPHS)– Better scores higher payments, low scores lower payments

• Nonpayment for Hospital Acquired Conditions– Higher payment withheld if condition not present on admission

• Payment penalties for readmissions

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GA HEN’s Innovative Approach

Proactive vs. Reactive

Friendly Competition

Reward and Recognition Results

2013Patient Safety

Leader’s Circle

New Data: GA HEN ACT Score is now 91!

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March to Rapid Results Project

12.5%

• Reduction in CAUTI Rate

20%

• Reduction in Falls with Injury Rate

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March to Rapid Results Winners

• Bacon County Hospital and Health System• Bleckley Memorial Hospital• Coffee Regional Medical Center, Inc.• Dodge County Hospital• East Georgia Regional Medical Center• Effingham Health System• Elbert Memorial Hospital• Emanuel Medical Center• Floyd Polk Medical Center• Higgins General Hospital

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March to Rapid Results Winners

• Jasper Memorial Hospital• Liberty Regional Medical Center• Louis Smith Memorial Hospital• Miller County Hospital• Monroe County Hospital• Morgan Memorial Hospital• Optim Medical Center - Jenkins• Optim Medical Center - Screven• Optim Medical Center - Tattnall

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March to Rapid Results Winners

• Phoebe Worth Medical Center• Pioneer Community Hospital of Early• South Georgia Medical Center - Berrien County Campus• Southeast Georgia Health System – Camden• Southwest Georgia Regional Medical Center• Sylvan Grove Hospital• Upson Regional Medical Center• Warm Springs Medical Center

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Leading Edge Advanced Practice Topics (LEAPT)

• Atlanta Medical Center• Chatuge Regional Hospital• Crisp Regional Medical Center• DeKalb Medical Center• Doctors Specialty Hospital• Effingham Health System• Floyd Medical Center• Habersham Medical Center

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Leading Edge Advanced Practice Topics (LEAPT)

• Midtown Medical Center• Newton Medical Center• Northside Medical Center• South Georgia Medical Center• Spalding Regional Medical Center• St. Mary’s Healthcare System• Ty Cobb Regional Medical Center• Union General Hospital• University Hospital

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Leading Edge Advanced Practice Topics (LEAPT)

Five (5) LEAPT Topics Hospital Lead(s)

• Sepsis Brandon Reece, Floyd Medical Center

Heidi Nelson & Nancy Fulmer, University Hospital

• C. diff Doug Blomberg, St. Mary’s Health Care System, Inc.

• Culture of Safety Nancy Curdy, DeKalb Medical Center

Teri Newsome, Habersham Medical Center

• Failure to Rescue Dawn Ojeda, Spalding Regional Hospital

• Procedural Harm Tina Thomas, Ty Cobb Regional Medical Center

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Quality and Patient Safety Awards - 2013

CRITICAL ACCESS HOSPITALS1st PlaceMonroe County HospitalCEO: Kay Floyd– PHA Contact: Kathy LouthPatient Fall Reduction 

2nd PlaceMorgan Memorial HospitalCEO: Ralph Castillo – PHA Contact: Kimberly MillerAdmission Medication Reconciliation Completion

 3rd PlaceMitchell County HospitalCEO: LaDon Toole – PHA Contact: Robin HayesOur Journey To Core Measure Success  

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Quality and Patient Safety Awards - 2013

HOSPITALS WITH LESS THAN 100 BEDS1st PlaceGrady General HospitalCEO: LaDon Toole – PHA Contact: Crystal RammCAUTI: Striving for Zero 

2nd PlaceHabersham Medical CenterCEO: Jerry Wise – PHA Contact: Teri NewsomeEliminating Elective Deliveries Less than 39 Weeks

 3rd PlaceGrady General HospitalCEO: LaDon Toole – PHA Contact: Crystal RammWe are the Voice of the Unborn Baby: Our Journey to Reduce Early Elective Deliveries

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Circle of Excellence Awards - 2013

 

Grady General Hospital

Habersham Medical Center

Upson Regional Medical Center

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Core Measures Honor Roll

• Chairman’s Honor Roll –

• Top 5% of all Georgia Hospitals (99.02 to 100)

• Trustee Honor Roll –

• Top 15% of all Georgia Hospitals (98.03 to 99.01)

• Presidential Honor Roll –

• Top 30% of all Georgia Hospitals (96.9 to 98.02)

Core Measure Honor Roll

Chairman’s Honor Roll Top 5 at 100% Sylvan Grove Hospital Mitchell County Hospital Good Samaritan Hospital Effingham Health System Mountain Lakes Medical Center 

Coffee Regional Medical Center, Inc.

Colquitt Regional Medical CenterCrisp Regional Hospital, Inc.Higgins General HospitalFannin Regional HospitalGordon Hospital

 

Core MeasureHonor Roll

Trustee Honor Roll Miller County HospitalGrady General HospitalChatuge Regional Hospital, Inc.Phoebe Sumter Medical CenterBarrow Regional Medical Center

Presidential Honor RollEvans Memorial Hospital, Inc.Piedmont Mountainside HospitalJasper Memorial Hospital 

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HCAHPS Comparison 10/1/2012- 09/30/2013

Percent of patients who reported that their nurses "Always" communicated well.

Percent of patients who reported that their doctors "Always" communicated well.

Percent of patients who reported that they "Always" received help as soon as they wanted.

Percent of patients who reported that their pain was "Always" well controlled.

Percent of patients who reported that staff "Always" explained about medicines before giving it to them.

Percent of patients who reported that their room and bathroom were "Always" clean.

Percent of patients who reported that the area around their room was "Always" quiet at night.

Percent of patients at each hospital who reported that YES they were given information about what to do during recovery.

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).

Patients who reported YES they would definitely recommend the hospital.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

80%

85%

69%

71%

65%

73%

69%

84%

69%

68%

National Average GA State Average Center for Rural Health Average

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Culture of Patient Safety Survey*

Teamwork Within Units

Supervisor/Manager Expectations & Actions Promoting Patient Safety

Organizational Learning--Continuous Improvement

Management Support for Patient Safety

Overall Perceptions of Patient Safety

Feedback & Communication About Error

Communication Openness

Frequency of Events Reported

Teamwork Across Units

Staffing

Handoffs& Transitions

Nonpunitive Response to Errors

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

83%

79%

74%

76%

70%

71%

64%

70%

70%

61%

56%

47%

2012 National Benchmark % 90th percentile 2012 National Benchmark % Average CFRH Average

*Data Source: 41/73 57% of CFRH hospitals reporting over 3 year period via GHA CoPS

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Overview of Pharmacy Measure

Adverse drug events account for 34.2% of all hospital acquired conditions (Partnership for Patients, 2010).

One solution to reducing this harm is to utilize appropriate technology to reduce errors. Evidence suggests that processing a prescription drug order through a CPOE system cuts the likelihood of error on that order by 48%.

However, technology in and of itself is not the final solution. With a larger goal of increased patient safety and medication management, it is also important to have a pharmacist enter or review the medication orders because they are the medication experts.

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Pharmacist CPOE/Verification of Medication Orders Within 24 Hours 2 Approaches

Preferred approach• Numerator: Number of

electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours.

• Denominator: Total number of electronically entered medication orders for inpatients admitted to a CAH (acute or swing-bed) during the reporting period.

Alternate Approach• Numerator: Number of

electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours – based on the pharmacist coverage hours.

• Denominator: Total number of electronically entered medication orders for inpatients admitted to a CAH (acute or swing-bed) during the reporting period.

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Seamless Care: Safe Patient Transitions Between Facilities

Ensuring appropriate and timely care beyond organizational silos is essential to transforming health care.

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Phase 3 Quality Measures:ED Transfer Communication Measures:

– Administrative communication

– Patient information

– Vital signs

– Medication information

– Physician information

– Nurse information

– Procedures and tests

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TeamSTEPPS Implementation

Improved team processes (e.g., Capella, et al., 2010)

Improved patient safety culture (e.g., Thomas & Galla, 2013)

Improved team performance (e.g., Weaver, et al., 2010)

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Summary – Hospital Goals for 2014-2015

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Go Georgia!!

Over 10,400 Patients from Harm

$63 - $92 Million!

We Have Saved So Far….

Marching Forward in 2014132 Days!

Success Needs to Spread and Accelerate!

We are up to the challenge!33