MedStar St. Mary’s Hospital Pioneers In Quality Presentation

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Presenter: Elizabeth Ballard, MSN, RN and Dawn Yeitrakis MS, RN, CEN

MedStar St. Mary's Hospital (MSMH) Mission & Vision

• Our Mission – MedStar St. Mary’s Hospital is a

community hospital that upholds its tradition of caring by continuously promoting, maintaining and improving health through education and services while assuring high quality, patient safety, and fiscal integrity

• Our Vision– To be the trusted leader in caring for

people and advancing health

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Population Served • St. Mary’s County – 110,000+ residents• Median household income - $82,529• 7.7% below poverty • Median age - 36 years• 14K military veterans + family members (40K

in region)• HPSA/MUA • 80% White, 14% Black/African American, 2.7%

Hispanic, 2.2% Asian• Naval Air Station, Patuxent River - 22,000

population• Department of Defense Contractors• Farmers• Watermen• Amish & Mennonite Communities• > 6,000 College Enrolled Students • Largest PhD Population per capita in

Maryland 3

MSMH Stroke Care Committee

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• Stroke Medical Director• Stroke Coordinator• Executive Leads• Clinical and Ancillary Department Leaders and

Clinical Coordinators– Emergency Department, Intensive Care Center,

Telemetry, Medical Surgical Pediatrics, Rehabilitation, Imaging, Laboratory, Organizational Learning and Research, Population and Community Health, Pharmacy, Nutritional Services and PI/HIM

MSMH Stroke Team

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• MedStar Stroke Services• MedStar SITEL• Health Connections• Stroke Team Associates

– License Independent Practitioners – RNs– Physical Therapist– Occupational Therapist – Speech Language Pathologists – Respiratory Therapists– Diagnostic Imaging Technologists – IT Support Staff

The MSMH Approach

• Early Adoption of Technology

• EHR Optimization

• Meeting and Exceeding Standards

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FADE/Change Management Process

• Focus on the problem/change• Analyze the situation• Develop a plan• Execute and Evaluate the plan

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FADE/Change Management Process

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Project Tactics

• Developed Team approach– Code Stroke Team– Real time monitoring of process

• Concurrent chart reviews• Overlay IT components

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Hardwiring Change

• Communication– Newsletters– Department Meetings– Safety Huddles

• Education– On-boarding – Annual Competency– Ongoing remediation– Simulation

• Partnership with MedStar SITEL10

MSMH Stroke Committee Focus Areas

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92%

4.8%

87.40%83.90%

38.5%

90.40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge

Com

plia

nce

Rate

Discharge Stroke Measures CY 2014 CY 2015

Arrival

• PowerPlans ED Stroke/TIA – Less

than 8 hours since Last Known Well

ED Stroke/TIA –Greater than 8 hours since Last Known Well

ED Stroke AlteplaseDecision

Stroke/TIA • Quality Measures,

Stroke order12

Thrombolytic Therapy Decision

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Time Management

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Quality Measures Dashboard

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Quality Measures MPage Component

• Acts as checklist for quality measure-related documentation.

• Component retrieves data from the clinical workflow, such as ordering, medication administration, documentation of allergies and problems, or other structured documentation.

• As documentation occurs, tasks that are completed move to the Complete section. Incomplete tasks remain in view at the top of the component.

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Clinicians InterActive View

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Discharge Triggers

Built Discharge Alerts for:– Stroke Anticoagulation Discharge Medication– Stroke Antithrombotic Discharge Medication– Stroke Statin Discharge Medication

Evoking Triggers– Discharge order– >18 years of age

Logic– Observation and Inpatient encounter status– Order find: Quality Measures, Stroke– Rule looks for completed ordered of specific type of medication – Rule looks for completed PowerForm with reason for not ordering

medication at dischargeAction

– Message to provider to consider ordering stroke discharge medications

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CPOE Of Discharge Order

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Nursing Depart Process

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Ongoing Process Improvement Outcomes

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92%

4.8%

87.40%83.90%

38.5%

90.40%

83.33%

60.38%

95.92%90.91%

84.62%

98.63%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Discharge Atrial Fib Anticoagulation Therapy Documented Modified Rankin Score at Discharge Cholesterol Reducing Drugs at Discharge

Com

plia

nce

Rate

Discharge Stroke Measures CY 2014 CY 2015 CY 2016 CY 2017

Sustaining Actions

• Continue monthly Committee meetings

• Concurrent reviews• Outlier reviews

– Real time follow up• Ongoing education

• Education • Partnering with

System resource to educate (SiTEL)

• Link to post acute care

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Next Steps