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IOM Workshop on Standards for Clinical Guidelines Monday, January 11, 2010 Elizabeth Mort, MD, MPH Massachusetts General Hospital Partners HealthCare, Inc. Partners HealthCare, Inc. - PowerPoint PPT Presentation

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  • IOM Workshop on Standards for Clinical Guidelines

    Monday, January 11, 2010

    Elizabeth Mort, MD, MPHMassachusetts General HospitalPartners HealthCare, Inc.

  • Partners HealthCare, Inc.Integrated, academic health system founded in 1994 by Brigham and Womens Hospital and Massachusetts General Hospital

    Four-part mission is patient care, teaching, research, and community service

    1.7 million patients receive care from Partners institutions and physicians

    170,000 hospital inpatient discharges annually

    4.3 million outpatient and physician visits annually

    We are a large consumer of clinical guidelines

  • Partners HealthCare Hospitals

  • Role of guidelines at Partners HealthCare, Inc Goal is to assure that all patients get the highest quality care, reliably delivered anywhere in the system.

    Identify priority areas for system-wide improvement.

    Review clinical guidelines using clinical experts and develop system-wide approaches.

    Implement guidelines using high reliability design, leveraging system resources such as electronic medical record, registries, clinical decision support rules, etc.

    Measure compliance transparently and study failures/variance.

    Refine as needed

  • http://qualityandsafety.partners.org/

  • Recommendations for guideline standards Concur with many of the presenters today that describing the level of the evidence and the strength of the recommendation is critical. Agree with developing a standard taxonomy to simplify.

    Describe the exact nature of and the probability of obtaining the benefit and risks. (Allows prioritization of action at all levels, from the system to the individual patient.)

    Highlight areas of controversy.

    Develop an organized, transparent, accountable, and safe approach to provide consensus opinion and expert opinion on the management of populations or situations that are not explicitly addressed in the clinical practice guidelines.

    Provide guidance to facilitate implementation if available and suggest performance measures if appropriate.

  • Additional FAQs Care of the elderly, pts with renal failure, who have CHF, what about CDEs, etc.

  • Include guidance on implementation: STEMIBradley, E. et. al; Reducing door-to-balloon times to meet quality guidelines: How do successful hospitals do it? Circulation 2004

    EMS does ECG

    EMS notifies ED of STEMI, starts IV, and draws blood

    ED calls operator to page cath lab staff and interventionalist

    Are pagesconfirmed?

    Cath lab staff and interventionalist arrive and scrub within 30 mins

    Patient arrives at ED triage

    Is STEMIsuspected?

    yes

    no*

    Is there apre-hospital ECG indicatingSTEMI?

    ED initiates treatment and consent forcath lab

    ED transports patient to cath lab

    ED communicates with cath lab to determine readiness to receive patient

    yes

    Final checklist and written consent completed

    ED does ECG and gives it to ED physician in 10 mins

    no

    Is STEMIconfirmed?

    Continue EDwork-up and cancel cath lab, as needed

    no

    Is PCI indicated?

    Startprocedure

    ED calls operator to page cath lab staff and interventionalist

    yes

    *if no response within 10 mins,go to next one on on-call list

    Are pagesconfirmed?

    Cath lab staff and interventionalist arrive and scrub within 30 mins

    yes

    no*

    Patient arrives in ED withoutpre-hospital ECG

    Patient has symptoms and calls EMS

    yes

    no

    no

    yes

    PATH #2

    PATH #1

    Admit patientto CCU

  • Include guidance on implementation: STEMITime for staff to arrive: 35 minTriage Time: 10 minLab arrival to reperfusion: 30 min. Bradley, E. et. al; Reducing door-to-balloon times to meet quality guidelines: How do successful hospitals do it? Circulation 2004

  • Recommendations for guideline standards Concur with many of the presenters today that describing the level of the evidence and the strength of the recommendation is critical. Agree with developing a standard taxonomy to simplify.

    Describe the exact nature of and the probability of obtaining the benefit and risks. (Allows prioritization of action at all levels, from the system to the individual patient.)

    Highlight areas of controversy.

    Develop an organized, transparent, accountable, and safe approach to provide consensus opinion and expert opinion on the management of populations or situations that are not explicitly addressed in the clinical practice guidelines.

    Provide guidance to facilitate implementation if available and suggest performance measures if appropriate.

    Three and a half pounds of guideline material produced by the ACC/AHA(Alice Jacobs)

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