2016 member showcase

2016

Member Showcase

Whitepapers

2016 Member Showcase

“If everyone is moving forward together, then success takes care of itself.”

— Henry Ford

The Texas Hospital Association’s mission is to serve Texas hospitals as the trusted source and unified voice to influence

excellence in health care for all Texans. Giving Texas hospitals the opportunity to share their best practices with one another

is just one of the many ways we work to honor this mission. Collaboration with others is a key strategy for transferring

information and expertise from one hospital to another.

We are pleased to once again present some of the diligent work taking place in hospitals across Texas at the THA 2016

Annual Conference and Expo. The stage for displaying these great ideas is the Member Showcase. This year, 14 hospitals are

presenting their work in the form of printed posters accompanied by detailed white papers. Topics range from launching a

wound care program to implementing a chronic disease management registry.

We hope you take a moment to visit the Member Showcase and review all of this year’s posters. If you have any

suggestions on how we can improve the experience, please share them with us. We also would like to encourage you to

visit THA’s online best practices library, KnowledgeShare. This resource allows members to both review other hospitals’

success stories and submit their own. For more information, visit www.tha.org/knowledgeshare.

Thank you,The THA 2016 Annual Conference and Expo Member Showcase Planning Team

3 Texas Hospital Association 2016 Member Showcase

The following facilities will showcase their best practices in the Member Showcase in the Exhibit Hall:

Baylor Scott & White Medical Center - CarrolltonDecreasing the Cost of Care for Cardiac Catheterization Patients by Opening a Progressive Care UnitElizabeth Abderrahman, director of acute care; Jennifer Baeza, service line coordinator; Ericka Boykin, informatics resource nurse; Mary Duah, progressive care unit staff nurse; Mike Lindahl, senior biomedical electronics technician; Christine Mohl, PCU super visor; Melanie Morgan, PCU staff nurse; Sidney Phillips, pharmacy director; Robin Rajaniemi, RN, intensive care unit supervisor; Paul Ratcliff, information systems director; Peggy Robbin, ICU manager; Mike Sanborn, FACHE, president; Barbara Vaughn, RN, chief nursing officer; and Joni Whitmore, lab director, Baylor Scott & White Medical Center - Carrollton

Ben Taub Hospital (Harris Health System), HoustonPeople and Service: Improving the Patient Experience Through an Interdisciplinary, Collaborative ApproachMaureen S. Padilla, D.N.P., RN, senior vice president and chief nurse executive, Harris Health System, Houston; and Mike Staley, vice president of operations, Ben Taub Hospital, Houston

CHI St. Luke’s Health Memorial LufkinPsychosocial Distress Screening in the Inpatient SettingMichael Plankers, RN, chief nursing officer; Sidney C. Roberts, M.D., radiation oncologist; Tanya Spivey, clinical informatics analyst; and Brenda Taylor, RN, renal/oncology unit director, CHI St. Luke’s Health Memorial Lufkin

Childress Regional Medical CenterTeleNeonatal Intensive Care Unit in the Rural HospitalJohn Henderson, CEO, Childress Regional Medical Center; Douglas G. Hock, president and chief operating officer, Children’s Medical Center Dallas, and executive vice president for clinical services, Children’s Health, Dallas; Holly Holcomb, RN, chief operating officer, CRMC; Kevin Latimer, chief financial officer, CRMC; SuLynn Mester, RN, chief nursing officer, CRMC; Kyla Nelson, RN, CRMC; and Laura Swaney, vice president of hospital outreach and physician engagement, Children’s Health, Dallas

Coryell Memorial Healthcare System, GatesvilleTelemedicine/Telepsychiatry in the Emergency RoomJeffrey Bates, M.D., chief medical officer; David Byrom, CEO; and Kathy Lee, director of special projects, Coryell Memorial Hospital, Gatesville

Faith Community Hospital, JacksboroFaith Community Hospital’s Replacement Facility and Expanded ServicesFrank L. Beaman, CEO; and Joy Henry, RN, chief nursing officer, Faith Community Hospital, Jacksboro

Guadalupe Regional Medical Center, SeguinDevelop a Comprehensive Inpatient and Outpatient Palliative Care and Advance Care Planning Program Carmen Anderson, palliative care social worker, Guadalupe Regional Medical Center; Liliana De La Torre, chaplain and director of advance care planning and bereavement services, GRMC; Tavie Erwin, RN, director, GRMC Hospice; Tom Jones, chaplain and executive director, GRMC Lifelong Intensive Family Emotional Care Services; and Charles R. Nolan, M.D., medical director, GRMC LIFE Care Services, Seguin

Limestone Medical Center, GroesbeckLimestone Medical Center Wound Care ProgramBrandy Kennedy, RN, wound care clinic manager; Larry Price, CEO; Leslie Ramirez, RN; and Michael Williams, chief financial officer, Limestone Medical Center, Groesbeck


Ochiltree General Hospital, PerrytonNext Level Care in Breast Health Services Jenny Barnes, mammography technologist; Brenda Castro, radiology technologist; Shayla Kenworthy, lead mammography technologist; F. Sean Leong, M.D., director of mammography; Carrie Olivares, ultrasound technician; and Nick Shields, director of radiology, Ochiltree General Hospital, Perryton

Palestine Regional Medical CenterPre-Hospital Emergency Blood Transfusions in the FieldJan Gardner, director of laboratory services; Chuck Skinner, director of emergency medical services; and Christi Watkins, RN, administrator, Palestine Regional Medical Center West

Parkland Health & Hospital System, DallasImplementation of a Chronic Disease Management RegistryAlicia Ayala-Quillen, Ph.D., senior project manager for population health; Sobha Fuller, RN, director of nursing; Teresa Garry, RN; Francesco Mainetti, project manager; Jon McManus, director of enterprise and data governance; Holt Oliver, M.D., vice president of clinical informatics, PCCI; Donna Persaud, M.D., medical director and chief of pediatrics for community medicine; Sue Pickens, director of population medicine; and Noel Santini, M.D., medical director and chief of adult medicine for community medicine , Parkland Health & Hospital System, Dallas

Parkland Health & Hospital System, DallasA Systematic Approach to Improving Myocardial Infarction Care QualitySandeep R. Das, M.D., associate chief quality and safety officer/medical director of acute coronary care at Parkland Health & Hospital System and associate professor of internal medicine at UT Southwestern Medical Center, Dallas; Jonathan R. Enriquez, M.D., assistant professor of medicine at the University of Missouri-Kansas City and director of the coronary care unit at Truman Medical Center in Kansas City, Missouri; Robert S. Hendler, M.D., associate chief medical officer/chief quality and safety officer, Parkland Health & Hospital System and clinical professor of medicine at UT Southwestern Medical Center, Dallas; Jacqueline Jones, RN, Parkland Health & Hospital System, Dallas; Lisa Mack, RN, Parkland Health & Hospital System, Dallas; Christopher J. Madden, M.D. professor of neurological surgery, UT Southwestern Medical Center; and Jason Spencer, RN, Parkland Health & Hospital System, Dallas

Texas Health Harris Methodist Hospital StephenvilleSaving Infants Masterfully With Use of SimulationFatima Michelle Inman, RN; and D’Nai Johnson, RN, Texas Health Harris Methodist Hospital Stephenville

Texas Health Presbyterian Hospital DallasImproving Resuscitation Outcomes With the American Heart Association Resuscitation Quality Improvement™ ProgramCole Edmonson, D.N.P., RN, FACHE, chief nursing officer; and Alex Klacman, RN, critical care clinical education specialist, Texas Health Presbyterian Hospital Dallas

The University of Texas Medical Branch at Galveston Community Health Program/Chronic Disease EducationCraig Kovacevich, associate vice president of waiver operations; and Katrina Lambrecht, vice president of institutional strategic initiatives, The University of Texas Medical Branch at Galveston

The University of Texas Medical Branch at GalvestonEnhance Interpretation/Culturally Competent CareCraig Kovacevich, associate vice president of waiver operations; Katrina Lambrecht, vice president of institutional strategic initiatives; and Martha M. Livanec, director of patient services, The University of Texas Medical Branch at Galveston


Member Showcase Best Practice

Initiative: Decreasing the Cost of Care for Cardiac Catheterization Patients by Opening a Progressive Care Unit

Authors: Elizabeth Abderrahman, director of acute care; Jennifer Baeza, service line coordinator; Ericka Boykin, informatics resource nurse; Mary Duah, progressive care unit staff nurse; Mike Lindahl, senior biomedical electronics technician; Christine Mohl, PCU supervisor; Melanie Morgan, PCU staff nurse; Sidney Phillips, pharmacy director; Robin Rajaniemi, RN, intensive care unit supervisor; Paul Ratcliff, information systems director; Peggy Robbin, ICU manager; Mike Sanborn, FACHE, president; Barbara Vaughn, RN, chief nursing officer; and Joni Whitmore, lab director, Baylor Scott & White Medical Center - Carrollton

Facility: Baylor Scott & White Medical Center - Carrollton

ObjectiveOpen a progressive care unit to serve as an intermediate level of care for patients in order to alleviate capacity issues in the intensive care unit and emergency department.

MethodAn analysis of admissions suggested a number of patients admitted to the ICU could have been managed in an intermediate level of care at a lower cost, specifically patients undergoing cardiac catheterization procedures.

This multistage process required:1. Closing half of a medical/surgical unit to convert those beds to a clinical decision unit;2. Closing the postpartum overflow unit to convert it to a new medical/surgical unit;3. Relocating the remaining half of the old medical/surgical unit to the new medical/surgical unit; and4. Opening the PCU following construction, staff hiring, orientation/training, etc.

Continued


ResultsThe PCU started admitting patients in December 2014. Patients undergoing cardiac catheterizations were admitted to the PCU instead of the ICU, yielding a cost savings of $2,035 per patient day for an annual cost savings of approximately $51,000 for the hospital. Through May 2015 Baylor Scott & White Medical Center - Carrollton realized a 25 percent reduction in the average total operating cost per patient day for these cardiac catheterization patients.



Initiative: People and Service: Improving the Patient Experience Through an Interdisciplinary, Collaborative Approach

Authors: Maureen S. Padilla, D.N.P., RN, senior vice president and chief nurse executive, Harris Health System, Houston; and Mike Staley, vice president of operations, Ben Taub Hospital, Houston

Facility: Ben Taub Hospital (Harris Health System), Houston

ObjectiveImprove patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems Survey scores at Ben Taub Hospital by engaging the entire leadership team in a collaborative, working committee to develop action plans.

MethodExecutive leaders at Ben Taub often heard that HCAHPS domain scores such as “overall rating,” “cleanliness” and “quietness” would neither improve substantially nor be sustainable due to the architecture and patient population the hospital serves. In response, the hospital’s chief nursing officer proposed a model of interdisciplinary, collaborative meetings structured to develop partnerships and accountability among all hospital leaders. In partnership with the vice president of operations, the People and Service Meeting was established.

ResultsThe hospital has seen improvements in the following HCAHPS domains:

• The “Overall rate the hospital” rating went from 74.7 in January 2014 to 78.6 in March 2015, which has resultedin movement from the 68th percentile to the 82nd percentile;

Continued


• Quietness scores have fluctuated, but there has been an incremental improvement in the quad rooms andgreater satisfaction scores with those rooms converted to semiprivate;

• Cleanliness scores have moved from 65.6 to 71.1;

• Pain management scores went from 68.7 in January 2014 to 74.6 in March 2015, which resulted in movementfrom the 33rd percentile to the 77th percentile; and

• The “communication about medicine” score improved from 62.1 in January 2014 to 68.2 in March 2015, whichresulted in a movement from the 43rd to the 82nd percentile.

Note: Organizational change in the Ben Taub Hospital executive team occurred in June 2015.



Initiative: Psychosocial Distress Screening in the Inpatient Setting

Authors: Michael Plankers, RN, chief nursing officer; Sidney C. Roberts, M.D., radiation oncologist; Tanya Spivey, clinical informatics analyst; and Brenda Taylor, RN, renal/oncology unit director, CHI St. Luke’s Health Memorial Lufkin

Facility: CHI St. Luke’s Health Memorial Lufkin

ObjectiveIdentify and address the psychosocial needs of the inpatient cancer patient.

MethodThe facility integrated the National Comprehensive Cancer Network Distress Thermometer (Figure 1) into its electronic health record system.

The implementation of the screening included:1. Completion of the screening by the floor nurse for all patients with an active cancer diagnosis or with a new

diagnosis of malignancy;2. An automatically generated daily report of all inpatients with a diagnosis of malignancy; and3. Utilization of the EHR system to trigger automatic consults depending on the level of distress noted.

Patients were asked to rate their level of distress on a scale of 0-10, with 0 being no distress and 10 being extreme distress. Charting a level of 4-10 generated a consult for case management for further intervention. All patients with an active cancer diagnosis, regardless of distress level, received resource material, located in FormFast, an electronic storage platform (Figure 2). If any emotional or spiritual problems were noted, an automatic consult for the chaplain was generated (Figure 3).

Figure 1

Continued


Figure 2

Figure 3

ResultsIn the first 50 screens, representing 100 percent of eligible patients, 40 percent scored <3 and were given resource material only. Sixty percent scored ≥4 and were referred to their case manager and/or chaplain, as appropriate, for further intervention.



Initiative: TeleNeonatal Intensive Care Unit in the Rural Hospital

Authors: John Henderson, CEO, Childress Regional Medical Center; Douglas G. Hock, president and chief operating officer, Children’s Medical Center Dallas, and executive vice president for clinical services, Children’s Health, Dallas; Holly Holcomb, RN, chief operating officer, CRMC; Kevin Latimer, chief financial officer, CRMC; SuLynn Mester, RN, chief nursing officer, CRMC; Kyla Nelson, RN, CRMC; and Laura Swaney, vice president of hospital outreach and physician engagement, Children’s Health, Dallas

Facility: Childress Regional Medical Center

ObjectiveProvide neonatal patients at Childress Regional Medical Center with 24/7 access to the Children’s Medical Center Dallas neonatal intensive care unit in order to reduce unnecessary transfers, enhance family-centered care and standardize neonatal care through shared protocols and best practices.

MethodCRMC is the primary health care provider for 30,000 rural residents in a five-county area and is the only facility that delivers babies within a 100-mile radius. Historically, a sick baby delivered at CRMC would immediately be transferred for a higher level of care that has, up until now, been unavailable at the facility. CRMC is now able to provide its neonatal patients with high-quality care through a TeleNICU partnership with Children’s Medical Center Dallas.

The program:1. Utilizes high-tech telemedicine equipment;2. Allows the newborn to remain in his or her home nursery while receiving care remotely;3. Monitors the care of a newborn waiting for transfer to a higher level NICU facility;4. Enhances the family experience by involving parents in the consult; and5. Allows participating hospitals to safely retain patients when appropriate.

ResultsWhile it is still too early to determine long-term results, one TeleNICU consult between Children’s Medical Center Dallas and CRMC physician staff resulted in successful stabilization and transfer of a newborn. Additionally, an unexpected success came in the form of a pediatric 17-year-old male who has been on dialysis for more than seven years, having to travel to Dallas three times a week for treatments. With the help of the telemedicine program at CRMC, the patient is now able to undergo dialysis treatments in Childress and again attend public school. To drive this access to care one step further, CRMC, in partnership with Amerigroup, has applied and been approved for Network Access Improvement Program funding for a project plan that will allow for the extension of TeleNICU to other rural Texas hospitals.

Continued


TeleNICU studio in action at Children’s Medical Center Dallas.



Initiative: Telemedicine/Telepsychiatry in the Emergency Room

Authors: Jeffrey Bates, M.D., chief medical officer; David Byrom, CEO; and Kathy Lee, director of special projects, Coryell Memorial Hospital, Gatesville

Facility: Coryell Memorial Healthcare System, Gatesville

ObjectiveProvide telepsychiatry services in the emergency room at Coryell Memorial Hospital in order to provide better access to emergent mental health services, reduce transfer time to the appropriate facility and improve timeliness of discharge for patients eligible to go home.

MethodThis initiative was designed as a regional project for Regional Healthcare Partnership 16 through the Medicaid 1115 Transformation Waiver. Coryell Memorial Hospital is a critical access hospital located in Gatesville and considered a rural provider in a designated health professional shortage area. Coryell Memorial partners with Providence Health Center in Waco, a 237-bed acute-care hospital also affiliated with Providence DePaul Center that offers both inpatient and outpatient mental health treatment programs in Central Texas. Providence is the lead provider for the telemedicine project in RHP 16 and provides the initial equipment for the project and coordinates professional services for Coryell Memorial and other hospital providers in RHP 16 who are participating in the regional telemedicine program.

Nursing staff in the emergency room fax required documentation to the program coordinator at JSA once a patient has been identified as needing a psychiatric consult. The telemedicine equipment is located on a mobile cart so that these services can be provided in various locations throughout the facility including the outpatient clinic, inpatient floor and long-term care facility, all located on the Coryell Memorial Healthcare System campus. The hospital is in the process of acquiring additional equipment so that consults can be performed at the same time in different areas of the facility.

ResultsSince the program launch in 2014, more than 108 consults have been performed in the emergency room, clinic, hospital and long-term care facility. The number of Medicaid and low-income uninsured patients exceed 50 percent of all consults.

Additionally, the hospital has witnessed a decrease in:1. Wait times for an outpatient psychiatric referral; and2. Mental health-related emergency room visits as a result of the program being expanded to the primary care clinic and

long-term care facility.

The regional project also has brought together multiple stakeholders in RHP 16 to share successes related to the program and explore ways to expand the project’s reach.

Continued


Hospital staff members demonstrate the telemedicine equipment used for psychiatric consults.



Initiative: Faith Community Hospital’s Replacement Facility and Expanded Services

Authors: Frank L. Beaman, CEO; and Joy Henry, RN, chief nursing officer, Faith Community Hospital, Jacksboro

Facility: Faith Community Hospital, Jacksboro

ObjectiveReplace an aging facility that would have lost its licensing by 2017. The secondary objective was to enhance the level of health care available in Jack County by adding additional services.

MethodIn order to execute this initiative, the hospital increased its taxing authority in 2013 to help fund the construction of the $28 million replacement facility. The bank loan is being paid back over 15 years through an increase in the hospital district tax rate. Rates were increased to 31.5 cents, up from 11.5 cents per $1,000 of assessed valuation. Senior citizens were given a homestead exemption so their tax rate would not increase significantly. This was the first time the county hospital increased its tax rate in more than 20 years.

ResultsIn September 2015, Faith Community Hospital officially opened its new hospital. The result was an 80,000-square-foot replacement facility that nearly triples the space of its older footprint.

The replacement facility offers many new services, including an expanded obstetrics unit for local delivery of babies, a permanent surgical unit, larger physical and cardiovascular therapy departments, and a new diagnostic imaging department. The hospital’s rural health clinic also has grown, expanding five times its previous size to 15,000 square feet. The clinic provides primary care services and specialty care for local residents, with ample room for patient care and the addition of new physicians to Jack County.

Continued



Initiative: Develop a Comprehensive Inpatient and Outpatient Palliative Care and Advance Care Planning Program

Authors: Carmen Anderson, palliative care social worker, Guadalupe Regional Medical Center; Liliana De La Torre, chaplain and director of advance care planning and bereavement services, GRMC; Tavie Erwin, RN, director, GRMC Hospice; Tom Jones, chaplain and executive director, GRMC Lifelong Intensive Family Emotional Care Services; and Charles R. Nolan, M.D., medical director, GRMC LIFE Care Services, Seguin

Facility: Guadalupe Regional Medical Center, Seguin

ObjectiveImplement an inpatient and outpatient palliative care program, including a comprehensive advance care planning network.

MethodGuadalupe Regional Medical Center developed a palliative care program called Lifelong Intensive Family Emotional Care Support Service that includes:

1. An interdisciplinary team comprising a physician champion, palliative care nurses, chaplains and social workers who address physical manifestations of disease as well as emotional, spiritual and existential dimensions of illness;

2. Services that are provided concurrently with other ongoing disease-directed therapies for cancer, congestive heart failure, pulmonary disease, kidney disease and dementia;.

3. Outpatient palliative care services that are delivered at home or at a nursing home following primary carephysician referral.

Additionally, the hospital implemented a three-component advance care planning facilitation program, Making Sure Your Voice Is Heard, based on the Respecting Choices® model developed by Gunderson Health System in La Crosse, Wisconsin. With disease-specific and last steps advance care planning, patient preferences for life-sustaining treatments (resuscitation, medically assisted breathing and artificial nutrition) are documented on a medical order for scope of treatment signed by the primary care physician and available in the electronic medical record to guide treatment in the emergency department or hospital.

ResultsIn the first year, 350 LIFE care consults were performed, of which 80 percent were inpatient and 20 percent were outpatient. Referral sources included 59 percent from the medical unit, 17 percent from the intensive care unit, 5 percent from the emergency department and 19 percent from the outpatient primary care physician. Sixty percent of consults were discharged to hospice, ICU care was avoided in 49 percent of consults, and compassionate withdrawal of ICU technology was provided for 7 percent of consults.



Initiative: Limestone Medical Center Wound Care Program

Authors: Brandy Kennedy, RN, wound care clinic manager; Larry Price, CEO; Leslie Ramirez, RN; and Michael Williams, chief financial officer, Limestone Medical Center, Groesbeck

Facility: Limestone Medical Center, Groesbeck

ObjectiveEnhance the quality of life in the community, improve positive outcomes, reduce emergency room visits and readmissions related to non-healing chronic wounds, and provide patients with a local facility for wound care management that is convenient and familiar to the community.

MethodIn order to successfully operate a wound care clinic, the hospital:

1. Partners with Wound Care Specialists, one of the largest operators of outpatient wound care and hyperbaric centers in the U.S., to assist in management;

2. Partners with Baylor Scott & White Hillcrest Medical Center in Waco to provide a general surgeon and general surgerynurse practitioner to treat patients at the clinic;

3. Uses a multidisciplinary team approach that provides the hospital and the patient with clinically proven, cost-effectivetreatment of chronic wounds;

4. Provides patient education utilizing a holistic approach to identify underlying issues that complicate or delay wound healing; and

5. Offers wound care appointments two days a week with five nurses to meet the demand.

ResultsWithout the services of the wound care clinic, residents requiring wound care would normally have to travel extended distances to receive this specialized care. The hospital has successfully decreased readmissions and emergency room visits due to chronic non-healing wounds and continues to educate patients and caregivers. In Fiscal Year 2015, the wound care clinic completed 752 patient visits.

Limestone Medical CenterWound Resolution Outcome Data

Year to date - 2015

Limestone Medical

Center Wound Center -

Average % Wounds

Resolved, 97.77%

Industry Standard, 90%

Average

Limestone Medical Center Wound Center -Average

Weeks to Resolve,

5.53 weeks

Industry Standard, 12

weeks



Initiative: Next Level Care in Breast Health Services

Authors: Jenny Barnes, mammography technologist; Brenda Castro, radiology technologist; Shayla Kenworthy, lead mammography technologist; F. Sean Leong, M.D., director of mammography; Carrie Olivares, ultrasound technician; and Nick Shields, director of radiology, Ochiltree General Hospital, Perryton

Facility: Ochiltree General Hospital, Perryton

ObjectiveExpand breast health services for patients and provide faster service and quicker results in a rural health care setting.

MethodThe hospital’s radiology department enlists a radiologist to perform various procedures, including breast ultrasounds, breast biopsies and cyst aspirations, and meet one-on-one with the patient to explain the results and procedures. Additionally, the radiologist follows the patient through the screening process by reading the initial mammogram. If indicated, the radiologist performs a diagnostic mammogram, ultrasounds the breast, performs a biopsy and drains any cysts.

The process includes:1. A plan created by the radiology department that ensures the patient receives the best possible care as well as time

with the radiologist, who explains the procedures, expedites the results and calms any anxieties; 2. A self-referral program that allows the patient to have a mammogram without a physician order;3. A grant program in conjunction with Texas Tech University Health Sciences Center to provide payment relief to those

with low incomes; and4. Special discounts during the month of October for all performed or scheduled mammogram patients.

ResultsBy working with a radiologist and utilizing the grant and discounts, the hospital has seen a steady increase in the number of screening mammograms performed each year. Additionally, there has been an increase in patient satisfaction and the survival rate based on early detection in Ochiltree County and surrounding areas.

Simple cyst found in left breast Ultrasound guided needle aspiration

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2012 2013 2014 2015(projected)

Screening Mammograms

# of exams

Continued


Simple cyst found in the left breast.

Needle aspiration of cyst in left breast.



Initiative: Pre-Hospital Emergency Blood Transfusions in the Field

Authors: Jan Gardner, director of laboratory services; Chuck Skinner, director of emergency medical services; and Christi Watkins, RN, administrator, Palestine Regional Medical Center West

Facility: Palestine Regional Medical Center

ObjectiveImprove a patient’s medical outcome by administering emergency blood transfusions to trauma patients in the field.

MethodThe pre-hospitalization blood transfusion initiative requires collaboration between local lab and emergency medical services personnel so that all steps are accomplished within a matter of minutes.

The process requires the:1. EMS responder to call the blood bank with a request for stat emergency blood units;2. Blood bank personnel to place a temperature indicator on each blood unit and place the units in a transport cooler;3. EMS responder to pick up the transport cooler and labels to place on the blood tubes they will draw; and4. EMS paramedic to administer the blood unit(s) on site.

ResultsIn May 2015, the Palestine Regional Medical Center ambulance was dispatched to the home of a male in his sixties who was found by a neighbor lying in a pool of blood. The paramedics determined that the source of blood was related to a recent gastrointestinal surgery, and they decided to initiate the blood transfusion protocol.

Once the patient began receiving the first unit of blood, his color started to return, his blood pressure increased, and he became responsive. A second unit of blood was started, and the patient was airlifted to the hospital, where he was stabilized. The ability to administer blood at the scene had a significant impact on the patient’s outcome. The consensus from responders is that this patient would have died prior to arrival at the facility without the collaboration of lab and EMS and their ability to administer blood products quickly.

Continued


The cooler used to transport blood units from theblood bank to the emergency scene.

Members of the Palestine Regional Medical Center lab team and EMS receive the Star of Life Reward for their success with the blood transfusion protocol.



Initiative: Implementation of a Chronic Disease Management Registry

Authors: Alicia Ayala-Quillen, Ph.D., senior project manager for population health; Sobha Fuller, RN, director of nursing; Teresa Garry, RN; Francesco Mainetti, project manager; Jon McManus, director of enterprise and data governance; Holt Oliver, M.D., vice president of clinical informatics, PCCI; Donna Persaud, M.D., medical director and chief of pediatrics for community medicine; Sue Pickens, director of population medicine; and Noel Santini, M.D., medical director and chief of adult medicine for community medicine, Parkland Health & Hospital System, Dallas

Facility: Parkland Health & Hospital System, Dallas

ObjectiveImplement a chronic care registry that provides support to providers in managing health care for patients enrolled in a medical home and who have chronic care conditions such as diabetes, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, pediatric asthma and adult or pediatric obesity.

MethodThe chronic disease management registries create a key repository for patient information specific to the patient’s condition, including:

1. A description of the natural history of the disease(s);2. Determination of clinical effectiveness/cost effectiveness of health care products and services; and3. Quality of care, and safety and harm measurement and monitoring.

The registries provide tools for providers managing patients’ chronic disease through: 1. Patient reports that provide condition-specific information used to recommend care and treatment at the point of care;2. Exception reports that identify patients with missed appointments, overdue care or challenges meeting

management goals;3. Progress reports on care teams’ delivery of care; and4. Stratified population reports that identify patients by risk categories for registry enrollment and target

disease-specific interventions.

ResultsParkland has enrolled almost 100,000 unique individuals in the chronic disease management registries. From baseline year to Sept. 30, 2015, the results include:

• A decrease in the risk-adjusted all-cause readmission rates (.75 to .64);• An increase in the number of patients in a primary care setting receiving recommended diabetic foot exams

(15 percent to 53 percent);• A decrease in the number of Hispanic patients who have poor control of their diabetes in a primary care setting

(40.09 percent to 34.38 percent);• An increase in the annual monitoring of patients on persistent medications in a primary care setting (81 percent to

87 percent); and • Information technology successes that include the ability to create pre-visit planning reports for physicians and

development of a history and current data table infrastructure.

Continued


OCT-2014 NOV-2014 DEC-2014 JAN-2015 FEB-2015 MAR-2015 APR-2015 MAY-2015 JUN-2015 JUL-2015 AUG-2015 SEP-201511,418 11,339 11,305 11,276 11,217 11,151 11,062 11,135 11,111 11,047 10,971 12,6234,280 4,242 4,246 4,222 4,207 4,192 4,176 4,217 4,229 4,243 4,288 4,2744,897 4,864 4,848 4,837 4,793 4,778 4,743 4,895 4,882 4,919 4,909 4,97630,780 30,618 30,486 30,340 30,169 30,067 29,929 28,283 29,221 29,574 29,662 30,19093,089 92,644 92,429 92,211 91,850 91,907 91,588 90,407 90,678 90,515 89,488 89,051

102,617 102,058 101,720 101,402 100,895 100,811 100,348 99,407 99,652 99,250 98,563 98,528

NUMBER OF UNIQUE PATIENTS IN THE REGISTRIES

Unique by Month

DIABETESOBESITY

ASTHMACHFCKD

REGISTRY

102,617 102,058 101,720 101,402 100,895 100,811 100,348 99,407 99,652 99,250 98,563 98,528

0

20,000

40,000

60,000

80,000

100,000

120,000

OCT-2014 NOV-2014 DEC-2014 JAN-2015 FEB-2015 MAR-2015 APR-2015 MAY-2015 JUN-2015 JUL-2015 AUG-2015 SEP-2015


'Unique Patients' 'GOAL - 10,000'

GOAL - 10,000

0.65 0.64 0.65 0.650.57

0.68 0.70 0.690.60 0.57

0.680.61

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15

Read

imis

sion

Rat

e (O

bser

ved/

Expe

cted

Rea

dmis

sion

s)

IT-3.22 30 Day All Cause Inpatient Readmission Rate

Goal = .675Annual Readmission Rate = .64

IT-3.22 Risk Adjusted All-Cause Readmission

OCT-2014 NOV-2014 DEC-2014 JAN-2015 FEB-2015 MAR-2015 APR-2015 MAY-2015 JUN-2015 JUL-2015 AUG-2015 SEP-201511,418 11,339 11,305 11,276 11,217 11,151 11,062 11,135 11,111 11,047 10,971 12,6234,280 4,242 4,246 4,222 4,207 4,192 4,176 4,217 4,229 4,243 4,288 4,2744,897 4,864 4,848 4,837 4,793 4,778 4,743 4,895 4,882 4,919 4,909 4,97630,780 30,618 30,486 30,340 30,169 30,067 29,929 28,283 29,221 29,574 29,662 30,19093,089 92,644 92,429 92,211 91,850 91,907 91,588 90,407 90,678 90,515 89,488 89,051

102,617 102,058 101,720 101,402 100,895 100,811 100,348 99,407 99,652 99,250 98,563 98,528


Unique by Month

DIABETESOBESITY

ASTHMACHFCKD

REGISTRY

102,617 102,058 101,720 101,402 100,895 100,811 100,348 99,407 99,652 99,250 98,563 98,528

0

20,000

40,000

60,000

80,000

100,000

120,000

OCT-2014 NOV-2014 DEC-2014 JAN-2015 FEB-2015 MAR-2015 APR-2015 MAY-2015 JUN-2015 JUL-2015 AUG-2015 SEP-2015


'Unique Patients' 'GOAL - 10,000'

GOAL - 10,000

0.65 0.64 0.65 0.650.57

0.68 0.70 0.690.60 0.57

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IT-3.22 30 Day All Cause Inpatient Readmission Rate

Goal = .675Annual Readmission Rate = .64

IT-3.22 Risk Adjusted All-Cause Readmission



Initiative: A Systematic Approach to Improving Myocardial Infarction Care Quality

Authors: Sandeep R. Das, M.D., associate chief quality and safety officer/medical director of acute coronary care at Parkland Health & Hospital System and associate professor of internal medicine at UT Southwestern Medical Center, Dallas; Jonathan R. Enriquez, M.D., assistant professor of medicine at the University of Missouri-Kansas City and director of the coronary care unit at Truman Medical Center in Kansas City, Missouri; Robert S. Hendler, M.D., associate chief medical officer/chief quality and safety officer, Parkland Health & Hospital System and clinical professor of medicine at UT Southwestern Medical Center, Dallas; Jacqueline Jones, RN, Parkland Health & Hospital System, Dallas; Lisa Mack, RN, Parkland Health & Hospital System, Dallas; Christopher J. Madden, M.D. professor of neurological surgery, UT Southwestern Medical Center; and Jason Spencer, RN, Parkland Health & Hospital System, Dallas

Facility: Parkland Health & Hospital System, Dallas

ObjectiveDevelop and test a multidisciplinary quality improvement intervention incorporating the established “Plan Do Study Act” conceptual framework and leveraging the electronic health record to improve the care of myocardial infarction patients at Parkland Health & Hospital System.

MethodAll patients hospitalized with ST segment myocardial infarction and non-ST segment myocardial infarction at Parkland are included in the ACTION® Registry-GWTG™, a large national registry of myocardial infarction care.

A multidisciplinary team:1. Designed and implemented an EHR-based intervention;2. Monitored response using data from the registry; and3. In collaboration with key stakeholders, iteratively improved the EHR tool and clinical pathway for myocardial

infarction care.

The EHR intervention went live with the new academic year at the start of Q3 2012. The primary outcome was defect-free care, calculated as the percent of patients receiving all of the following therapies for which they were eligible: aspirin, beta-blocker, statin, ACE-inhibitor, smoking cessation counseling and cardiac rehabilitation referral. Eligible STEMI patients required primary percutaneous coronary intervention within 90 minutes. A secondary safety outcome was the rate of excess unfractionated heparin dosing.

ResultsDefect-free care improved from 67 percent pre- to 95 percent post-intervention (p<0.001), with improvement persisting more than one year post-intervention (Figure 1). Significant improvements also were observed for excessive unfractionated heparin dosing, which improved from 65 percent pre-intervention to 13 percent post-intervention (p<0.001, Figure 2). Although a benefit with regard to clinical outcomes cannot be confirmed, the EHR-based intervention was associated with better patient safety and quality of care. Furthermore, this intervention was simple, entailed relatively low resource cost and can easily be replicated.

Continued


66.7% 66.0%68.6%

94.4%

100.0%96.6%

88.4%

94.1% 95.4%

60%

70%

80%

90%

100%

Defect Free Care

Parkland

US average (benchmark)

Intervention

Figure 1

63%68% 65%

25% 29%

8%0% 0%

15%

0%

20%

40%

60%

80%

100%

Excess Unfractionated Heparin DosingIntervention

Figure 2

Figure 1. Defect-Free Care Before and After Intervention

Figure 2. Excess Heparin Dosing Before and After Intervention

Implementation of the EHR-based intervention was associated with an improvement in defect-free care. This effect persisted at 18 months post-intervention.

Lower rates of unfractionated heparin overdosing were seen after implementation of the EHR-based intervention.



Initiative: Saving Infants Masterfully With Use of Simulation

Authors: Fatima Michelle Inman, RN; and D’Nai Johnson, RN, Texas Health Harris Methodist Hospital Stephenville

Facility: Texas Health Harris Methodist Hospital Stephenville

ObjectiveIncrease rural, perinatal nurse competence and team effectiveness during neonatal resuscitation efforts through the use of high-fidelity simulation to ultimately improve neonatal outcomes within rural communities.

MethodPerinatal nursing is a highly specialized area in which the nurse plays a key role in outcomes. Competencies in newborn resuscitation, stabilization and team skills are imperative in situations where seconds can impact newborn mortality and morbidity rates. Skills can be developed during high-fidelity simulation drills to create an effective team culture while promoting outcomes.

The simulation process includes:1. Administering pretest questionnaires, TeamSTEPPS Teamwork Attitudes and Teamwork Perceptions, to 16 rural, perinatal

nurses at the hospital, with 15 of the nurses completing a neonatal resuscitation drill scenario in small groups utilizing a high-fidelity newborn simulator followed by a team debriefing;

2. A post-scenario debriefing, with 14 of the 15 participants completing the same post-test questionnaire; and3. Inputting the data in Excel to obtain an average raw score.

ResultsAll teamwork situational monitoring scores used to measure nurse competency and team effectiveness improved post-intervention, and the T-TAQ and T-TPQ scores increased by 12 percent and 18 percent, respectively. Nurses expressed an increased sense of confidence and competence during post-intervention debriefing. Team processes and roles were reviewed and discussed with guidelines prescribed by TeamSTEPPS verbiage. Based on these findings, it is recommended that quarterly perinatal simulation-based drills are incorporated into staff development plans as an adjunct to newborn resuscitation and emergency preparedness training.

Continued


Teamwork Attitudes Questionnaire (T-TAQ)

Situation Monitoring Strongly Disagree Disagree Neutral Agree Strongly

Agree

I. Individuals can be taught how to scan the environment for important situational cues.

II. Monitoring patients provides an important contribution to effective team performance.

III. Even individuals who are not part of the direct care team should be encouraged to scan for and report changes in patient status.

IV. It is important to monitor the emotional and physical status of other team members.

V. It is appropriate for one team member to offer assistance to another who may be too tired or stressed to perform a task.

VI. Team members who monitor their emotional and physical status on the job are more effective.

TeamSTEPPS®

Teamwork Perceptions Questionnaire (T-TPQ)

Situation Monitoring Strongly Agree Agree Neutral Disagree Strongly

Disagree

I. Staff effectively anticipate each other’s needs.

II. Staff monitor each other’s performance.

Formatted Table

TeamSTEPPS®

Teamwork Perceptions Questionnaire (T-TPQ)

Situation Monitoring Strongly Agree Agree Neutral Disagree Strongly

Disagree

I. Staff effectively anticipate each other’s needs.

II. Staff monitor each other’s performance.

III. Staff exchange relevant information as it becomes available.

IV. Staff continuously scan the environment for important information.

V. Staff share information regarding potential complications (e.g., patient changes, bed availability).

VI. Staff meets to reevaluate patient care goals when aspects of the situation have changed.

VII. Staff correct each other’s mistakes to ensure that procedures are followed properly.

TeamSTEPPS®

TeamSTEPPS©

TeamSTEPPS©



Initiative: Improving Resuscitation Outcomes With the American Heart Association Resuscitation Quality Improvement™ Program

Authors: Cole Edmonson, D.N.P., RN, FACHE, chief nursing officer; and Alex Klacman, RN, critical care clinical education specialist, Texas Health Presbyterian Hospital Dallas

Facility: Texas Health Presbyterian Hospital Dallas

ObjectiveImprove survival rates for in-hospital cardiac arrest following implementation of the American Heart Association’s Resuscitation Quality Improvement™ Program and improve staff confidence in their ability to perform high-quality cardiopulmonary resuscitation during cardiac arrests. A secondary objective was to decrease costs associated with classroom-based basic life support and advanced cardiac life support training.

MethodTexas Health Presbyterian Hospital Dallas became the first hospital worldwide to implement the AHA’s RQI™ Program in February 2014.

The program:1. Addresses the rapid decline in CPR skills following initial training through quarterly, low-dose (10-15 minute) training

performed on the clinical unit at a resuscitation skills station equipped with adult and infant manikins and acomputer system;

2. Allows for perpetual certification of a provider’s CPR and ACLS card for each quarter of successful skills demonstration; and

3. Provides real-time audio/visual feedback on key CPR metrics during trainings.

ResultsPrior to implementation of the RQI program, survival rates from cardiac arrest at the hospital were similar to the national average of 19 percent, ranging from 15 percent to 23 percent. One-year post-implementation analysis of the program revealed that survival rates from cardiac arrest had improved by 21 percent. Quarterly skills training completion rates for the more than 2,000 staff in the program remained greater than 98 percent. The hospital also realized a savings of more than $250,000 in the first year following implementation through decreased costs associated with classroom-based life support training.

Continued


Resuscitation Quality Improvement™ Program skills station.(Image approved for use by the American Heart Association)

Skills debriefing dashboard. (Image approved for use by the American Heart Association)



Initiative: Community Health Program/Chronic Disease Education

Authors: Craig Kovacevich, associate vice president of waiver operations; and Katrina Lambrecht, vice president of institutional strategic initiatives, The University of Texas Medical Branch at Galveston

Facility: The University of Texas Medical Branch at Galveston

ObjectiveProvide care coordination and disease management services in Galveston and Brazoria counties to adult Medicaid, dual-eligible (Medicare/Medicaid), and uninsured and underinsured patients with chronic diseases such as diabetes, hypertension, heart disease and chronic obstructive pulmonary disease.

MethodThe Community Health Program/Chronic Disease Education Initiative emphasizes patient education and self-management support, especially for patients with multiple chronic conditions. The initiative is made possible through the Texas Medicaid 1115 Transformation Waiver and has a five-year project scope.

Through the care management program: 1. Patients receive self-management support and education opportunities to better manage their chronic conditions and

decrease utilization of acute health care; and2. Educational outreach is provided to assist patients and their caregivers on methods to better self-manage at home or in

ambulatory settings.

The underlining goal of this project aligns with the Institute for Healthcare Improvement Triple Aim of health care, which includes improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Results• By the end of DY2 (10/1/2012-9/30/2013) the patient navigation project was working toward hiring and training the

needed staff to conduct the project on a day-to-day basis.• At the close of DY3 (10/1/2013-9/30/2014) the patient navigation project was fully staffed by qualified individuals focused

on meeting the project metrics to implement the identified best practices within the target population. • In DY4 (10/1/2014-9/30/2015) the program is working toward a DY goal of 213 patients enrolled in the program and

60 percent of that population demonstrating an improvement in their health or quality of life. At last measure, there were 291 patients enrolled with roughly 48 percent demonstrating improvement.

Continued



Initiative: Enhance Interpretation/Culturally Competent Care

Authors: Craig Kovacevich, associate vice president of waiver operations; Katrina Lambrecht, vice president of institutional strategic initiatives; and Martha M. Livanec, director of patient services, The University of Texas Medical Branch at Galveston

Facility: The University of Texas Medical Branch at Galveston

ObjectiveHelp caregivers attain clinical cultural competence in order to be made aware of the impact of social and cultural factors on health beliefs and behaviors; be equipped with the tools and skills to manage these factors appropriately through training and education; and empower patients to be more active partners in the medical management of their conditions.

MethodThe hospital implemented the initiative by:

1. Purchasing 10 iPads for video remote interpretation in units throughout the hospital by using incentive funds that were acquired through a Texas Medicaid 1115 Transformation Waiver project;

2. Using the tablets to offer patients on-demand video language interpretation services with a live person; and3. Ensuring that patients who require an interpreter have access to services even when staff and/or department interpreters

cannot be present in person.

Since April, the department has increased the number of iPads to 15 with more on the way, which will bring the total to 26.

Results• In DY2 (10/1/2012-9/30/2013) the project began purchasing equipment and scheduled implementation and training for

remote video interpreting services.• In DY3 (10/1/2013-9/30/2014) managers and language specialists attended “train-the-trainer” sessions so they could

begin teaching the 40-hour sessions and certification exams for UTMB faculty and staff. • In DY4 (10/1/2014-9/30/2015), from Oct. 1, 2014, to March 31, 2015, there were 1,930 video remote interpretation

encounters.• In DY5 (10/1/2015-9/30/2016) UTMB hopes to increase the number of encounters by an average of 500 calls from the

baseline per month or 6,000 encounters.

Continued


A demonstration of video remote interpreting.

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