celebrating our success continuing our positive net forward energy december 5, 2012
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Georgia Hospital Engagement Network Patient and Family Centered Safe Care Putting Patients First 40/20 by ‘13. Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012. The GHAREF HEN Team. Objectives. - PowerPoint PPT PresentationTRANSCRIPT
Georgia Hospital Engagement NetworkPatient and Family Centered Safe Care
Putting Patients First40/20 by ‘13
Celebrating Our Success
Continuing Our Positive Net Forward Energy
December 5, 2012
Learn. Act. Improve. Spread. Keep the Drum Beat Going.22
The GHAREF HEN Team
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Objectives
• Discuss Year One Results for the Georgia Hospital Engagement Network
• Describe the anticipated Positive Net Forward Eliminating Preventable All Cause Harm Approach
• Outline how your organization will implement an all cause harm approach to eliminating preventable patient harm.
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Outline
• Welcome & Introduction• State of the HEN from the National View • Year 1 Results
– State of the State HEN Report– Education Snapshot– Learning Collaboratives
• EED• HAC• HAI• Readmission
– Small Rural and Critical Access Hospital Learning Community
• Positive Net Forward Energy 2013
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Introduction
Where We Started
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Partnerships Essential to Success
• HEN Partners– HEN Hospitals– Community Partners– State Agency Partners– Healthcare Partners– Professional Society Partners– National Affinity Groups– Quality Improvement Partners– Other HENs
If we are not working together, we are not doing our job!
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State of the GA HEN
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
20
40
60
80
100
120R
ead
mis
sion
s
Ear
ly E
lect
ive
De-
liver
ies
(EE
D)
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I12:
Pos
top
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ive
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or D
VT
(s)
Fal
ls a
nd
Tra
um
a
PS
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Pre
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re
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ers
Su
rgic
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ite
Infe
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r C
ath
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ns
109
50
96 111111
47
111
111
Hospitals Who Met Q2-12 HEN Targets
% Met Target Total # of Hospitals
% o
f Hos
pita
ls
Tot
al #
of H
ospi
tals
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Financial Impact: Baseline 2010 to July 2011 - June 2012
Financial Impact: Baseline 2010 to July 2011 - June 2012
Hospital Acquired Condition Cost Per Incident Incidents Reduced Cost Savings
PSI3: Pressure Ulcers $109,869* 11 $1,208,566PSI12: DVT PE $64,476* 65 $4,190,940PSI 7 Central Venous Catheter-Related Bloodstream Infections $82,147* 107 $8,789,729PSI 17 Birth Trauma-Injury to Neonate $88,000* 46 $4,048,000PSI 18 Obstetric Trauma-Vaginal Delivery With Instrument $90,000* 78 $7,020,000PSI 19 Obstetric Trauma-Vaginal Delivery Without Instrument $96,000* 111 $10,656,000SSI $27,407** 5 $137,035Falls and Trauma $33,894*** 16 $542,304Catheter Associated UTI $1,750***** 26 $45,500Readmission $7,400**** 1,000 $7,400,000Sources:
* AHRQ Quality Indicators Tool Kit (February 2012)
** The Joint Commission,
***Studor Group 2008. - Slide 7
****Report to the Congress: Promoting Greater Efficiency in Medicare. MedPAC, June 2007.
*****Saint, el al. Ann Intern Med. 2009 June 16; 150(12): 877–884.
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Results
Over $44 Million Saved!
1,465 Patients’ Harm Prevented!!
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Education - A Key Element to Promote Change
• January 4 – November 19 GHA HEN education facts:– 60 Educational Activities– 4,414 individuals participated– 341.25 hours of education– Average evaluation score 4.56 on a scale of 1-5
• Topics included:– Evidence Based Leadership– CUSP– Reliable Process Design– Lean Six Sigma– Defects Analysis– Rounding– Transitions of Care Coordination
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EED - Overview
• EED Action Group met in April 2012 to review 2009 data regarding EED– Key stakeholders: March of Dimes, Department of Public Health,
OB/GYN Society of Georgia Atlanta Chapter, Georgia Nurses Association, and other were in attendance
• Developed and agreed upon plan to reduce EED’s by 40%– Ultimate overall goal for Georgia: 0%– Timely goal for August 2012: 5% or less
• Plan: Encourage use of “hard stops”, March of Dimes Toolkit or IHI bundles to empower nurses and schedulers
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EED - Results
• There are 83 birthing hospitals in Georgia• 58 (70%) of those hospitals turned in data• 19 (31%) of the 58 hospitals were already at a 0% EED rate• Of the 39 hospitals needing improvement about ½ showed
significant gains!!• 3 of those hospitals went from a 14% or higher EED rate to a
0% rate sustained for at least 3 months!!
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EED: The Results 6
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EED: Financial Impact
• According to Managed Care Magazine it costs around $41,000 for a late preterm NICU visit
• The incidents went from 147 incidents in March 2012 to just 32 in August 2012
• That’s a decrease of 117 incidents• If even a ¼ of the babies went to NICU, we saved Georgia
Healthcare $1,178,750.00
OVER 1 MILLION Dollars!!
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• 39 hospitals participated in the HAC LC • Quarter 2 2012, 22 of the 39 hospitals had outcome rate above
target for at least 1 of 3 conditions:• 11 hospitals above target for FALLS• 7 hospitals above target for DVT/PE• 4 hospitals above target for PRESSURE ULCERS
• Medication Reconciliation 2013
HAC: Falls, Pressure Ulcers, VTEs
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PSI3: Pressure Ulcer Rate Q2 - 20120.
0 to
<=
0.55
0.55
to <
= 1.
1
1.1
to <
= 1.
65
1.65
to <
= 2.
2
2.2
to <
= 2.
75
2.75
to <
= 3.
3
8.25
to <
= 8.
8
8.8
to <
= 9.
35
0
20
40
60
80
100
120
99
3 41 1 1 0 0 0 0 0 0 0 0 0 1 1
Rate per 1000 Discharges
# of
Hos
pita
ls
Sheet22Histogram
Sheet7Histogram
Q2-2012 HEN Target = .55/1000 Discharges# of Hospitals Achieving Target = 99# of Hospitals Not Achieving Target = 12
HEN 40/20 by 13 Target: 0.47/1000 Discharges
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PSI12: Postoperative PE/DVT Rate Q2 - 2012
0.0
to <
= 2.
35
2.35
to <
= 4.
69
4.69
to <
= 7.
04
7.04
to <
= 9.
38
9.38
to <
= 11
.73
11.7
3 to
<=
1...
14.0
7 to
<=
1...
23.4
5 to
<=
25.8
0
20
40
60
80
100
120
62
139
3 1 3 40 0 0 1
Rate per 1000 Discharges
# of
Hos
pita
ls
Sheet25Histogram
Sheet7Histogram
Q2-2012 HEN Target = 4.69/1000 Discharges# of Hospitals Achieving Target = 75# of Hospitals Not Achieving Target = 21
HEN 40/20 by 13 Target: 4.05/1000 Discharges
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Falls and Trauma (CMS-HAC5) Histogram Q2 - 20120.
0 to
<=
0.33
0.33
to <
= 0.
66
0.66
to <
= 0.
99
0.99
to <
= 1.
32
1.98
to <
= 2.
31
2.31
to <
= 2.
64
2.64
to <
= 2.
97
2.97
to <
= 3.
3
3.3
to <
= 3.
63
8.58
to <
= 8.
91
0
20
40
60
80
100
120
89
11
3 1 0 0 2 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Rate per 1000 Discharges
# of
Hos
pita
ls
Sheet9Histogram
Sheet7Histogram
Q2-2012 HEN Target = .33/1000 Discharges# of Hospitals Achieving Target = 89# of Hospitals Not Achieving Target = 22
HEN 40/20 by 13 Target: 0.29/1000 Discharges
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HAI: CLABSI, CAUTI, VAP, SSI
• First Focus : CLABSI • We used what we learned from CUSP to spread to other
hospitals and units • Created the NICU Affinity Group to address CLABSI in the
NICU• CAUTI work began • Device Utilization Focus – get them out!• 2013:
– All HAI Prevention– National SUSP Program– VAP to VAE
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Our CLABSI Outcomes
2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q30
0.2
0.4
0.6
0.8
1
1.2
0.881 0.831
1.003
0.8620.777
0.774 0.694
GHA HEN SIR National Goal
GHA HEN CLABSI SIR - PPS Q1 2011 – Q3 2012
N = 51
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CLABSI – Spread to Other Areas
2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 0
0.2
0.4
0.6
0.8
1
1.2
0.964 0.9781.014
0.906
0.826
0.9
0.5
GHA HEN CLABSI SIR – All Units Q1 2011 - Q2 2012
N= 48
CLABSI SIR National Goal
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NICU Affinity Group CLABSI
Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 20120
0.2
0.4
0.6
0.8
1
1.2
0.831
0.65
0.833
1.086
0.761 0.797
0.5
GHA HEN NICU CLABSI SIR Q1 2011 - Q2 2012
N = 20
CLABSI SIR National Goal
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CAUTI Improving
2012Q1 2012Q2 2012Q30
0.2
0.4
0.6
0.8
1
1.21.081
0.928
0.938
0.81 0.81
0.81
GHA HEN CAUTI SIR - PPS Q1 2012 - Q3 2012
N = 48
GHA HEN CAUTI SIR 25 % Reduction Goal
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VAP – Prevention Is Occurring
• 22 Hospitals with Zero VAP Q2 2012 • Move to VAE in NHSN February 2013
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Readmissions
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Small Rural & Critical Access Hospitals
Getting Back To Basics
Creating a Culture of Safety
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SMALL RURAL AND CRITICAL ACCESS
• Nine Learning Community Education Sessions held• 60 Small Rural and Critical Access Hospitals participated
– 15 Critical Access Hospitals worked on multiple topics– 18 Small Rural Hospitals worked on multiple topics– 1 Small Rural Hospital worked on all ten topics
• New ideas defined and studied• Successful networking • Variety of quality improvement topics presented
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CHALLENGES
• Communication regarding expectations• Knowledge surrounding submitting data• Feedback regarding hospital-specific data• Information related to participation• Time commitment related to participation• Physician and Staff Engagement
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IMPROVEMENTS
• Data submission simplified• Meeting standardization• Evaluations appreciated, comments acted upon• All Teach, All Learn• Executive Leadership Survey• Development of Executive Quality Action Council• Refocus on the Voice of the Patient: Patient and Family
Centered Safe Care Advisory Action Group• Feedback from recognition program reviewed and triggered
change
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Positive Net Forward Energy
• 24 Hospitals highlighted in GHA Weekly Mail• Georgia Getting National Recognition
o HEN Virtual Meeting, May 2012, Dr. William Bornstein, Emory Healthcare o National Rural Health Association Meeting, Rural Affinity Working Group
Presentation, July 2012, Norma Jean Morgan, Effingham Health Systemo Strong Start Webinar November – EED, Lynne Hall, Vi Nayloro QNET, December 2012 Presentations
Sue Bowen, Shepherd Center Heidi Nelson, University Hospital Vi Naylor, Georgia HEN
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Moving to Eliminate “All Cause Harm”
• Patient and Family Centered Safe Care Culture• Emphasis on Hospital Visits and Coaching• Enhancing Education opportunities• Process Measure Data Submission Continues
All Teach, All Learn
Member Input Essential
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Upcoming Educational Opportunities
• GHA Patient Safety Summit January 9 – 10 • GHA Trustees Conference January 11 -13 • February 2013 HEN Kickoff
34
Thank You for All You Do to Keep Patients Safe
We Look Forward to Working With You in
2013!
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Contact Information
• Phone: 770-249-4500
• Vi Naylor: [email protected] • Kathy McGowan: [email protected]• Joyce Reid: [email protected] • Denise Flook: [email protected] • Faizah Muheb: [email protected] • Martha Harrell: [email protected] • Lynne Hall: [email protected] • Lorna Martin: [email protected]