THA Hospital Improvement

Innovation Network (HIIN)

Monthly Check-In

2-21-18

• Site Visits

• Contact List

• Workforce Resilience Webinar Series

• Sepsis Webinar Series

• Sepsis Consultation Service

• Success Story Articles

• HIIN Quarterly Survey—due to

jmcitosh@tha.com by March 9

Reminders

Health Equity

and Addressing Disparities

*Diversity can include racial, ethnic, gender, cultural, language, socioeconomic or other relevant factors. THA Responses: 57 / 77 hospitals (74%)

HRET Responses: 1,315 / 1,683 hospitals (78%) Source: THA HIIN Quarterly Survey conducted Nov. 2017

TCPS HIIN Health Equity Survey

TCPS HIIN Health Equity Survey

TCPS HIIN Health Equity Survey

TCPS Performance with Updated Baselines

Includes Only Tennessee Partners

* MRSA and CDIFF SIR are calculated on a quarterly basis. Data shown is for January – September

This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.

This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.

Topic Reporters Events Rate HRET Rate

Readmissions - 30 Day 123 50,880 8.486 8.473 Readmissions - Medicare 121 30,304 11.318 11.246

Sepsis - Postoperative 79 211 0.399 0.4177 Sepsis - Hospital Onset Mortality 104 1,975 35.656 21.173 Sepsis - Overall Mortality 104 5,408 20.425 12.568

VTE 88 336 3.142 3.000

Hospital Claims and PSI Harms THA Partners and HRET HIIN Rate Comparison

January – September 2017

Data Source: THA HIN and HRET Comprehensive Data System: Tennessee hospitals

HIIN Self-Reported Measures THA HIIN and HRET HIIN Rate Comparison

February – October 2017

This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.

Topic Reporters Events Rate HRET Rate

ADE – Anticoagulation* 58 3,343 15.019 3.381

ADE – Glycemic* 52 15,283 19.014 4.634

ADE - Opioids 55 2,810 1.097 0.584

Falls with injury 62 844 0.568 0.693

Pressure Injuries 53 242 0.091 0.219

WS - Patient Handling 52 420 0.119 0.122 WS - Workplace Violence 53 184 0.051 0.081

Data Source: THA Report Distributor and HRET Comprehensive Data System: Tennessee hospitals only

* Measure definition differs between THA HIIN and HRET HIIN

Adverse Drug Events

(ADE)

• HRET HIIN measure for opioid ADE

– Numerator = Number of patients treated with

opioids who received naloxone

– Denominator = Number of patients who

received an opioid agent

– Includes inpatient and outpatient

– Excludes Emergency Department

Adverse Drug Events (ADE) Opioids

Adverse Drug Event – Opioids

2017 TN Harms TN Rate HRET Rate

February 322 1.14 0.54

March 302 1.00 0.52

April 339 0.95 0.52

May 316 1.12 0.63

June 302 1.06 0.58

July 328 1.28 0.65

August 319 1.07 0.61

September 298 1.23 0.58

October 284 1.18 0.63

Num

ber

of patients

who r

eceiv

ed a

n O

pio

id r

evers

al

De-identified Hospitals

Num

ber

of patients

who r

eceiv

ed a

n O

pio

id r

evers

al

De-identified Hospitals

Num

ber

of patients

who r

eceiv

ed a

n O

pio

id r

evers

al –

Rate

per

100

De-identified Hospitals

------------------------------------------------------------------------------------------------------

HRET National Average: 0.584

Num

ber

of patients

who r

eceiv

ed a

n O

pio

id r

evers

al –

Rate

per

100

De-identified Hospitals

------------------------------------------------------------------------------------------------------ HRET National Average: 0.584

• Are there particular areas of the hospital

with high Narcan use to target?

– Procedure areas, ICU, wards?

• Are there specific patient populations?

– Opioid naïve, post-surgical patients, patients

on pain pumps?

• Are we doing sedation assessments on

patients?

ADE Questions

• THA HIIN data:

– From inpatient claims - provisional

– 66 TN hospitals

• Three metrics:

– Post-operative sepsis rate (AHRQ PSI-13)

– Hospital-onset sepsis mortality rate

– Overall sepsis mortality rate

Sepsis Measures

• Mortality

– Inpatient sepsis deaths only

– Patients aged 18-89 years

– Primary discharge diagnosis = an ICD-10

code for severe sepsis or septic shock utilizing

AHRQ PSI-13 criteria

– Hospital-onset sepsis identified by “No” on

“Present on Admission” flag

• Post-op Sepsis

– AHRQ PSI-13 criteria

Sepsis Data Definitions

Data pull: 1-19-2018

Mortalities Cases Mortality Rate

Hospital Onset Sepsis

Mortality 1728 5180 33.36%

Overall Sepsis Mortality

5211 27889 18.68%

Sepsis Mortality

18.6% of the total sepsis cases are hospital onset sepsis,

but account for 33.2% of the sepsis mortalities.

October 2016 through September 2017

0.61

0.41 0.00

0.50

1.00

1.50

2.00

2.50

3.00

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17

Post-op Sepsis Rate - 10/16 thru 9/17 THA HIIN Hospitals (n=49)

Comparison to HRET HIIN Hospitals (n=904)

THA HRET

• Are you tracking overall sepsis and hospital-

onset ? Are you seeing the same prevalence

and trends? – If so, is hospital onset sepsis medical vs surgical population?

– Associated with devices or specific procedures?

– ICU or floors at diagnosis?

– Are EHR/clinical systems triggering alerts effectively?

• Would committee members be willing to review

10 of your charts for root causes to better

understand the issue and design interventions?

Sepsis Questions

• Care Transitions Coordinator Coalition Meeting – Thurs., March 8

• Medication Safety Summit – Thurs., April 26

• TCPS Regional Meetings – Tues., April 10 – Knoxville

– Thurs., April 12 – Nashville

– Tues., April 17 - Memphis

• Sepsis Readmissions Workshop – Weds., May 9

• Health Equity Summit – Thurs., May 17 (tentative)

Upcoming Events

HIIN Participation Recognition

Request the number that you need by contacting Teresa Benedetti at tbenedetti@tha.com or 615.401.7414.

Retractable pen pull with dry erase marker

Questions and comments?