Working Together to Champion Patient Safety

Carol WagnerVice President Patient SafetyWashington State Hospital Association

Randy BensonExecutive DirectorRural Healthcare Quality Network

Overview:

Understand how economic turmoil and healthcare reform is making patient safety even more important

Understand how the WSHA Patient Safety Program & RHQN support rural Washington Hospitals

Interactive Session

This will be an interactive session

Please feel free to ask questions

Use of voting

Question:

At Chelan, my favorite event is the:a) Sessions and meetingsb) Ice cream socialc) Barbequed) Sitting out on our patio watching the

lake

Question:

I have been to this conference ___ times:a) Once, this is the first timeb) 2-5 timesc) 6-10 timesd) 11 or more times

Question:

Your role at your hospital is:a) Community board memberb) CEO or administratorc) Physician or nursing leadershipd) Other hospital leadership

Question

Is payment for care in your hospital likely to:a) Increase over the next few yearsb) Stay the same over the next few yearsc) Go down over the next few yearsd) I don’t know

Question:

Pressure to increase quality and safety of care is coming in our region the most strongly from:a) Media and communityb) Payorsc) Regulators d) Hospital staffe) Board members

Question:

Hospitals should be paid for:a) Providing a service (regardless of safety

and quality)b) Providing a service safely (did not harm

the patient)c) Providing a service, safely with quality

(evidence based, timely care with no harm to patient)

d) Don’t know

Question:

Critical Access Hospitals are currently paid for:a) Providing a service (regardless of safety

and quality)b) Providing a service safely (did not harm

the patient)c) Providing a service, safely with quality

(evidence based, timely care with no harm to patient)

d) Don’t know

Question:

Urban or PPS Hospitals are starting to be paid for:a) Providing a service (regardless of safety

and quality)b) Providing a service safely (did not harm

the patient)c) Providing a service, safely with quality

(evidence based, timely care with no harm to patient)

d) Don’t know

Healthcare Reform Philosophies

Payment for quality*, safe care Don’t pay for harm

Readmissions for 30 days Hospital acquired infections Adverse events Hospital compare

*care follows the medical evidence

Initially impact PPS/urban hospitals

“Rehospitalizations among Patients in the Medicare Fee-for Service Program” New England Journal of Medicine, April 2, 2009

19% of Medicare patients were rehospitalized within 30 days

50% of the 30-day readmissions, there was no physician bill between the discharge and readmission

70% of readmitted surgical patients is for a medical reason

Costing Medicare $17.4 billion a year

WA Hospital 30-Day Readmission Rate*

0%

10%

20%

30%

40%

50%

60%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50Hospital

Average 30-Day Readmission: 14.4%

Critical Access Hospitals

Non-Critical Access Hospitals

*Data from Jan 07 to Dec 08 w here hospitals have submitted in UB04 format only.*Data Source: DOH Preliminary Revisit File for Q3 2008 discharges with UB04 reporting.

Learning from each other – Sharing best practices

TESTING SPECIFIC STRATEGIES TO REDUCE READMISSIONS

Support of Commonwealth Fund and IHI

Looking for approximately 10 hospitals to participate

Washington Rehospitalizations

Hospital Acquired Infections

100,000 people die from hospital acquired infections each year.

Media response to MRSA and hospital acquired infections has been intense.

Question

What is the most effective way that staff can prevent transmission of infection in your hospital?

a) Hand hygieneb) Test all patients for MRSAc) Sterilize more equipmentd) Keep visitors out so they don’t spread

infections

Eliminating Hospital Acquired Infections

Hand Hygiene Central Lines Ventilator Associated Pneumonia MRSA – Multidrug Resistant Organisms Surgical Site Urinary Catheter Staff Immunizations

CEO and Trustee Challenge

Washing hands can reduce hospital acquired infections by 25%

Soap and Sanitizer Usage

2008 traveled over 1,500 miles conducting “secret shopper” visits and listening to nurses!

Lessons Learned:

Nurses liked the focus on hand hygiene- - important to keeping their families safe

Soap containers just inside and outside the door were viewed very positively by nurses

Staff were positive about seeing their results.

Many staff had stories about how they had carried home organisms to their families.

Hand Hygiene on Entry to Hospitals

Sanitizer by Staff and Family Lounges

Sanitizer at Nursing Stations

Hand HygieneMedical/Surgical Units Top

Leaders(Performing at 100%)

Intensive Care Units Top Leaders

(Performing at 100%) Harborview Medical Center Pullman Regional Hospital Swedish Medical Center - Cherry Hill Toppenish Community Hospital Whitman Hospital & Medical Center Yakima Regional Medical and Cardiac Center

Harborview Medical Center United General Hospital Yakima Regional Medical and Cardiac Center

Medical/Surgical Units Exceptional Performance

Intensive Care Units Exceptional Performance

Othello Community Hospital Lourdes Medical Center MultiCare Health System Providence Mount Carmel Hospital Sunnyside Community Hospital St. Joseph Hospital – Bellingham Swedish Medical Center – Ballard United General Hospital

Gray Harbor Community Hospital MultiCare Health System St. Joseph Hospital – Bellingham Swedish Medical Center - Cherry Hill

As of June 3, 2009

Winners to be announced at the WSHA Annual Meeting!

BEST HANDS ON CARE AWARD

Kick-off Meeting

July 15, 2009 Dr. Peter Pronovost Sam Watson

Meeting designed specifically to build upon the work Washington hospitals have already done…challenge us to higher levels!

Eliminate infections and enhance skills to identify and eliminate defects.

WA Central Line-Associated Blood Stream Infection Rates(Med/Surg ICUs, April 08-Mar 09)

0 0 0 0 0 0 0 0 0 0 00

0.5

1

1.5

2

2.5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Hospital #

CL

AB

SIs

/10

00

Lin

e D

ay

s

Data Source: NHSN Database Med/Surg ICU Rates from 22 WA Hospitals, April 2008 - March 2009.

The number of central line-associated blood stream infections varies among Washington hospitals.

Standardization

Emergency Code Calls

Isolation Precaution Signage

Wristbands – if using

World Health Organization Surgical Checklist

WSHA Board ApprovedImplementation Goal October 1, 2009

Healthcare Reform Philosophies

Payment for quality*, safe care Don’t pay for harm

Readmissions for 30 days Hospital acquired infections Adverse events Hospital compare

*care follows the medical evidence

Initially impact PPS/urban hospitals

Adverse events reported to the DOH are considered public information and can be disclosed to the press.a) Trueb) False

Question:

An adverse event must be reported to the DOH within what timeframe?a) 48 hrs. of their occurrenceb) 21 days of their occurrencec) 48 hours of you knowledge of the eventd) 21 days of your knowledge of the event

Question:

For every adverse event reported to the state, a Root Cause Analysis (RCA) must be completed.a) Trueb) False

Question:

Reporting adverse events is optional; a hospital can decide if it is really needed.a) Trueb) False

Question:

What percent of Washington hospitals have reported an adverse event since 2006?a) 0-20%b) 21-40%c) 41-60%d) 61-80%e) 81-100%

Question:

Adverse Events Support Provide education concerning recognition of adverse

events External peer review to promote ‘best practice’ and avoid adverse events Train staff on how to properly conduct a root cause

analysis (RCA) On-site support when RCA occurs

"External peer review, provided by the Rural Healthcare Quality Network, is invaluable to us in maintaining and enhancing quality patient care, preventing adverse events and delivering 'best practice' medicine”.

Jon Smiley, CEO Sunnyside Community

Hospital

RHQN providing on-site support for quality and survey readiness. Classes for administrators Training for staff Problem resolution

Using Lean and Six Sigma 101 – Supporting CAH

Activities Related to Hospital Compare Facility Education Concerning Smoking

Cessation CounselingProvision of training through the

Washington State Tobacco Quit LineProvision of brochures and other

supplies for patient education Facility Education Concerning Discharge

Planning Documentation

Heart Failure Measures for RHQN Hospitals

  Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08

HF - 1 Discharge Instruction 59% 45% 62% 63% 63% 69%

HF - 2 LVF Assess 89% 91% 70% 79% 81% 81%

HF - 3 ACE/ARB 89% 91% 87% 90% 92% 94%

HF - 4 Smoking 65% 55% 74% 75% 69% 78%

RHQN Target 90% 90% 90% 90% 90% 90%

Fed Target 80% 80% 80% 80% 80% 80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08

HF - 1 Discharge Instruction HF - 2 LVF Assess

HF - 3 ACE/ARB HF - 4 Smoking

Carol WagnerCarolW@wsha.org

(206) 577-1831

Randy Bensonrandyb@wsha.org

(206) 577-1821