Committed to Quality and Safety
Hospitals across America have made great advances in improving care. Hospitals are participating in AHA's Hospitals in Pursuit of Excellence initiative, the national implementation of the Comprehensive Unit-based Safety Program, local programs at hospital associations and individual performance improvement projects, among others to make care better for their patients and communities.
Arista Adventist Hospital, a 114-bed facility in Louisville, Col., used best practices and peer-to-peer learning to reduce harm across the board. By focusing on engaging all staff and the board, improving care processes and using storytelling, the hospital had a 53.7% reduction in patient harm and a 100% reduction in central line-associated bloodstream infections. Significant results also were achieved by minimizing adverse drug events and reducing falls with injury.
Baxter Regional Medical Center, a 268-bed facility in Mountain Home, Ark., used best practices and peer-to-peer learning to reduce harm across the board. By creating a culture of collaboration, the hospital reduced patient harm by about 50%. Significant results were achieved by minimizing adverse drug events, falls with injury, catheter-associated urinary tract infections, and pressure ulcers.
Colorado Hospital Association is working with its member hospitals and health systems toward achieving zero incidences of avoidable harm by 2015. Members are receiving technical assistance and support that responds to the unique needs of the individual facilities. As part of this project, CHA is focusing its efforts on reducing facility-acquired infections, avoidable readmissions and avoidable mortality.
Yale-New Haven Hospital’s “Ruby Slipper” program assesses patients who are at risk for falling as soon as they are admitted. They are given specific preventive instructions and assistance, including special red slipper socks, so that nurses can readily identify and help them.
Medical knowledge never stands still, which is why St. Vincent Health has an extensive network of physicians researchers to help pioneer new medical procedures, find innovative uses for existing technologies and participate in clinical trials in areas reaching from children’s health topics, orthopedics, sports performance and trauma.
HealthEast Care System is partnering with the Minnesota Metropolitan Area Agency on Aging to offer “A Matter of Balance,” an evidence-based program with several goals for participants: reduce the fear of falling, reduce falls, stay safe at home and increase exercise. This program and other studies have validated that exercise—simple stretching exercises sitting in a chair or holding on to a chair—and strength and weight training decrease the risk of falls. Since autumn 2013, nearly 150 people have participated in the program, and in 2015 it will be expanded, including modifications to target patients with Parkinson’s disease and their caregivers.
The Ohio Hospital Association recently launched the Safe Sleep is Good4Baby statewide initiative to draw attention to the importance of safe sleep in the hospital, at home and in the community. The goal is to reduce the infant mortality rate by 5 percent each year from 2014-2016.
Hand hygiene continues to be the number one way to prevent the spread of infection in any environment. In 2007, Mercy Medical Center in Iowa implemented the “Foam In, Foam Out” campaign. This is a slogan that continues today. Hand hygiene, either with soap and water or with our automatic hand foam, is a culturally accepted practice. Everyone understands that as they go from one environment to another, a hand hygiene opportunity exists; they must wash our hands.
Utah was recognized for having the nation’s highest percentage of stroke patients who receive clot-busting drugs within 60 minutes of their arrival in a hospital emergency department. The state’s rate of 62% in 2012 was dramatically better than the national average of 43%.
The Diabetes/Renal Unit at Lynchburg General Hospital in Virginia wasn’t satisfied with its patient fall rates. Within a year of putting new strategies in place, the unit experienced a 68% decrease in total and an 80% decrease in fall with injuries during same time period.
Hasbro Children's Hospital has been funded participants in a U.S. Department of Defense project, MedTeams, to transfer lessons learned in army aviation to hospital emergency departments. One of the benefits of implementing a teamwork training curriculum in emergency medicine – clinical error rate decreased from 30.9% to 4.4%
Community Hospital of Anaconda, Montana, received the Highest Quality Award from the Mountain Pacific Quality Health Foundation eight years in a row.
Crouse Hospital in New York has produced a video that uses music and humor to convey a very important message: Hospital Acquired Conditions (HACs) are deadly serious – and Crouse Hospital is deadly serious about reducing and eliminating them. But prevent works best when every single staff member is on board. Regardless of where they work in the hospital, the focus is the same for every hospital employee: providing the safest, highest quality care they can to patients.
Since 2008, St. James Mercy Hospital in New York has been using a high-tech system to makes sure its patients get the right medicine, at the right time, in the right dosage. "Barcode Medication Verification"—or BMV—starts working when patients get admitted through the hospital’s registration area or emergency department and they receive a bracelet imprinted with a unique barcode. When the physician orders any needed medications, the orders go electronically to the pharmacy. The pharmacist fills the orders, and double checks for any allergies. Each medication has its own unique barcode, specific to that medicine and strength. The nurse or respiratory therapist wheels the BMV cart with the medications to the patient at bedside, scans the bracelet, and scans each medication. If anything doesn’t match—patient name, medication name, dose or time—an alert will immediately come up on the screen so that corrections can be made before the medication is given to the patient.
Each physician group at Duke Children's Hospital and Health Center in Durham, NC, has one or more teams that focus on clinical quality and patient safety. These teams are led in many instances by pairs of physicians and nursing/administrative leaders. The teams conduct patient safety rounds in conjunction with their organization’s executives, interviewing staff and physicians about their perspectives on clinical quality and patient safety. Issues are discussed at the team meetings along with concerns identified through other avenues. Priorities are established and plans to resolve issues are developed and executed. Each team’s activities are reported through the performance improvement infrastructure at their organization and up to the governing body for the organization.
Many patients have difficulty understanding and acting upon health information. Northeastern Regional Hospital’s “Ask Me 3” intervention is a patient education program designed to improve communication between patients and health care providers, urge patients to become active members of their health care team and promote improved health outcomes. The program encourages patients to ask their health care providers three questions: What is my main problem? What do I need to do? Why is it important for me to do this? Review of patient surveys indicate that patients are feeling more knowledgeable about the “symptoms/problems they should look for upon discharge” as well as “understanding the purpose of taking medications.”
MemorialCare HealthSystem understands the importance of reliable, consistent and safe patient care and has committed to the creation and integration of a robust patient safety program as an essential component of quality patient care. MemorialCare’s patient safety program is a formalized, multi-faceted plan that includes a strong leadership commitment culture of safety survey, patient safety education, physician and employee development programs, awareness campaigns and clinical tools and the program is evaluated annually.
To ensure that patients are getting the care and support they need after leaving the hospital, hospitals are partnering with physicians, skilled nursing homes, state agencies and other health care organizations to support “Care Transitions.” Specifically, the Washington State Hospital Association and Puget Sound Health Alliance developed a toolkit to help foster safe, timely, effective and coordinated care between settings. The toolkit includes guidelines about coordinated follow-up, reconciliation or medications and timely visits to primary care providers.
The Lawrence Memorial Hospital Patient Safety Program not only improves a patient’s safety, but it also improves the safety of visitors, volunteers, and hospital and medical staff. Proper hand hygiene is the number one way to prevent the spread of infection. At LMH, they collect data on how often and how well physicians and staff clean their hands as required. Using either hand sanitizer or soap and water, they must clean their hands before and after touching food or medications, examining patients and inserting an IV or other medical device. Staff are also required to wash their hands before and after changing dressings, handling something that contains body fluids (for example, bed pans or specimen cups) and after using the bathroom or whenever their hands are dirty. LMH collects this data by observing staff members and physicians, as well as by measuring the amount of hand hygiene products used on each unit and as a result has exceled in hand hygiene as demonstrated by the Centers for Disease Control comparative benchmarks.
Several safety initiatives have been implemented by the nursing staff at Lifespan hospitals. In place in all units is a “closed-loop” medication system, which is designed to enhance patient safety. It is a collaboration between pharmacy, nursing and medical staff to reduce the human opportunity for error. It helps ensure that the right patient receives the correct dosage of prescribed medications at the right time.
Molina Healthcare established a patient safety program to help meet the goal of ensuring that patients and families remained safe and healthy. Key aspects of the program involve educating patients about what to ask the doctors and their care team, engaging families in that process, as well as having a strong emphasis on coordinating care for patients as they move from one setting to another – ensuring a smooth, safe transition.
One of the primary patient safety initiatives at Jones Memorial Hospital is encouraging patients to take an active role in their health and SPEAK UP. The hospital is engaging patients to become more informed health care consumers, keep track of their medical history, work with doctors and other health care professionals as part of a team, involve a family member of friend in care and then follow doctor’s directions. The SPEAK UP framework is actively shared with patients and community.
After learning about the unacceptably high fall rates in the three of the hospitals within the St. Elizabeth Healthcare System, staff were charged with reducing the clinical impact of falls of patients and enhancing patient and family education of the topic of fall risk and prevention. A standardized fall risk assessment was implemented across all hospitals, as well as a multi-pronged approach, including customized toolkits for different areas, huddles at the beginning of each shift change to identify high-risk patients and patient and family education. These efforts have resulted in a downward trend for falls, and the multi-disciplinary team continues to meet bi-monthly to examine current rates and identify other approaches to improve patient safety.
The Minnesota Hospital Association’s Good Catch for Patient Safety award is presented to Minnesota hospital staff and physicians who demonstrate their commitment to keeping patients safe by "speaking up" to prevent potential harm to a patient. Their efforts remind us what a difference one person can make to keep patients safe. The Good Catch Award is a tiered award. Individuals and/or team members recognized with the award are entered into the running to win the quarterly Good Catch for Patient Safety award. Quarterly recipients are eligible to win the annual Good Catch for Patient Safety award. Most recently a neonatal nurse at St. Mary’s Medical Center was recognized for lending a voice to a patient who did no have one.
Patient safety is a top priority for physicians and staff at Jefferson University Hospitals. The hospitals have implemented systems and processes to assure that they deliver high-quality, safe care for patients. To proactively address safety risks, a team representing key departments makes Patient Safety Rounds and then makes recommendations for changes. If a potentially unsafe event occurs, Jefferson responds immediately using the Patient Safety Net, a web-based reporting system offering real-time problem solving.
Determined to address a common but preventable problem, Indiana University Health’s Bloomington Hospital has spent several years working to lower the number of patient falls. As part of this effort they implemented a mandatory fall risk assessment tool and held post-fall huddles but realized that screening along odes not equate to prevention. They worked hard to move beyond screening to consistent action based on comprehensive and personalized approach that identify why specific patients are at risk and design intervention specific to each patient. Additionally, the hospital held a mandatory educational retreat for nursing staff to help explain and hardwire new practices like bedside reports, hourly rounding and use of whiteboard inside patient rooms. The hospital has seen good progress and a reduced number of patient falls as a result of these efforts.
After experiencing three catheter-acquired urinary tract infections (CAUTI) in a six month period, Vernon Memorial Healthcare decided it needed to examine its policies and use of foley catheters. The quality department did an assessment across the organization and found several culprits for the widespread use of foley catheters and was then able to begin changing the practice of standing orders for catheters after joint surgery as well as institute a new protocol involving bladder scanning that can determine if the catheter is needed. To ensure changes were taking place, quality staff attended nurses meetings to discuss the new program, developed story-boards for each department and as a result Vernon has seen an 11% drop in catheter use and no CAUTIs since the effort began.
Reducing ventilator-associated pneumonia has been a long-standing priority at St. Joseph Health Services of Rhode Island. Striving to follow best practices, it put into place policies and procedures for its 15-bed open, mixed critical care unit based on field guidelines. St. Joseph’s joined a state collaborative to further support their efforts; their CEO led a multidisciplinary team that included a physician leader, nurse leader, staff nurse, pharmacist, respiratory therapist and infection control nurse to fine-tune current approaches and continuing to improve care. Through this work, VAP rates at the hospital remain very low and patient care has continued to improve through a more individualized approach to medication dosing and multidisciplinary rounds.
Committed to improving patient safety, St. Catherine Hospital turned its attention to lower its patient fall rate. To do so, the hospital established a falls prevention committee composed of nursing staff from several different units to research the best practices in falls prevention and then develop a fall risk assessment for patients. The hospital’s education department held training sessions on the new interventions, such as the implementing the risk assessment for all patients, hourly rounding, visual cues such as armbands for high-risk patients and call lights at the bedside. Through these interventions, St. Catherine’s was able to achieve a 26 percent reduction in patient falls from the previous year.
Despite the University of Arkansas Medical Center’s double-check policy, medication errors were occurring too frequently. Staff at UAMC knew they needed to reduce medication errors for opiates and other high-risk medications and pulled together a team, led by a pharmacist champion to evaluate and analyze the specific causes. The team determined that a “hard” limit should be developed and included in the drug library software to alert clinicians to a potentially unsafe drug therapy before the treatment begins.
While safety has always been at the forefront of the care provided by Catholic Health Initiatives, they knew they could do better and created SafetyFirst. SafetyFirst is a system-wide effort designed to offer the safest care for patients, as well as a safe working environment for the medical staff and employees at every care location across the country. SafetyFirst not only improves patient and employee safety but has increased error reporting and highlights near misses to help prevent future occurrences. So far, thousands of employees and physicians have attended error-prevention training. Doctors, nurses and other support staff have adopted proven safety behaviors – behaviors based on high-reliability science used by industries such as commercial aviation, nuclear power and naval-maritime. Specially trained safety coaches are working side by side with staff, helping caregivers, patients and their families ensure safe care and new measurement tools provide constant feedback so staff can learn and make improvements.
Valley Health’s 10-bed cardiac surgery intensive care unit experienced a spike of three catheter-associated urinary tract infections in one quarter, so the hospital determined it needed to take immediate steps to reduce and ideally eliminate CAUTIs. The hospital appointed a task force that identified practice issues, including inconsistent catheter insertion techniques, inappropriate usage of catheters and not removing catheters in a timely manner. To correct the situation, the team developed and implemented a plan that called for education on catheter best practices, equipment changes and leveraging multidisciplinary rounds. After instituting the changes, Valley Hospital went 26 months without a single CAUTI.
Kaiser Sunnyside Medical Center formed a multidisciplinary surgical site infection prevention committee. The committee examined the organization’s culture and expectations as it related to SSI and it became clear that the medical center needed to move its culture from one where “SSIs are inevitable” to one where “all SSIs are preventable”. The clear picture of the cultural mindset laid a strong foundation for understanding the causes of SSI and appropriate resources and structured framework were put in place as a “Pathway to Zero”. Staff education and strong communication were cornerstones for the program and through these efforts within 18 months SSIs had dropped 45%.
Prevention of pressure ulcers has long been a focus at Columbus Regional Healthcare System, led by a skin care committee that was established nearly 10 years ago. Despite a low rate of pressure ulcers, the hospital lacked a formal, consistent approach for assessing the risk of or managing pressure ulcers, a preventable condition that can be painful and even dangerous for patients. Columbus Regional set out to hardwire a clear structure and process to obtain consistently positive results. The goal was to devise a process that was as simple as possible to allow staff to recognize the risk for pressure ulcers, treat that risk and treat any existing or acquired pressure ulcers with the minimal amount of time lapse between recognition and treatment. The team mapped the current process, then began developing a new best-practice process. The new approach requires a skin risk assessment upon admission for all adult patients, upon return from surgery, with status change and with every shift. It also created a "bundle" of interventions for high-risk patients and importantly, the bundle has been implemented as a nursing standing order, so it can be enacted without a physician order. Nurses put the bundle into action for patients given a low skin risk assessment score or based on nursing judgment.
Dedicated to delivering excellent patient care, Saunders Medical Center developed an official initiative to identify and consistently implement best practices for venous thromboembolism VTE prevention. The critical access hospital started by updating the order sheet to make it less complicated and, thus, increase the likelihood it would be filled out. The first revised VTE standing order sheet required the nurses to complete the top portion of the form and the doctors to complete the lower portion of the form. While the new order sheet increased compliance, Saunders felt it still needed work. So the CAH collaborated with colleagues within the state as well as worked with national VTE prevention leaders to rework its order sheet again. Saunders has seen impressive progress since launching the VTE initiative. After the first revision of the standing order sheet, compliance of the VTE protocol and prevention measures more than doubled, to 85% and after the second revision it has reached 100% compliance on the VTE prophylaxis.
Safe Hands is St. Vincent Health’s Patient Safety Initiative, in which the hospital focuses on the seven aims of clinical excellence to provide safe patient care. Those include, continuous healing, customizing care centered on patient needs and values, recognizing that our patients are the sources of control, sharing knowledge, evidence-based decision making, emphasizing safety as a system priority and anticipating needs of patients and providers. Through the Safe Hands initiative, St. Vincent measures the care they provide using long-range goals targeted over five years, clinical outcome measures and process measure – and are held accountable for those measures by regular reporting to their parent system Ascension Health.
Rapides Regional Medical Center was determined to make a major course correction, and moved decisively to dramatically lower early elective deliveries. Rapides appointed a local improvement team to identify necessary changes. Given the widespread acceptance of EEDs locally, it found that educating physicians, staff and patients about the dangers of EEDs would be essential to success, along with process changes at the hospital. Following a Lean exercise focused on the medical center’s overall admission process, the committee zeroed in on obstetrical admissions and, as a result, created a new position for an admissions nurse. With the admissions nurse acting as the hospital gateway, obstetricians and general nursing staff were forced to make important changes. To counter physician resistance, Rapides recruited physician champions early on. It also held training to empower nurses about no longer accepting patients directly into the units. Rapides made significant improvement, dropping from what was originally a 78% rate of EEDs to a rate of 16% and moving lower.
Committed to improving patient safety, St. Catherine Hospital turned its attention to patient falls and launched an initiative to lower falls by 20%. The hospital began by establishing a falls prevention committee comprised of nursing staff from several different units. After researching best practices, they developed a falls risk assessment along with a series on interventions based on common risk factors. These interventions were presented to all nursing managers and after piloting the program on one unit, the hospital’s education department led hospital-wide trainings. Additionally, St. Catherine’s instituted a “No Passing Zone” for call lights, meaning that all hospital staff – clinicians and non-clinicians alike – had to stop and respond to a call light. Through the nursing staff, patient and family education was also included in this campaign. The hospital has exceeded their goal and reduced rate of patient falls by 23%.
Good Samaritan Regional Medical Center cites two major components of their patient safety program as being instrumental in their progress: their multi-disciplinary Patient Safety Committee and their commitment to systematic learning about problems and solutions. The medical center has seen a dramatic reduction in various infection rates. Additionally, the medical center has implemented a multitude of process improvements as a result of their commitment to patient safety at all levels of their organization.
Troubled by an increase in 30-day readmissions, Bayfront Medical Center set out to systematically lower 30-day all-cause readmissions levels. Rather than settling for a more limited scope, leaders felt strongly that increasing patient safety depended on extending the program throughout the hospital. With this goal, the hospital began their work focused on congestive health failure and began an education campaign that included patient resources, staff training and an interactive toolkit to facilitate discharge communications. These along with other tactics of the quality initiative have been credited with decreasing all-cause readmissions by 20%.
Northridge Hospital Medical Center’s No Harm Campaign was developed with the goal of improving patient outcomes and safety through prevention of infection. The campaign included identifying and scaling best practices for use within the medical center. Through collaborating with multi-disciplinary staff, Northridge was able to reduce their ventilator-associated pneumonia rate and maintain a zero infection rate for six months.
The mission of Mount Auburn Hospital’s Department of Quality and Safety is to ensure that Mount Auburn patients receive outstanding care in all aspects of their experience. This is done by developing hospital systems to deliver care based on the most up-to-date medical evidence and the best technology. Systems are designed throughout the hospital to achieve high quality, efficient processes, strong communication within the clinical team and the most ‘patient-centered’ care possible. The Quality and Safety Department focuses on proactive system design to achieve these goals, and includes key feedback from front-line staff as well as from patients in the optimum design of excellent health care delivery systems. One such example is in their patient infection prevention initiatives that include clean environments, screenings, use of best practices as well as patient education efforts on a variety of topics to help patients and their families become active participants in our goal of eliminating patient infections
Oklahoma University Medical Center employs new technologies to prevent and protect patients from possible medication errors. The hospital has trained staff and now employs the use of an electronic Medication Administration Record system. This allows for the electronic coordination of patients medication histories, dosing schedules, patient allergies and pharmacy prescriptions onto the bar code of a hospital patient’s armband. In addition to education sessions for staff, educational materials for patients and families were used as the new technology was rolled out have seen great results and improved medication safety.
In an effort to decrease medication errors and improve patient safety, Randolph Hospital has made fundamental changes in the way medications are ordered, stored, dispensed and administered. One of the safety measures being used is a standardized process to correctly identify patients. Multiple checks are used to ensure that the right medication is being delivered in the right dose at the right time for the right patient. In addition, a team of nurses, pharmacists, physicians, technicians and information technology staff developed safe procedures to separate, label and identify medications that have look-alike or sound-alike names. Also, the elimination of confusing abbreviations continues to be a hospital-wide initiative. Randolph Hospital continues to focus on medication safety and is working to ensure that each time a patient enters the hospital or changes a level of care, an accurate and current medication history is obtained and reviewed by the patient's nurse, pharmacist and physician.
Teamwork between infection control and environmental services professionals at Hunterdon Medical Center has helped reduce infections at the 178-bed hospital. "Constant education" has been key so health care workers understand the importance of thorough cleaning and disinfecting as well as proper hand hygiene. Education also emphasizes that "cleaning is everyone's responsibility," which requires a culture change. At Hunterdon, environmental services staff attend annual lectures for updates on infection control, including data and feedback. Infection prevention and environmental services directors perform observational rounds together, which has helped the hospital develop a cleaning sequence for high-touch surfaces in patient rooms. Hospital leadership has supported infection prevention efforts, including investing in a computerized surveillance system and rapid-testing equipment for the lab, providing washable computer keyboards and hiring additional staff. Between 2006 and 2011, C.diff infections dropped by 79%, MRSA by 66% and VRE by 23%.
A “simple” complex plan is reducing readmissions at Wythe County Community Hospital. Care teams review data to determine which patients keep returning to WCCH within 30 days of discharge – and frequently visiting the ED – and developed the “15 Families Initiative.” Before discharging identified patients, care providers meet with patient and family to discuss the patient’s condition, medical history and care plan. Family members learn how to help provide care, but working with patients one-on-one is key. After discharge, Wythe’s director of patient education follows up by phone, tailoring information to each patient’s and family’s needs. Using the teach-back method they are able to intercept issues and give patients the tools they need to control disease processes at home. WCCH’s hospital-wide readmission rate was 6.8% in 2012 and is down to 4.7% to date in 2013.
The Florida Surgical Care Initiative, developed in association with the American College of Surgeons, involved 67 Florida hospitals making it the largest statewide surgical collaborative in the nation. The initiative focused on high-impact areas like surgical outcomes for elderly patients and surgical site infections and has had tremendous over the past two years: 89 lives saved, 165 complications did not occur, 14.5% decrease in total post-operative complications, 15.8% fewer surgical site infections and 35.7% lower risk of death.
All departments at Penobscot Valley Hospital have been participating in improvement activities, implementing national best practices and coming together as a team to enhance processes for patients. One infection prevention project involves the Environmental Services staff who have been testing their own thoroughness in cleaning patient rooms. The Infection Prevention practitioner first adds glo-germ dust to the room in a high-touch area and the staff then cleans the room. Afterward, a black light is used to detect any areas that are missed in the cleaning process, teaching staff which areas need more focus during their rounds. This has been duplicated in ambulances to help decrease hospital-associated infections.
Stanford Hospital and Clinics employs best practices to coordinate complex care processes. It recently launched a major performance improvement project focusing on early detection and treatment of sepsis that includes hospital-wide education on recognizing early signs and symptoms of sepsis, as well as ongoing monitoring and evaluation to improve early detection and treatment.
The Michigan Health & Hospital Association (MHA) recently released the 2013 MHA Patient Safety and Quality Annual Report: A Decade of Making Care Safer quantifying Michigan hospitals’ patient safety and quality improvements. MHA Keystone Center interventions to improve the quality and safety of health care in Michigan saved more than $116 million in health care costs from 2011 to 2012 by helping hospitals reduce and avoid pressure ulcers, various types of infections, readmissions, high-risk baby deliveries and more.
Memorial Health System was recently recognized for innovative quality interventions and best practices within a health system. They received recognition for their “Lean Six Sigma” methodologies project to reduce hospital-acquired pressure ulcer prevalence. The initiative surpassed the health system’s initial 50% reduction goal, achieving a 79% reduction in hospital-acquired pressure ulcers.
MemorialCare has set “Bold Goals” improving safety and quality with a focus on reducing mortality, infections and unnecessary complications. Best Practice Teams have been identified throughout the health system and these teams of caregivers have implemented screening tools along with standardized prevention protocols and refined the way they track medications from the time a patients enters the hospital, through treatment to prescriptions they may need who they return home. All of these efforts have had significant positive results for patients with infections (per 100) being reduced by 73%, pressure ulcers (per 100) by 71% and mortality by 33%.
Continuous quality improvement is part of the underlying culture at Meriter Hospital and, as an organization, they have set bold quality aims that includes zero health care-associated infections. The hospital has a board-level Quality of Healthcare Committee that consists of five community representatives, six members of the medical staff and four hospital leaders who set quality goals. Additionally, frontline staff are engaged in setting goals and priorities, nurses are empowered to take charge of their work as it relates to practice, competence and quality. This strong commitment and comprehensive approach is what drives them to achieve the top quartile in patient satisfaction, pain management, zero medication errors and preventing harm or injury to patients.
CoxHealth launched an ambitious program to decrease elective inductions by 50% in six months and to less that 3% of all deliveries within a year, with the ultimate goal of as close to zero as possible. Hospital leadership announced a voluntary program to decrease inductions and this did bring down elective deliveries by 9% but that drop was not enough. Executive and clinical leaders at CoxHealth decided to institute a “hard stop” to scheduling any elective inductions prior to 39 weeks. While they did meet with some initial resistance, the policy has now become accepted as best practice and is in large part successful because of the strong physician and executive leadership champions.
Zero is an important number at Broward Health North. The 409-bed community hospital is “chasing zero,” that’s zero for 0 infections and 0 falls to keep patients safe. To reduce central line-associated blood stream infections, the hospital focused on three things: 1) paying attention to the infection rate, 2) consistently implementing initiatives using the CLABSI prevention bundle and 3) ensuring supplies needed to comply with the bundle are present in patient rooms and convenient to staff. Each day, hospital nurses assess the central lines and confer with physicians—a collaborative approach that ensures lines are removed as soon as possible. The hospital’s ICU CLABSI rate has been zero for 10 months straight.
Delivering safe, high-quality patient care is at the core of what Ortonville Area Health Services strives to achieve. Situated on Minnesota’s western border with South Dakota, Ortonville Area Health Services is a critical access hospital with 25 beds. Yet the hospital doesn’t let its limited resources impact its commitment to patient safety. Ortonville is among only a handful of hospitals to have reached the national Partnership for Patients goal of a 40% reduction in five different hospital-acquired conditions and a 20% reduction in readmissions. Ortonville was able to redesign its space to better accommodate patient-centered care. In addition to adding computers in the patient rooms, Ortonville implemented an electronic medical record, and together this allows nurses to chart and document at the bedside in real time. Changes such as these and the hospital’s involvement in Transforming Care at the Bedside, a nurse-led initiative, have helped increase nurse time at the bedside from 38% to 73% in an 18-month time period.
Despite the University of Arkansas Medical Center’s double-check policy, medication errors were occurring much too frequently. The staff, hospital leadership and a pharmacist champion responded quickly to pull appropriate individuals together to evaluate and analyze the specific cause of the errors. Important changes were made to update the drug library, further education for nursing staff was conducted, and implementation of a hard stop with alarms were added to infusion pumps to alert clinicians before a potentially unsafe drug therapy before the treatment begins.
It is both “a sprint and a marathon.” That’s how a team at St. Joseph Mercy Hospital in Ann Arbor, MI, described reducing catheter-associated urinary tract infections. They are using the Comprehensive Unit-based Safety Program to reduce CAUTI rates and improve patient safety and quality. They have been successful using a two-pronged approach: implementing evidence-based clinical, or technical interventions, while simultaneously creating a strong culture of safety that facilitates and encourages improvement. SJMH’s results include an increase in the percentage of catheters that are removed within two days post-operation, from 79% to about 97%.
Calvert Memorial Hospital has invested in new smart IV pumps in the hospital’s infusion therapy center, operating rooms and intensive care units along with its emergency department and family birth center with the belief that this new technology will benefit their patients. This advanced system features many built-in safeguards and provides superior accuracy; coupled with existing initiatives like bar coding and electronic prescribing the new technology puts CMH at the forefront of medication safety scoring a 96.3% for medication safety on an annual survey conducted by the Institute of Safe Medication Practices – surpassing the national average of 71%.
Franklin Woods Community Hospital was recently honored for their innovation in quality improvement and safety. As a new hospital, Franklin Woods Community Hospital has been strategically designed to provide patient-centered, high-quality care. The hospital has impressively aligned their goals from a strategic level to an operational and personal level in a manner that truly involves staff in quality and process improvement. Additionally, the hospital has had success in reducing mortality by at least 31%, reducing readmissions by at least 12% and reducing preventable harm events for patients.
Beth Israel Deaconess Medical Center, an urban academic medical center serving patients and communities in the Greater Boston area, was recently honored with the American Hospital Association–McKesson Quest for Quality Prize. The award was given for the medical center’s creation of a sustainable and pervasive approach to the IOM’s six aims and a culture of quality and safety by collecting, analyzing and using data in a transparent manner. The medical staff at Beth Israel Deaconess are full participants in quality and process improvement efforts, and they work collaboratively across departments with other clinical staff to address common issues. Strong leaders and engaged staff throughout the organization actively involve patients and family members in quality and safety improvement, and in all aspects of hospital operations.
New York Methodist Hospital is committed to continually improving the quality of care provided to patients, and in doing so consistently develops and designates priorities for quality improvement based on hospital data and that of similar organizations in New York State and throughout the nation. To ensure the best possible outcome for patients, NYM employs Rapid Response Teams, a patient safety initiative consisting of a critical care nurse, respiratory therapist and physician who are on call and poised to respond to signs of a sudden decline in a patient’s health. The RRT mobilizes before the patient’s condition deteriorates and acts to assess and treat the patient so as to avoid ICU transfer, cardiac arrest or death. Innovations and new trends in clinical care also drive quality improvement programs at NYM to promote continuous improvement and clinical excellence.
The University of Arizona Medical Center understands that quality and safety are everyone's responsibility. Through their Quality & Safety First Program, they have integrated error prevention and quality improvement into the many systems and processes that serve patients, staff and visitors. The hospital has embraced numerous high tech systems — from Smart IV Pumps that ensure accurate medication dosages; to computerization of medical records and physician orders that enhances accessibility, efficiency and accuracy; to sophisticated data collection programs that can help pinpoint opportunities for improvement as well as a continuous investment in training staff-physicians, nurses, pharmacists and others on quality and patient safety measures.
Mid-Columbia Medical Center has a successful patient safety program that involves all levels of staff, including hospital leadership, in root cause analysis and efforts to improve care. By educating staff about how to identify adverse events and why doing so is important, the medical center has seen a positive impact on staff efforts to improve patient care. Also by incorporating root cause analysis discussions into management meetings and openly discussing adverse event cases, MCMC staff have been able to overcome fear of blame or punishment when something goes wrong and, instead, are able to work together to positively impact communication and investigations. MCMC’s patient safety program also engages in the use of a safety huddle to review adverse events and determine severity levels, as well as initiatives to reduce language barriers and readmissions.
Hospital executives at St. Vincent’s Medical Center determined a need to strengthen the surgery department by improving operating room performance while also reducing costs. St. Vincent’s achieved these objectives by using an operating room benchmarking service to drive improvements in case scheduling accuracy, case start times and block utilization. Through a first-case start-time initiative, the medical center’s percentage of on-time first cases rose from a low of 20% to a high of 74.8%. Premium overtime hours were also reduced by 25%. Most significantly, the hospital lowered its Serious Safety Event Rate by 63%.
East Alabama Medical Center has been recognized for providing safe, reliable and efficient care by the Premier healthcare alliance’s QUEST: High Performing Hospitals® collaborative. EAMC achieved high marks in the following four domains: reducing the average cost of care to less than $5,690 per discharge; reliably delivering all evidence-based care measures to patients in the areas of heart attack, heart failure, pneumonia and surgical care at least 95 percent of the time; improving the hospital experience so that patients favorably rate their stay and would recommend the facility to others at least 73% of the time; and reducing preventable harm events.
Variations in the use of overhead paging in hospitals can cause confusion among caregivers, staff and patients and can lead to adverse patient safety events. A survey conducted by the Minnesota Hospital Association found 22 different codes for patient abduction; 18 different codes for a security alert; code green indicated four different emergencies; and code yellow had five different meanings. Often staff does not know all the color or name codes for various emergencies. This can be particularly troublesome for health care professionals who work in more than one hospital. MHA aims to help its 144 member hospitals reduce variation in emergency overhead pages through the development of an Emergency Overhead Paging Tool Kit to help hospitals move toward the use of plain language in overhead pages and to determine which emergency situations need to reach the patients’ and all staff awareness. This effort is still in its early stages, but hospitals are encouraged to make these changes to improve transparency and communication and help reduce noise for patients.
Boulder Community Hospital has implemented several hospital-wide programs to reinforce its culture of safety and quality care. In addition to educating staff, BCH is encouraging patients, their families and visitors to play a role in enhancing quality and safety. As part of that work, BCH has joined the “Speak Up” campaign, a nationwide initiative designed to inform hospital visitors and patients about their important role in infection prevention and overall patient safety. Customized brochures were developed that review important safety information and encourage individuals to “speak up” when they have safety-related questions or concerns. These brochures are distributed to all hospital inpatients, and the issue is so important that BCH also offers Spanish-language versions of the brochures.
One of several current quality improvement projects underway at UC San Diego Health System is a multi-pronged project examining the discharge process. This project has the goal of improving discharge education, communication with referring physicians and optimizing information systems. The health system has implemented a hospital-wide standardized patient information and provider communication module for inpatient discharges that monitors compliance of process; updating standards associated with the process to meet additional needs based on patient and provider feedback.
Concord Hospital made a strong commitment to improve the quality of diabetes management provided by the hospital when several patients voiced concerns about inpatient diabetes care. The commitment to improve was made at the top, with the CEO, COO and chief medical information officer all engaged. Through implementing a computerized physician order entry solution, Concord Hospital has been able to address critical issues like optimal use of insulin and standardized training for nurses and nursing assistants. One hundred percent of the nursing staff participated in the standardized training.
Hospitals have been actively working to improve quality. The Health Research & Educational Trust, an affiliate of the AHA, has been providing education and training to more than 1,600 hospitals. Over the course of a year, these hospitals have seen a 42% reduction in non-medically necessary early elective deliveries, saving $10 million and a 14% reduction in readmissions, saving over $100 million.
Ensuring the highest quality for patient care and at Verde Valley Medical Center that means continuously reviewing processes and outcomes. VVMC reviews processes and outcomes to prevent inpatient harm in several clinical areas. One example is in an effort to prevent ventilator-associated pneumonia, VVMC developed a checklist for bundle compliance and a tracking tool for capturing ventilator days. Staff standardized peer-to-peer reporting using SBAR—situation, background, assessment, recommendation. A VAP team is responsible for policies and monitoring of the initiative, including educating physicians and nurses to maintain consistency in identifying a VAP diagnosis. Staff uses Lean processes to implement the VAP bundle and provides family education using the teach-back method. Since June 2009, VVMC has had only one VAP (which after review was deemed unpreventable).
Natividad Medical Center was nationally recognized by the Picker Institute and selected to join the Always Events® Community and Recognition Program for its “Know Your Physician” initiative. “Know Your Physician” is a communication improvement program developed to ensure that every caregiver on the medical/surgical floor knows the roles and responsibilities of each attending physician and resident at all times as well as their patient assignments and call schedules. The new program includes well-defined physician roles and responsibilities, a master call schedule and assignment tools all leading to improved patient safety.
Edward Hospital works to do everything it can to promote safe care, as well as encouraging patients and families to part of the team. Edward participates with the Food and Drug Administration’s Medical Product Safety Network, a program that works with health care providers to identify, report, understand and solve medical device-associated problems. By identifying and understanding potential problems, Edward is better situated to work toward preventing potential medical errors.
Close to 90% of Illinois hospitals and health systems are participating in one or more PREP initiative. PREP - Preventing Readmissions through Effective Partnerships - is a landmark collaborative for reducing potentially preventable readmissions between the Illinois Hospital Association's Institute for Innovations in Care and Quality and Blue Cross Blue Shield of Illinois. As part of this initiative, Illinois hospitals are now able to better understand the attributes of clinically related readmissions that occur at seven and 30 days following an initial hospital admission, allowing them to account for their discharged patients who later are readmitted to other facilities in addition to those readmitted to their own hospitals.
An 18-month patient safety effort by 21 hospitals in the Greater Cincinnati region has reduced incidents of patient falls that result in injury in these hospitals by 64%, according to the Greater Cincinnati Health Council. Before this effort began, hospitals were working individually to reduce the risk of falls in their facilities. But the decision was made that progress could be made more quickly by working together. The 21 hospitals agreed to share incident data with one another for the first time and to use a formal improvement model developed by the Institute for Healthcare Improvement. They set a goal of reducing by 50% the regional rate of patient falls that occur in hospitals and that result in moderate or severe injuries. They surpassed that goal by achieving a 64% reduction.
Lead by the Wisconsin Hospital Association, the Wisconsin Transforming Care at the Bedside project fosters innovations and improvement to the quality and safety of patient care. WHA has been conducting site visits at the 22 nursing units participating in the project to ensure that each team has successfully launched TCAB on their unit. The Wisconsin TCAB initiative is an 18-month project that will end March 2014. Participants will each be expected to outline a plan to sustain the project after that date.
Chester County Hospital implemented the Heart Tracks program to provide individuals with their personal risk factor profile for coronary heart disease via an online risk calculator or at an in-person assessment. The in-person assessment program includes risk factors and lifestyle screening. Participants review their findings with a professionally trained counselor and those with moderate or greater risk are contacted by a Cardiovascular Nurse Navigator. The online risk calculator is considered an expansion of the original program to bring awareness to a wider audience. More than 95% of heart attack patients receive life-saving catheterization at the Hospital within 90 minutes of calling 911. This is credited to the extensive Early Heart Attack Care (EHAC) education. Additionally, the hospital's Door-to-Balloon time goal of <90 minutes improved from 72% in 2007 to >95% in 2012.
The Partnership for Health and Accountability recently presented its prestigious Quality and Patient Safety Award to Emory-Adventist Hospital at Smyrna for its project that improved safety through better communication. This annual award recognizes Georgia health care organizations for achievement in reducing the risk of medical errors and improving patient safety and medical outcomes.
Quality patient care, dedication to patient satisfaction and rigorous attention to patient safety are hallmarks of Cedars-Sinai Medical Center. With more than 140 central lines in place on any given day, Cedars-Sinai Medical Center has virtually eliminated central line-associated blood stream infections from multidrug-resistant organisms, while dramatically reducing other CLABSIs throughout the hospital. Since an ongoing initiative to reduce these infections was launched in 2005, Cedars-Sinai has implemented a number of recommendations from its CLABSI task force, including stringent central-line insertion practices, a new policy to ensure appropriate maintenance of central lines and daily review of the continued necessity of the lines.
Executive Walkrounds at Cleveland Clinic offer insight into the care process and the potential of harm to the next patient. Team representatives from the Quality & Patient Safety Institute, unit/area management and a Cleveland Clinic senior executive walk a particular unit/area on a monthly basis. The goals of these rounds are to: demonstrate to frontline staff senior leadership's commitment to patient safety and develop an ongoing relationship with a clinical unit; emphasize dual ownership for unit level safety; facilitate a non-punitive just culture of safety; encourage reporting of safety opportunities and speak directly to frontline staff regarding how to can improve our systems and processes..
Central line-associated bloodstream infections cause serious illness and death. Front-line caregivers in 100 neonatal intensive care units in nine states - caring for 8,400 newborn patients - used prevention practice checklists and improved communication to prevent an estimated 131 CLABSIs and up to 41 deaths, while avoiding more than $2 million in health care costs. They used the Comprehensive Unit-based Safety Program to improve a safety culture and consistently implement catheter insertion and maintenance guidelines. When the project began, participating NICUs had an overall infection rate of 2.043 per 1,000 central line days. After 11 months, the rate was reduced to 0.855 per 1,000 central line days, a relative reduction of 58%. The NICU project is part of a larger effort funded by the Agency for Healthcare Research and Quality to implement CUSP to prevent CLABSI nationwide.
More than 117,000 babies are born in Michigan each year. To ensure these babies come into the world in optimum health, Michigan hospitals are focused on eliminating preventable fetal and maternal harm through the MHA Keystone: OB collaborative. Michigan hospitals have reduced the occurrence of early elective births by nearly 67%, from 5.28% to 1.76%, from March 2010 to March 2012. This includes a roughly 34% reduction in elective cesarean sections before 39 weeks and a more than 49% reduction in elective inductions before 39 weeks. Michigan hospitals also reduced neonatal ICU admissions by more than 43% during that same time period. In addition, Apgar scores indicating the health of newborns increased 34%.
Schneck Medical Center's commitment to a patient first culture has led to many innovative health care practices. SMC submits data for nine of the 10 Hospital Engagement Network focus areas and has demonstrated performance excellence in several of the measures, including low rates of healthcare-acquired infections and dramatically reduced readmissions. SMC was also the recipient of the 2011 Malcolm Baldrige National Quality Award.
Verde Valley Medical Center is a full-service, nonprofit hospital serving North Central Arizona that has made a strong commitment to improving quality. Some of VVMC's successes so far include: no central-line infections since May 2010, no ventilator-associated pneumonias since June 2009 and significant declines in readmission rates since October 2011.
Boone Hospital Center in Columbia is working intensely on four focus areas of the Hospital Engagement Network initiative and has been entering data on six HEN focus areas. Through its work with the HEN, the hospital has had significant success in reducing hypoglycemic adverse drug events in patients receiving diabetic agents. Boone has demonstrated a 47% reduction in the median rate of hypoglycemia in 2012.
Benewah Community Hospital, a 19-bed critical access hospital in a small remote town in northern Idaho, is actively addressing five of the Centers for Medicare & Medicaid Services' targeted areas for quality improvement - early elective deliveries, readmissions, surgical-site infections, catheter-associated urinary tract infections and falls. Falls have been reduced from 25 per 1,000 patient days in January 2012 to zero in July and August 2012. Additionally, all-cause 30-day readmissions are down from 11% in February 2012 to 4% in August 2012, and urinary catheter days decreased by two-thirds, from 45 in March 2012 to 15 in August 2012.
Essentia Health has committed to decreasing preventable falls in its cardiac telemetry unit by 50% by June 30, 2013. To meet that goal, staff have tested and implemented multiple interventions including intentional rounding, teach-back on the use of the call-light and post-fall huddles. In addition, the fall risk level is systematically recorded - written with colored markers on white boards in the unit and included in every shift report. As a result, from January to September 2012, the unit's fall rate decreased from 7 falls per 1,000 patient days to 2.4 per 1,000 patient days.
Buffalo Hospital continues to make important strides in overall quality, patient safety, patient experience, performance improvement outcomes and demonstrates a culture dedicated to achieving and sustaining excellence. One of Allina Health's system-wide strategies includes preventing patient falls. In working to reduce patient falls, Buffalo Hospital has developed a fall prevention toolkit, conducted fall education for all staff, developed guidelines to match new interventions and held meetings with ancillary departments to share fall reduction strategies throughout the hospital, creating a safety net of health care workers to assist in fall reduction.
Altoona Hospital has implemented a new computer-assisted medication administration system as an additional check to assure that medications are being properly administered. The system allows caregivers to more accurately and confidently identify patients and give correct medications. When a physician writes an order for a medication, the order is electronically scanned to the pharmacy, the pharmacist then enters the order into the computer system and before a patient receives the medication the medication bar code is scanned and the computer verifies against the patient's information its name, dosage, time and route to be given. If everything matches, a green check mark appears. If something is amiss, a red "X" appears and the nurse must troubleshoot the error. The computer keeps a complete record. After administering the medication, the computer system logs the medication details, including the initials of the staff administering it.
Throughout the University of Pennsylvania Health System, residents are participating in a new program that is aimed at improving quality and safety across the health system. Training the teachers in quality and safety education is a key component of these efforts. Each residency program has begun sending one or two of its faculty for skills training to learn how to teach residents in key quality areas. This year, they will focus on the handoff between doctors, e.g., transferring a patient from the operating room to the ICU, the best way to safely relay information between doctors when they change shifts at night and all the components of patient discharge when patients are “handed off” to their primary care provider. Positive changes throughout the hospitals already have resulted from involving residents in quality improvement.
Consumers in Alabama can now access information on healthcare-associated infections in Alabama hospitals. A recent report published by the Alabama Department of Public Health, provides hospital-specific infection data for several types of infections. Hospital leaders were pleased to have been a part of this important work and remain committed to a strong infection prevention program.
Michigan hospitals' successful patient safety and quality efforts continue to save lives, reduce costs, prevent harm and infections, and empower consumers. The Michigan Health & Hospital Association recently released the 2012 Patient Safety and Quality Annual Report: Improving Patient Care Across the Health Care Continuum that highlights the lifesaving, cost-reducing initiatives under way in Michigan hospitals.
During the nationwide October convening for the hospital engagement networks of the Partnership for Patients initiative, U.S. Health and Human Services Secretary Kathleen Sebelius cited the OHA HEN as an example of excellent work that the PfP is accomplishing. OHA's first focus of the initiative was on the reduction of infections, specifically the Integration of Care: Infection-related preventable harm. The integrated infection bundle was introduced to help streamline the assessments at the bedside. In the first six months of 2012, OHA HEN participating hospitals were able to reduce infection rates by 56%.
Jones Memorial Hospital is committed to improving patient safety and one of its primary initiatives is focused on encouraging and empowering their patients to take an active role in their own health care and SPEAK UP. Jones Memorial Hospital is working to help patients "participate in their safety" by being involved and informed members of the health care team.
Hartford Hospital is dedicated to providing both their patients and health care providers with up-to-date information on the hospital's performance. As one way of meeting that goal, Hartford created The Patient Safety Action Group, a multidisciplinary team of some 30 people representing most of the departments and patient service areas in the hospital. It employs a dynamic, inclusive process that brings together people from all roles and functions within the organization on a daily basis. The PSAG produces a weekly newsletter to keep hospital employees informed of efforts within the institution regarding patient safety. Current and past issues are posted on the hospital's website.
Focusing on patient education and collaboration with physicians and the hospital, Gundersen Lutheran's care coordination program has achieved remarkable results. The program has not only improved patient outcomes but also reduced health care costs. RNs and social workers serve as care coordinators, working with each patient to increase compliance with medication and treatment plans, help manage social and emotional needs and prevent hospital readmission.
The Minnesota Hospital Association created the “Good Catch for Patient Safety” award, which they present to Minnesota hospital staff and physicians who demonstrate their commitment to keeping patients safe by "speaking up" to prevent potential harm to a patient. Efforts such as those of the award recipients remind us what a difference one person can make in keeping patients safe.
The Illinois Hospital Association Institute for Innovations in Care and Quality recently honored eight hospitals for their innovative interventions and best practices designed to advance quality patient care. The awards were presented to hospitals in two categories: urban and rural/critical access. Recipients were selected by a panel of 30 nationally recognized quality improvement leaders. Award recipients have achieved measurable and meaningful progress in advancing one or more elements of the Institute of Medicine's six aims for improvement.
A new study from the Agency for Healthcare Research and Quality recently revealed that hospitals participating in a unique nationwide patient safety project were able to reduce the rate of central line-associated bloodstream infections in intensive care units by 40%. This is based on the agency's preliminary findings of the largest national effort to combat CLABSIs to date. The project used the Comprehensive Unit-based Safety Program to achieve its landmark results that include preventing more than 2,000 CLABSIs, saving more than 500 lives and avoiding more than $34 million in health care costs. The national project involved hospital teams at more than 1,100 adult intensive care units in 44 states over a four-year period.
Valley Hospital can count many accomplishments, including its work developing a culture of safety. About 15 years ago, the 451-bed hospital serving northern New Jersey experienced a blip up in medication errors. Valley administrators and staff investigated and concluded their complex process for reporting errors needed improvement and the culture needed to change. Staff started reporting near misses, and the hospital rewarded their improvement efforts and also implemented bar coding. As a result, Valley reduced medication errors by 30 to 35%.
23 Wisconsin hospitals will participate in the the second Transforming Care at the Bedside (TCAB) initiative. Lead by the Wisconsin Hospital Association and supported by Wisconsin’s statewide participation in an Aligning Forces for Quality (AF4Q) grant, 25 hospital units from 23 Wisconsin hospitals will begin an 18-month improvement strategy. TCAB is an innovative model that calls for nurses to lead unit and hospital-wide team efforts to improve the quality and safety of patient care. It focuses on nurses’ creativity, teamwork and focus on patients.
Though more work needs to be done, our nation's hospitals are making advancements in providing quality care for every patient, regardless of race or ethnicity. Nearly 950 hospitals and health systems responded to a benchmarking survey fielded by the AHA's Institute for Diversity, Health Forum and the Health Research & Educational Trust, and reported their actions to reduce health care disparities and increase diversity in leadership and governance. The majority of respondents-between 87 percent; and 94 percent-reported collecting race, ethnicity and primary language (REAL) data from patients. Hospitals are just beginning to use REAL data, but nearly 30 percent of hospitals now use primary language data to benchmark gaps in care. More than 80 percent of hospitals provide cultural competency training to staff.
St. Cloud Hospital works to create an environment of patient safety with a program titled “Speak Up.” This program urges patients to get involved in their care, and it provides information and advice on how they can make their care a positive experience.
Canton-Potsdam Hospital initiated a comprehensive antimicrobial stewardship program after senior leadership noted unacceptable infection rates. The hospital’s patient safety director and infection prevention officer led a task force comprised of key frontline staff from across the organization. They implemented automated screening systems, improved signage, educated non-clinical staff on their role, and held education sessions for the entire staff and physicians. Infection rates subsequently plummeted and the hospital went eight consecutive months without a hospital-acquired C-difAuficile infection.
University Hospitals Case Medical Center in Cleveland was awarded the 2012 American Hospital Association-McKesson Quest for Quality Prize for demonstrating leadership and innovation in quality improvement and safety.
Truman Medical Centers and the Hospital Hill Economic Development Corporation launched the TMC Healthy Harvest Mobile Market. The TMC Healthy Harvest Mobile Market is a mobile grocery store unit that will travel throughout the urban core on a weekly basis bringing residents opportunities to purchase healthy choices such as fresh fruits and vegetables in their community at an affordable cost.
Seton Family of Hospitals in Central Texas became a pilot site for programs to reduce birth trauma. This initiative was part of Journey to Zero, a systemwide campaign at Ascension to deliver safe care within several clinical areas. Seton implemented the 39-week rule, which held physicians accountable for declining all requests for elective deliveries prior to 39 weeks, unless medically necessary. As a result, Seton has not performed any elective deliveries before 39 weeks, birth trauma incidence rates have seen a 93 percent reduction and admissions to the neonatal intensive care unit have decreased.
As one of its first initiatives, the Illinois Hospital Association (IHA) Quality Care Institute developing -- Raising the Bar: Call to Action -- to reduce hospital readmissions and hospital-acquired conditions and infections. As part of this campaign, nearly 200 hospitals from across Illinois signed a pledge to engage in these interventions over three years.
Charles Cole Memorial Hospital was recently recognized with an achievement award in patient safety by the Hospital & Healthsystem Association of Pennsylvania for its approach to care transitions and hospital readmissions. The hospital decreased readmissions rates by 15.3% and improved care coordination and quality of patient care transitions through community collaboration.
The Ohio Patient Safety Institute recognized Summa Akron City Hospital and Riverside Methodist Hospital, Columbus, as the recipients of the fourth annual OPSI Best Practice Award. The award honors a health care organization for implementing the most innovative, evidence-based patient safety practice in the state.
The hospitals of Sinai Health System aim to be a national model for the delivery of urban health care. By using evidence-based infection reduction strategies, reviewing data regularly, participating in learning collaboratives and creating zero-defect teams, the health system has significantly reduced the rate of healthcare-associated infectons in adult intensive care units. Collaboration among senior leadership and medical, nursing and infection control staff has been key.
Thirty-one Massachusetts hospitals have joined the Massachusetts Hospital Association (MHA) in an effort to improve patient care and reduce healthcare costs throughout the commonwealth. MHA is coordinating a Hospital Engagement Network (HEN) in Massachusetts as part of the federal Partnership for Patients (PfP) Campaign, which has as its stated goals to reduce inpatient harm by 40 percent and cut readmissions by 20 percent at participating hospitals.
For people with diabetes, getting the proper treatment for foot wounds can prevent lingering problems and even amputation. The patient community in the rural area served by Claxton-Hepburn Medical Center has a high incidence of diabetes and obesity, which can cause a high rate of non-healing wounds. Identifying a need and opportunity, CHMC, a 130-bed community hospital and regional referral center, worked with National Healing Corporation to develop a wound healing program.
Mary Washington Hospice and Mary Washington Healthcare’s Department of Pathology and Laboratory Medicine were recently recognized for their respective quality improvement projects - “Changing a Culture to Achieve Excellence" and "Chemistry Redesigned: Leaning Towards the Future.” The awards were given by George Mason University’s Health and Human Services Department for Excellence in Clinical Improvement and Excellence in Service Improvement.
The New Jersey Hospital Association recently launched a consumer website for heart failure patients designed to help better manage their condition and protect them from return visits to the hospital. The user-friendly website offers a wealth of up-to-date information, advice, resources and links and allows patients to enroll in heart failure clinics so they can receive comprehensive follow-up care, search a list of pharmacies that deliver medications and find educational programs and exercise classes. And for health care providers, the site provides a valuable resource they can share with heart failure patients, with the goal of improving quality of care and reducing the high cost of hospital readmissions.
Woman’s Hospital in Baton Rouge, LA, has been a leader in implementing new ideas and guidelines that help provide exceptional care and improve the health of women and infants. In 2007, they launched a collaborative with the Institute for Healthcare Improvement to eliminate elective inductions prior to 39 weeks. Eliminating these deliveries improves outcomes for the newborn and mother and as clinical and policy support for the project grew, a larger movement evolved to reduce all early elective inductions and deliveries, unless medically necessary. To educate patients, the hospital provided physicians and patients with pamphlets describing the risks associated with elective inductions. From 2006–2011, primary cesarean delivery rates at Woman’s decreased 19% percent, and admissions to the neonatal intensive care unit decreased by 28.9% percent.
Through a creative, data-driven hand hygiene campaign Abington Memorial Hospital was able to increase its hand-washing compliance rate from 31% to over 90%. The campaign started with secret shoppers observing and collecting data in clinical units. Individual units created signs to remind staff, the administration offered an incentive bonus to all employees, reminders were displayed on computer screen savers and noncompliant staff received letters from the administration. In addition, with progress in hand hygiene, health care-acquired infections at the hospital have plummeted, with many departments reporting zero infections.
Rhode Island hospital ICUs continues to make significant strides in quality improvement and patient safety. The Rhode Island ICU Collaborative recently released data that shows the rate of central line-associated blood stream infections and ventilator-associated pneumonia reached an all-time low last year. Intensive care units make use of the greatest advancements in medical science and represent areas with great opportunity to prevent death and reduce costs.
Cincinnati Children’s Hospital Medical Center was recently recognized by the Ohio Hospital Association for decreasing pediatric catheter associated blood stream infection rates on the Hematology/Oncology and Bone Marrow Transplant units over three years by 65% and 68%, respectively.
The Ohio Patient Safety Institute (OPSI) recently announced Summa Akron City Hospital, Akron, and Riverside Methodist Hospital, Columbus, as the recipients of the fourth annual OPSI Best Practice Award, which honors a health care organization for implementing the most innovative, evidence-based patient safety practice in the state.
Wisconsin hospitals are sharing data that shows how well they are doing in preventing one of the most serious infections that can occur in an intensive care unit – central line-associated blood stream infections (CLABSI). The results show that 58 percent of the hospitals that reported data had zero CLABSI infections in their ICUs during the first six months of 2011.
Improving quality of care can go hand in hand with eliminating disparities in care. University of Mississippi Medical Center in Jackson participated in an initiative aimed to improve quality of cardiac care for African-American and Hispanic patients by improving care for all patients. UMMC adopted standardized protocols to collect race, ethnicity and language data; provided monthly reports on care performance measures, stratified by patient race, ethnicity and primary language, and tracked core measures of care for heart attack patients. In two years at UMMC, the number of patients receiving all core measures of care for heart attack increased from 74 percent to 82 percent. UMMC also set up an outpatient heart failure management clinic, led by a nurse practitioner who helps patients manage their disease after leaving the hospital. One year after opening the clinic, no patients had a readmission to the hospital.
When Kaiser Permanente in California measured its incidence of pressure ulcers in patients three years ago, it found that its rate of 2.8 percent was considered good, at least in comparison with other hospitals. But Kaiser decided it could do “significantly better” and set a goal to reduce pressure ulcers to less than 1 percent of the health care system's patients. As a result, from 2008 through 2011, Kaiser reduced the rate of pressure ulcers in patients to 0.6 percent.
Hospitals participating in the Tennessee regional collaborative of the American College of Surgeon's National Surgical Quality Improvement Program (ACS NSQIP®) achieved substantial improvements in surgical outcomes, such as reducing the rates of acute renal failure and surgical site infections.
For its efforts to reduce the incidence of ventilator-associated pneumonia, pressure ulcers and health care-acquired infections, South Texas Health System (STHS) has been honored with the Texas Hospital Association's 2011 Bill Aston Award for Quality. The award recognizes a hospital's measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative.
In an effort to improve infant outcomes and particularly prematurity in Oklahoma, 55 Oklahoma hospitals participated in a harm reduction and quality improvement collaborative to eliminate unnecessary early deliveries prior to 39 weeks of gestation unless there is a documented medically necessary reason for the early delivery. This collaborative was appropriately called, “Every Week Counts .”
Every New Hampshire hospital has committed to achieving 100% compliance with appropriate hand hygiene practices in order to reduce the chance that patients and staff acquire a healthcare associated infection while receiving care. The 'High Five' campaign commits the hospital to investing in the 5 pillars of best practice of the program which include: Leadership Commitment, availability/convenience of products, hand hygiene training and competency, measurement, and accountability.
The Ohio Hospital Association (OHA) have partnered with the Ohio Patient Safety Institute (OPSI) to work with member hospitals, nursing homes and home health agencies throughout the state to improve patient care in 11 clinical areas, ranging from preventing infections and falls to helping patients fight disease from multidrug-resistant organisms.
Nassau University Medical Center has received the Get With The Guidelines®-Heart Failure Bronze Quality Achievement Award from the American Heart Association. Get With The Guidelines is a quality improvement initiative that provides hospital staff with tools that follow proven evidence-based guidelines and procedures in caring for heart failure patients to prevent future hospitalizations. The recognition signifies that NUMC has reached an aggressive goal of treating heart failure patients for at least 90 days with 85 percent compliance to core standard levels of care outlined by the American Heart Association/American College of Cardiology secondary prevention guidelines for heart failure patients.
Integrating the electronic health record to improve the overall care and health of the communities it serves is an overarching goal at West Virginia University Healthcare. The hospital created its Center for Quality Outcomes to integrate functions related to quality, safety and performance improvement. The center conducts research and develops strategies to ensure organizational readiness for new challenges and requirements such as meaningful use.
Earlier this month, 20 Central Ohio hospitals staged simultaneous Scrub Up! events to highlight the critical importance of hand hygiene to reduce infections and disease transmission. The Ohio Hospital Association's (OHA) Quality Institute spearheaded the observance, which engaged staff and visitors of every hospital in six counties.
The Oregon Association of Hospitals and Health Systems has launched a patient-centered initiative to highlight Oregon hospitals' quality programs. The Hospitals4Health initiative will showcase community partnerships and other efforts, and encourage patients to be active participants in their care.
The first Kentucky Infection Prevention Boot Camp was held October 11-14 in Louisville and was attended by more than 230 health care professionals from all types of health care settings including, long-term care facilities, ambulatory surgery centers, public health settings and hospitals (97 of the state's 130 hospitals participated). Attendees shared the common goal to reduce the risk of health care related infections.
Hospitals across Rhode Island were among the first in the nation to have unanimous voluntary adoption of a surgical protocol. The protocol establishes uniformity across hospitals so health care practitioners working at multiple organizations will follow the same routine for all surgical procedures.
To date, the collaborative efforts of the Michigan Hospital Association and Michigan hospitals have saved more than 2,000 lives and more than $300 million.
Alabama's hospitals have decreased the rate of central-line associated blood stream infections in participating intensive care units by 38%. Through this focused approach, hospitals have saved approximately $1.5 million and decreased the number of hospital days by 397.
The Hospital & Healthsystem Association of Pennsylvania (HAP) partnered last week to launch a health care worker universal influenza vaccination campaign. The campaign provides tools to support all hospitals in Pennsylvania in implementing an evidence-based universal vaccination initiative, working toward flu vaccination among health care workers becoming a condition of employment by 2013, as part of a comprehensive approach to prevent all health care-associated infections.
The voluntary patient safety and quality efforts led by Michigan hospitals continue to prevent infections, save lives, introduce efficiencies, save millions of health care dollars and empower consumers. The Michigan Health & Hospital Association released the 2011 Patient Safety and Quality Report: Hospitals Putting Patients First that highlights the safety, quality and efficiency efforts under way in Michigan hospitals and health systems.
The California Hospital Association launched a statewide patient safety awareness campaign called “ Caring is Our Calling,” which features a statewide television ad, a web-based video, patient safety issue briefs, and digital and social media activities. The goal of the campaign is to showcase the efforts of California hospitals in providing access to safe, high quality care for all patients.
At Thomas Jefferson University Hospitals, a team representing key departments makes patient safety rounds to proactively address safety risks then makes recommendations for changes. If a potentially unsafe event occurs, Jefferson responds immediately using the Patient Safety Net (PSN), a Web-based reporting system offering real-time problem solving. The Jefferson Health System is the first Pennsylvania health system using the PSN.
The Texas Hospital Association recently launched the Texas Center for Quality and Patient Safety, within its nonprofit foundation, to advance the adoption of proven strategies that enhance the quality and safety of care provided in Texas hospitals.
Study shows that Massachusetts hospitals to have enhanced quality of care and while reducing costs by more than $151 million for acute and specialty care hospitals statewide between 2007 and 2009 due to a commitment to performance improvement measures. The improvements were credited to increased intra-hospital collaboration and a sense of responsibility to voluntary public reporting of nursing-sensitive care measures.
Florida's hospitals are recognized for their effectiveness and continued focus on eliminating central line-associated blood stream infections (CLABSI). Over the past two years, 21 Florida hospitals have participated in this effort to eliminate CLABSI in intensive care units and have done so with a focus on improving care through enhanced teamwork and a culture of patient safety.
Simi Valley Hospital in Simi Valley, Calif. is involved in an effort to reduce pressure ulcers, in conjunction with parent company Adventist Health. The goal of the campaign is to facilitate an interdisciplinary approach to avoiding pressure ulcers, efficiently managing care when they occur and identifying and implementing best practices to reduce the incidence of pressure ulcers. The rate of pressure ulcers at Simi Valley Hospital dropped throughout 2010, thanks in large part to education efforts with the hospital's staff, as well as patients and their family members and other caretakers.
Pennsylvania was the first state to create a patient safety organization, the Pennsylvania Patient Safety Authority. Hospitals report serious events and near?miss information to the Pennsylvania Patient Safety Authority, which reports, analyzes, and makes recommendations on how to improve care and prevent medical errors.
Transplant recipients are fragile patients, at high risk for infections and require complex follow-up care. In 2009, the transplant team at Cincinnati Children's Hospital Medical Center created a standard discharge process to prevent errors and unplanned preventable occurrences and to improve communication and care delivery between caregivers and the medical team.
Responding to an explosive growth in patient population, Yale-New Haven Hospital implemented a successful initiative to achieve safer patient flow. Method changes for patient services included standardizing the discharge process, using status boards for visual control and improving the accuracy and timeliness of data entry. Results include a 32% percent improvement in discharges by 11 a.m. and an 11% decrease in average bed cleaning turnover time.
Saint Joseph-London in London, KY has improved care and reduced readmissions for chronically ill patients, focusing first on heart failure patients. To better prepare patients for discharge, the hospital implemented a transition coach program. With this intervention, the readmissions rate for heart failure patients has decreased to 15.9% from 27.7%.
Minnesota Hospitals continue to aggressively combat wrong-procedure events throughout their organizations and are doing so through a Time Out Campaign designed to eliminate wrong-site events through administration, physicians and front-line staff joining together to hold each other accountable for conducting robust, effective time-outs for every patient, every invasive procedure, every time.
The Ohio Hospital Association honors hospitals with its Hospital Safety Awards for successful hospital safety programs and superior employee safety records.
The Texas Center for Quality and Patient Safety is an affiliate of the Texas Hospital Association’s nonprofit foundation. Established in 2010, the center is bringing together Texas hospitals, state and national experts and evidence-based health care practices in an effort to improve the quality of care at the bedside and reduce costs.
Eighty-one percent of Oregon hospitals now use a safe surgery checklist to reduce surgical complications.
The University of Michigan Health System created "Improving Patient Safety in Hospitals: Turning Ideas into Action" to promote best practices that exemplify safe and high quality patient care.
Minnesota Hospital Association is conducting "SAFE SITE," a statewide campaign to prevent wrong-site surgeries.
Hospital Compare is a public/private website focused on hospital quality.