Patient Care Quality Outcomes

Patient Care and Quality Outcomes

Deborah Bulger, CPHQ Vice President, Product Management Performance Management

Paul Gartman Vice President, Product Management Enterprise Visibility

Learning Objectives f

Determine how IT can support an organization’s quality performance goals

f

Understand the difference between departmental capacity management and patient flow issues that affect the entire organization

f

Learn how advanced care planning tools can help address an initiative of the IHI: Transforming Care at the Bedside

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“Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process measures.” Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007

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Crossing the Evidence Bridge Strategic direction

Tactical implementation

Effective care planning

Safety technology and culture

Constituent based analysis

Visible communication to all stakeholders

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Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity

The higher the bar… the greater the opportunity!

64%

63%

55% 41%

f December 2007 f IHI National Forum f 92 responses f MD, RN, QA, Board

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity

64%

63%

55%

“No single tool can solve every problem; often, the answer will lie in the discovery, implementation, and execution of several tools.”

41%

Grout J. Mistake-proofing the design of health care processes. AHRQ Publication No. 07-0020. May 2007.

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Mistake Proofing Your Processes Recognition and Prevention of Failure Points % of “No” Responses The higher the bar, the greater the opportunity

Automated med reconciliation Visiblility to changes in pt status Patient safety attributes Barcode scanning

74%

f Online allergies and med history

for each patient f Rapid reporting of critical lab

values

54%

f “Five rights” barcoding 51%

73%

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Removing a Failure Point Barcode Scanning Technology Bedside barcode scanning of meds

f Quantifiable results

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99.7% compliance with bar-code scanning 39% increase in reporting of medication errors and near misses 33% decrease in percentage of errors causing harm 48% decrease in missed doses 73% decrease in extra doses 63% decrease in wrong doses

─

Enhanced charge capture

─

Increased clinician satisfaction and retention

─ ─ ─ ─

Rapid adoption of technology

─

Increased productivity and efficiency ─ $300,000 savings in transcription fees ─ And on… and on… ─

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“Dockside to Bedside” 100% Barcoded Medication Management

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Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity

64%

63%

55% “A hospital is a great example of a complex adaptive system. You have a number of people who are making day-to-day, even minute-to-minute, decisions in their own microsystem … that impact hospital-wide patient flow, and they are making these decisions without access to information about the macro view, or what is going on in the rest of the hospital.”

41%

Kirk Jensen, MD, MBA, FACEP, IHI faculty member and co-author, Leadership for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved Bottom Line

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Optimize Patient Flow System-wide Visibility to Patient Status % of “No” Responses The higher the bar, the greater the opportunity

Real time census

35%

communications create delays

Real time discharge orders Observation ALOS <24 hrs Average ED hold time <4 hrs

f One-to-one paper, verbal 61%

f Departmental “micro-delays”

affect system-wide throughput 29%

f Lack of capacity impacts

organizational success

38%

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Visual Controls in Everyday Life

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Visual Controls in Healthcare

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Addressing the Challenge of Capacity and Throughput Management f

f

Beds are full – supply & demand misaligned ─

ED diversions

─

Medical cases crowd out more profitable surgical cases

New Joint Commission standards around patient flow ─

Patient bed space

─

Efficiency and safety

─

Support service processes Late rounding, late test results, charts incomplete, poor discharge planning etc.

Mid-day bed crunch due to misalignment of admissions, discharges.

6a

7a

8a

9a 10a 11a 12a 1p Peak Admission Period

2p

3p

4p

5p

6p

7p

12a

Peak Discharge Period

Source: Advisory Board interviews and analysis, 2006.

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Enterprise Visibility Platform

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Reading the Display Board Pending discharge

Case manager alert

Transport alert

Results notification

Observation patient

Scheduled discharge

Isolation

Cleaning in process

Medications ready

Patient location (radiology) Patient safety alert

Orders notification

Bed reserve communication

Hold room for maintenance

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One Hospital’s Success $5.5M revenue increase within 6 months

─

Improves bed turns by 19%

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Expands overall acute care capacity by 12%

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Reduce ED diversions by up to 60%

─

Reduce EVS staff by up to 20%

Return on Investment analysis conducted by the Advisory Board - published June 2006

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Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity

64%

63%

55%

“By looking at macrosystem and microsystem measures frequently— daily, weekly, or monthly—the organization can better monitor its performance, find improvement opportunities, and prevent quality levels from eroding without anyone noticing.”

41%

Whole System Measures, IHI, 2007

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Adopt Whole System Measures Meaningful Information to Sustain Improvement % of “No” Responses The higher the bar, the greater the opportunity

Automated data collection

65%

f Data rich, information poor f IT investment should decrease

manual collection – but doesn’t "Are we getting better?" Constituent based metrics Single "source of truth"

46%

f Increasing regulatory

requirements 74%

72%

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Removing Data Silos Source data integration HIS

Data warehouse & healthcare applications Medication safety analysis

Financial DSS

Surgical cost & quality

Payroll

Productivity and profitability

Med administration

Patient safety

Patient experience

Grouping and reimbursement

Surgery IS

Departmental initiatives

Laboratory IS

Hospital-wide initiatives

Publication & analysis of results Information transparency

Dashboards Scorecards

Graphs

Radar Charts

Actionable insight

Control charts

Document links

Action Triggers

Work lists

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Constituent-based Metrics C Suite, Board f

Highest level, composite metrics

f

Month-over-month trends

f

Links to accountable staff

f

Drill by unit, caregiver, drug, date, time, etc., so manager can take immediate action

f

Metrics updated after each shift

f

Principled action triggers

f

Criteria-based review lists

f

Streamlined case review

Nursing Executive

Quality Manager

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Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity

64%

63%

55%

“Patients say ‘They give me exactly what I want (need) exactly when I want (need it).”

41%

Rutherford, et al, Transforming Care at the Bedside, IHI, 2004

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Transform Care at the Bedside Evidence-based, Interdisciplinary Care Delivery % of “No” Responses The higher the bar, the greater the opportunity

Visible care plan

55%

Access to evidence at bedside Care plans integral to pt management > 70% of time in direct pt care

64%

f Automated plans that drive care

delivery f Integrated orders, documentation, assessments, etc. f Prioritize activities based on patient progress

46%

54%

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Care Process Alerts Core Measure - Patient Monitoring Pneumonia Patient

Antibiotic 22 min. Overdue

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“Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process measures.” Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007

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Thank you! f How does your organization measure up? ─

Take the Quality Care Assessment in McKesson booth #3035 Feb. 25-28 at HIMSS

f Deborah Bulger

[email protected]

f Paul Gartman

[email protected]

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