Improving Harm Across the Board

St. Francis HospitalAngela King, BSN, CPHQ, CPHRM

Administrative Director, Patient Safety and Quality

Best Care – Best Way – Every Patient – Every Day

2

Cut “harm across the board” by 37%

1Q10 2Q10 3Q10 4Q10 1Q1 2Q11 3Q11 4Q11 1Q12 2Q12153

203

253

303

353

403 Total Harms by Quarter

Tota

l H

arm

s by Q

uart

er

2012 Breakthrough in Readmission: From 246 to 144

1Q10 2Q10 3Q10 4Q10 1Q1 2Q11 3Q11 4Q11 1Q12 2Q1292

112

132

152

172

192

212

232

252

272Readmissions

Readm

issi

ons

by Q

uart

er

Reduced 30 Day Readmission RateFrom 9% to 5%

1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 4Q11 1Q12 2Q120.00

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

0.09

0.10

Readmissions

Drivers of safety that produce these results include:

• Patient and family engagement - Caught You Washing” cards

- “Turn” signals throughout hospital- Joint Camp/Heart Camp

• Physician led improvement efforts. • Empowering staff to “speak up” in the

interest of safety leads to a culture of safety.

Pearls

Pearls (continued)Development of best practice protocols and

checklists. This can lead to recognition for disease specific certifications.

Providing data to direct caregivers and involving them in developing improvement plans. For instance, stratifying why patients are non-compliant leads to process changes that impact their care. For example: The Heart Failure patient readmitted because they do not have funds to fill prescriptions or do not have a private physician to follow up with for care.

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Defining Moment In Our JourneyA landmark was reached with VAP compliance

when we went 884 days with ZERO VAP cases!Staff realized they could get to zeroStaff realized they could reduce harmWe began tracking on our Intranet in real

time – this was a commitment to transparency

Risk Profile: The Areas of Risk We Are Committed To ControllingAnnual discharges: 10,756 HAC risk opportunities/discharge:

5.55Slide 8

HACs Estimated annual number of patients at risk in each area Number of Opportunities

ADE # of inpatients: 10,756

CAUTI # pts in IP units with catheter in place: 1,613

CLABSI # pts in IP units with central lines: 6,445

Falls # of discharges: 10,756

Ob AE # of women with deliveries: 0

Pr Ulcer # of discharges: 10,756

SSI # of applicable surgical pts: 9,013

VAP # of patients on a ventilator: 1,310

VTE # of inpatients: 9,013

EED # of women with elective deliveries 0

TOTAL Risk opportunities for harm across the board 59,662

Readmit # of inpatients at risk of readmit: 10,756

Our improvement journeyImprovement Scale:The stages we move

throughIDEAL: level represents zero harm

At Target: level represents meeting improvement target

Progress: level shows movement but not yet at target

Opportunity: level is an opportunity to launch aggressive action

Number of risk areas (0-9) at

each stage_____4_____

_____2_____

_____0____

_____3_____

Slide 9

Improving Harm Rates (per discharge)HACs Baseline Rate

[2010]Target Rate

ADE 0.004 0.003CAUTI 0.003 0.002CLABSI 0.001 0.000Falls 0.012 0.011Pr Ulcer 0.003 0.002SSI 0.004 0.003VAP 0.000 0.000VTE 0.010 0.009

Total 0.037 0.030

Readmit 0.066 0.056

• Areas of strength at the beginning were CLABSI and VAP

• Areas that represented biggest challenges were all others

Improving Harm Rates (per discharge)HACs Baseline Rate

[2010]Target Rate Current Rate

[Q1 – Q2 2012]Improvement Status

ADE 0.004 0.003 0.006 OpportunityCAUTI 0.003 0.002 0.000 IdealCLABSI 0.001 0.000 0.000 IdealFalls 0.012 0.011 0.013 OpportunityPr Ulcer 0.003 0.002 0.000 IdealSSI 0.004 0.003 0.002 At TargetVAP 0.000 0.000 0.000 IdealVTE 0.010 0.009 0.011 Opportunity

Total 0.037 0.030 0.032

Readmit 0.066 0.056 0.047 At Target

Our Hospital Risk Score CardOur Safety Mandate

Annual Volume (Discharges) 10,756

Total risk: annual harm opportunities 59,662

Risks per patients (Total Opportunities)/Discharges)

5.55

Number of Risk Areas

Number of PfP Risk Areas Applicable (0 – 11) 9

Number of PfP Risk Areas Applicable & Adopted 9

Our Progress

Number of PfP Areas with Improvement Opportunity

3

Number of PfP Areas at Improvement Target 2

Number of PfP Areas at Progress 0

Number of PfP Areas at Ideal 4

Slide 10

Hospital CEO and Safety Team

Next Big Step to Reduce Harm

Hardwiring safety tools to impact daily operations

Teamwork training utilizing proven patient safety methodologies

Training in clinical processes to impact patient safety and quality, creating greater efficiency and reliability