Patient Care Quality Outcomes

Deborah Bulger, CPHQVice President, Product ManagementPerformance Management

Patient Care and Quality Outcomes

Paul GartmanVice President, Product ManagementEnterprise Visibility

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Learning Objectives

Determine how IT can support an organization’s quality performance goals Understand the difference between departmental capacity management and patient flow issues that affect the entire organization 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

Effective care planning

Visible communication to all stakeholders

Constituent based analysis

Strategic direction

Safety technology and culture

Tactical implementation

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Perfect Care Assessment Identifying the Opportunity

December 2007IHI National Forum92 responsesMD, RN, QA, Board

63%

41%

64%55%

Mistake ProofYour

Processes

OptimizePatient Flow

Adopt WholeSystem

Measures

TransformCare at the

Bedside

The higher the bar…the greater the opportunity!

% of “No” ResponsesThe higher the bar, the greater the opportunity

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63%

41%

64%55%

Mistake ProofYour

Processes


Adopt WholeSystem

Measures


Bedside


“No single tool can solve every problem; often, the answer will lie in the discovery, implementation, and execution of several tools.”Grout J. Mistake-proofing the design of health care processes. AHRQ Publication No. 07-0020. May 2007.

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Mistake Proofing Your Processes Recognition and Prevention of Failure Points

73%

51%

54%

74%

Barcodescanning

Patient safetyattributes

Visiblility tochanges in pt

status

Automated medreconciliation


Online allergies and med history for each patient Rapid reporting of critical lab values“Five rights” barcoding

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Removing a Failure PointBarcode Scanning Technology

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

Bedside barcode scanning of meds

Rapid adoption of technology

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“Dockside to Bedside”100% Barcoded Medication Management

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63%

41%

64%55%

Mistake ProofYour

Processes


Adopt WholeSystem

Measures


Bedside


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

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Optimize Patient Flow System-wide Visibility to Patient Status

One-to-one paper, verbal communications create delaysDepartmental “micro-delays”affect system-wide throughputLack of capacity impacts organizational success

38%

29%

61%

35%

Average EDhold time <4 hrs

ObservationALOS <24 hrs

Real timedischarge

orders

Real timecensus


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Visual Controls in Everyday Life

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Visual Controls in Healthcare

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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

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

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

Peak Admission Period Peak Discharge Period

6a 7a 8a 9a 10a 11a 12a 1p 2p 3p 4p 5p 6p 7p 12a

Source: Advisory Board interviews and analysis, 2006.

Addressing the Challenge of Capacity and Throughput Management

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Enterprise Visibility Platform

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Scheduled discharge

Patient location (radiology)

Cleaning in process

Transport alert

Observation patient

Case manager alert

Results notification

Orders notification

Medications ready

Hold room for maintenance

Isolation

Pending discharge

Bed reserve communication

Patient safety alert

Reading the Display Board

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

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

─ Improves bed turns by 19% ─ Expands overall acute care capacity by

12% ─ Reduce ED diversions by up to 60% ─ Reduce EVS staff by up to 20%

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63%

41%

64%55%

Mistake ProofYour

Processes


Adopt WholeSystem

Measures


Bedside


“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.”Whole System Measures, IHI, 2007

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Adopt Whole System Measures Meaningful Information to Sustain Improvement

Data rich, information poorIT investment should decrease manual collection – but doesn’tIncreasing regulatory requirements

72%

74%

46%

65%

Single "sourceof truth"

Constituentbased metrics

"Are we gettingbetter?"

Automated datacollection


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Removing Data Silos

Medication safety analysis

Surgical cost & quality

Productivity and profitability

Patient safety

Grouping and reimbursement

Departmental initiatives

Hospital-wide initiatives

Source data integration

Data warehouse & healthcare applications

Publication & analysis of results

Scorecards

Graphs

Document links

Action Triggers

Control charts

Work lists

Information transparency

Actionable insight

Dashboards

Radar Charts

Financial DSS

HIS

Med administration

Surgery IS

Laboratory IS

Patient experience

Payroll

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Constituent-based Metrics

Highest level, composite metrics Month-over-month trendsLinks to accountable staff

C Suite, Board

Nursing Executive

Drill by unit, caregiver, drug, date, time, etc., so manager can take immediate actionMetrics updated after each shiftPrincipled action triggers

Quality Manager

Criteria-based review lists Streamlined case review

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63%

41%

64%55%

Mistake ProofYour

Processes


Adopt WholeSystem

Measures


Bedside


“Patients say ‘They give me exactly what I want (need) exactly when I want (need it).”Rutherford, et al, Transforming Care at the Bedside, IHI, 2004

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Transform Care at the Bedside Evidence-based, Interdisciplinary Care Delivery

Automated plans that drive care deliveryIntegrated orders, documentation, assessments, etc.Prioritize activities based on patient progress

54%

46%

64%

55%

> 70% of time indirect pt care

Care plans integral to ptmanagement

Access toevidence at

bedside

Visible careplan


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PneumoniaPatient

Antibiotic 22 min. Overdue

Care Process AlertsCore Measure - Patient Monitoring

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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!

How does your organization measure up?─ Take the Quality Care Assessment in McKesson booth #3035

Feb. 25-28 at HIMSS

Deborah Bulger [email protected]

Paul Gartman [email protected]

Health & Medicine

Patient Care Quality Outcomes