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They may not walk down a runway or receive crowns, but staff in the sterile processing department (SPD) at H. Lee Moffitt Cancer Center and Research Institute (Tampa) were as delighted as any beauty queen to receive the Healthcare Purchasing News 2011 SPD of the Year Award. The clinical sterile processing team has worked hard to turn around a history of lackluster performance with the operating room (OR) to a high-performing relationship of trust and mutual respect.
To achieve this turnaround, the SPD and OR developed a program they called Sterile Processing & Operating Room for Continuous Quality, or SPORCQ (rhymes with fork). Drawing on staff from both departments, they created a strategy team to share business intelligence; gain better understanding of each department’s unique responsibilities and skill sets; and identify and address problems.
Among the strategies were:
- Developing a detailed service agreement between SPD and OR
- Launching a quality improvement iniative based on a lean management philosophy
- Mandating staff certification and education
- Creating a clinical employment ladder with related compensation
- Centralizing flexible endoscope processing and implementing scope processing and tracking improvements
- Recognizing achievements with a “Providing Excellent On-Going Niceness” (PEON) citation.
Source: Barlow, R. D. Moffitt busts traditional SPD mold with stellar performance.Healthcare Purchasing News. 35(5):10-16, May 2011.
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Striving for Top Box: Hospitals Increasing Quality and Efficiency
Posted on May 6, 2011 by dculbertson
This latest release in the Hospitals in Pursuit of Excellence Signature Leadership Series shares insights and best practices based on visits and interviews with three innovative health systems focused on improving both efficiency and quality of care.
- Novant Health in North Carolina shares its experience in two areas: creating a remarkable patient experience and moving toward a payer neutral revenue system and away from cost-shifting.
- The top box strategy of Piedmont Health in Georgia focused on physician alignment/clinical integration and on robust use of clinical data and information systems for performance measurement of cost management/efficiency and of infection control and preventable mortality.
- The performance improvement strategy for Banner Health in Arizona centered on creating a culture of accountability, consistently communicating and measuring performance initiatives, sharing best practices across the system, and recognizing employees for performance improvement.
Recommended key elements for top box improvement include:
- Start by addressing supplies and staffing for cost reduction.
- Focus on incremental improvements that will snowball into big gains.
- Address areas that will have substantial cost and quality impact.
- Develop action plans stating crisp aims for improvement.
- Share data transparently throughout the organization.
- Manage with a payer neutral revenue strategy.
- Reduce unnecessary clinical variation for quality improvement.
- Invest in data infrastructure for frequent and detailed reporting.
Source: Health Research and Educational Trust/Hospitals in Pursuit of Excellence. Striving for top box: hospitals increasing quality and efficiency. Chicago: American Hospital Association, May 2011. http://www.hret.org/topbox/index.shtml
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Filed under: Best practices, Efficiency, Financial management, Health Care Quality, Hospital Costs, Patient Safety, Posted by Diana Culbertson, Technology | Tagged: care coordination,Clinical integration, cost savings, cost-shifting, dashboards, health information technology, health systems, hospital leadership, hospital physician alignment, organizational culture, patient experience, patient satisfaction, payer revenue neutrality, Performance improvement | Leave a Comment »
More on supply cost savings
Posted on May 5, 2011 by The AHA Resource Center
We last addressed the issue of supply cost savings in a blog entry on April 27 about supply utilization management. An article from HealthLeaders Media looks at another key tool in achieving supply chain success: supplier relationship management (SRM). SRM can lower costs and improve quality by creating relationships between the hospital and the supplier that are based on mutual goals and enhanced communication. Effective SRM builds loyalty on the part of the hospital and accountability on the part of the vendor. Examples are given of strategies used byIntermountain Healthcare and York (ME) Hospital and the outcomes produced in terms of cost savings, efficiency, and the quality of goods and services.
Source: Minich-Pourshadi, K. How managing supplier relationships reduces revenue cycle costs. HealthLeaders Media. Apr. 14, 2011.http://www.healthleadersmedia.com/content/MAG-264900/How-SRM-Reduces-Revenue-Cycle-Costs
Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org
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60% of burn patients admitted to burn centers: U.S.
Posted on May 4, 2011 by kmgarber
North Carolina has two burn centers verified by the American Burn Association. Despite the availability of these resources and a well-established state EMS system, only half of burn victims were found to be admitted to North Carolina’s two verified burn centers during the study period from 2000 to 2007. This compares with 60 percent nationally. Interestingly, a commentator on this article cited similar data from a study of burn referral patterns in Florida — about half of burn patients were referred to burn centers. The North Carolina study also looked at outcomes of the specialized burn centers compared to burn patients in other hospitals. The burn centers’ median length of stay was 7 days compared to 4 in other hospitals and mortality was higher (7.5 percent compared to 1.5 percent). The burn centers also were more likely to perform operations on the burn patients. These outcomes are consistent with the likelihood of having more seriously-injured patients in the specialized burn centers. Patients treated in hospitals other than the specialized burn centers were found to have a higher percentage of discharges going to skilled nursing facilities.
Sources:
Holmes, J.H. IV, and others. The effectiveness of regionalized burn care: an analysis of 6,873 burn admissions in North Carolina from 2000 to 2007. Journal of the American College of Surgeons;212(4):487-495, Apr. 2011.
Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org
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Best practices in avoiding retained surgical sponges
Posted on May 3, 2011 by kmgarber
Despite established practices for counting, cotton sponges are the most common item to be left behind in a patient after intraabdominal surgery. Several years ago, theMayo Clinic (Rochester, MN) implemented a data-matrix-coded (fka bar coded) sponge counting system. In 18 months of continuous use, there have been just under 2 million sponges used in the Mayo Clinic Rochester operating rooms and zero retained-sponge events. There is a short learning curve to learn to use the new system (about 4 cases), and no increase in overall operative time was found. There was an average cost increase of just under$12 per case to implement this new system.
Source: Cima, R.R., and others. Using a data-matrix-coded sponge counting system across a surgical practice: impact after 18 months. The Joint Commission Journal on Quality and Patient Safety;37(2):51-58, Feb. 2011. Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org
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Medication-Related Adverse Outcomes in Hospitals and ERs
Posted on May 2, 2011 by dculbertson
An overview of the incidence of medication-related adverse outcomes in hospital inpatients and emergency outpatients is provided in a new report from the Agency for Healthcare Research and Quality. Three types of prescription drug-related adverse outcomes were looked at:
- Adverse drug reactions — side effects — where harm was caused by a drug at normal doses
- Adverse drug events where harm was caused by use of a drug, such as unintentional overdosing by a patient
- Medication errors where there was inappropriate use of a drug, such as a prescribing or dosing error
In 2008 there were 1.9 million inpatient hospital stays [nearly 5% of all stays] and another 838,000 treat-and-release visits to emergency departments involving a drug-related adverse outcome. Over half of inpatient adverse outcomes were with patients aged 65 and older; in the emergency outpatient setting, most adverse outcomes visits [36%] were with patients aged 18-44. The incidence of medication-related adverse outcomes increased by 52% between 2004 and 2008 and is expected to grow further with an aging population, rising comorbidities, and polypharmacy.
Corticosteroids were the leading cause of adverse outcomes for hospital inpatients, while analgesics and antibiotics were most often caused the adverse outcomes for treat-and-release emergency visits.
Cases involving use of illicit drugs and intentional drug overdosing were excluded in the data analysis.
Source: Lucado J, Paez K, and Elixhauser A. Medication-related adverse outcomes in U.S. hospitals and emergency departments, 2008. Agency for Healthcare Research and Quality, HCUP Statistical Brief #109, April 2011. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb109.pdf
Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org
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Opportunites and Challenges for Rural Hospitals in an Era of Health Reform
Posted on May 2, 2011 by dculbertson
A new Trendwatch report from the American Hospital Association provides a snapshot of the nearly 2000 rural community hospitals that serve a quarter of the nation’s population. Challenges facing rural hospitals include:
- Rural residents are older, have lower incomes, are more apt to be uninsured, and are more likely to suffer from chronic diseases.
- Rural health care workers are aging and are nearer retirement age than their urban counterparts. The growing shortage of health workers may have a greater impact on rural facilities.
- Access issues, such as longer travel distances and lack of reliable transportation, can delay treatment by rural patients, aggravating health problems and leading to more expensive care when received.
- Rural hospitals are smaller — nearly half have 25 or fewer beds — but must still maintain a broad range of basic services to meet the needs of their communities. Costs per case tend to be higher, because fixed expenses are spread over fewer patients.
- The shift from inpatient to outpatient care is more pronounced in rural hospitals, and rural hospitals are more likely to offer home health, skilled nursing, and assisted living services. Medicare payment shortfalls are greater for outpatient, home health, and skilled nursing care.
- 60% of gross revenue in rural hospitals comes from Medicare, Medicaid, or other public programs.
- Insufficient access to capital affects the abilities of rural hospitals to modernize facilities and acquire new technologies to improve operational effectiveness. Rural hospitals lag their urban counterparts in adoption of health information technology.
Special Medicare programs, such as critical access hospital, sole community hospital, rural referral center, and Medicare-dependent hospital designations, have been developed to stabilize rural hospitals. The new health reform law has provisions to further help rural hospitals, such as programs to bolster the supply of rural health workers. Health reform’s expansion of insurance coverage should reduce uncompensated care costs, but may require upfront investments by rural hospitals to handle the increased demand of new patients. Medicaid enrollment could expand by a third in many rural states, due to the new health reform law, yet Medicaid underpays hospitals for the cost of care.
The report includes several brief case studies focused on what rural areas are doing to address these challenges.
Source: American Hospital Association. The opportunities and challenges for rural hospitals in an era of health reform. Trendwatch, April 2011.http://www.aha.org/aha/trendwatch/2011/11apr-tw-rural.pdf
Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org
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Quality improvement: what is the best of current thinking?
Posted on May 2, 2011 by kmgarber
The editors of the policy journal Health Affairs take on important themes and provide a forum that attracts top-notch contributors. The April 2011 issue is devoted to the theme, “Still Crossing the Quality Chasm,” and provides 27 meaty, scholarly, data-rich articles, including several case study-like reports. Here are some of the highlights: (Classen, et al.) suggest that the number of adverse events is seriously underreported in U.S. hospitals just by the nature of the reporting mechanisms. (Goodman, Villarreal, and Jones) calculated that adverse medical events resulted in a social cost of $393-$958 billion in 2006. (Van Den Bos, et al.) calculated that measurable medical errors resulted in an annual cost of $17.1 billion nationally in 2008. (Pryor, et al.) describes the success achieved by the large system Ascension Health in reducing the rate of avoidable deaths by at least 1,500 annually. (Gabow and Mehler) review the approach taken at Denver Health to improve quality which included establishment of a department of patient safety and care quality. (Joyce, et al.) describe how Legacy Health has been able to cut infection rates through its Big Aims initiative. (Pronovost, Marsteller, and Goeschel) report on the progress nationally in cutting central line-associated bloodstream infections (CLABSI).
Classen, D.C., and others. ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured, pp 581-589.
Goodman, J.C., Villarreal, P., and Jones, B. The social cost of adverse medical events, and what we can do about it, pp 590-595.
Van Den Bos, J., and others. The $17.1 billion problem: the annual cost of measurable medical errors, pp 596-603.
Pryor, D., and others. The quality journey at Ascension health: how we’ve prevented at least 1,500 avoidable deaths a year, and aim to do even better, pp 604-611.
Gabow, P.A., and Mehler, P.S. A broad and structured approach to improving patient safety and quality: lessons from Denver Health, pp 612-618.
Joyce, J.S., and others. Legacy Health’s ‘Big Aims” initiative to improve patient safety reduced rates of infection and mortality among patients, pp 619-627.
Pronovost, P.J., Marsteller, J.A., and Goeschel, C.A. Preventing bloodstream infections: a measurable success story in quality improvement, pp 628-634.
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Do-it-yourself release of information
Posted on May 2, 2011 by The AHA Resource Center
For the last several years, the health information management (HIM) department of Massachusetts General Hospital (MGH) has been moving toward a do-it-yourself environment for patients’ requests for release of information. MGH partnered with a vendor to develop a secure web server that can safely provide patients with a PDF copy of their health information upon request. Implementing a record request form on the MGH web site (see http://www.massgeneral.org/notices/medicalrecords.aspx) increased the number of typed requests, which can be then read by optical character recognition software. A query form allows the user to identify specific information to be included. To retrieve a record, the requestor logs in with a unique user name and password, and, after authentication, downloads the file from the server.
The use of electronic processing has significantly increased productivity of HIM staff. At the same time, it has changed the nature of some of inquiries they receive, such as more questions about the content and format of medical records.
Source: Haas, M. DIY ROI: putting release of information in the hands of patients.Journal of AHIMA. 82(4):26-49, Apr. 2011.
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Filed under: Efficiency, Electronic health records, HIPAA, Hospitals, Posted by Jeanette Harlow,Uncategorized | Tagged: medical records, patient portal | Leave a Comment »
Patient experience? I’ll know it when I feel it.
Posted on May 2, 2011 by sarabeazley
A recent survey conducted by the Beryl Institute shows that hospital leaders rank improving patient satisfaction and the patient experience second only to improving quality and safety. While over half the hospitals report having a formal mandate regarding the patient experience, and almost 70 percent have a formal structure in place to manage the process, only 27 percent have a definition of what actually constitutes “the patient experience.” Consequently, there are many avenues the survey participants are taking to achieve the objective: noise reduction appears to be the favorite, but improving the discharge process, increasing staff responsiveness, and decreasing wait times are not far behind. The brief 20-page summary also includes some benchmarking data on the size of the patient experience committee that many of the respondents have implemented and the frequency of the committee’s meetings.
Source: The Beryl Institute. The State of Patient Experience in American Hospitals. April 13, 2011.http://www.theberylinstitute.org/resource/resmgr/benchmarking_study/2011_pe_benchmarking.pdf
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