Partnership for PatientsSafe Deliveries Roadmap
Safe Table November 19, 2013
Presented at Washington State Hospital Association Safe Table 11/19/2013
CME Credits• You will receive an email with a link to the
evaluation form. • After you complete the evaluation, you will be
redirected to a CME credit claim form where you will enter the number of credits you are claiming.
• Once you click “submit,” you will receive your CME certificate automatically.
Nurses can claim Category 1 credit toward their state relicensure.
Presented at Washington State Hospital Association Safe Table 11/19/2013
Safe Tables
•Confidential•Safe•All teach•All learn
Presented at Washington State Hospital Association Safe Table 11/19/2013
Partnership for Patients
•40 – Percent reduction in harm
•20 – Percent reduction in readmissions
•13 – by 2013
Saving Lives
Presented at Washington State Hospital Association Safe Table 11/19/2013
10 Targeted StrategiesInfection Reduction:1. Catheter-associated urinary tract infections (CAUTI)2. Central line-associated blood stream infections (CLABSI)3. Surgical site infections (SSI)4. Ventilator-associated pneumonia (VAP)Nursing Care:5. Injuries from falls and immobility6. Pressure ulcersHigh Risk:7. Adverse drug events8. Obstetrical adverse events9. Venous thromboembolism or blood clots (VTE)Continuity of Care:10. Prevention of readmissions
Cultural Transformation
Leadership Engagement
Patient and Family Engagement
Presented at Washington State Hospital Association Safe Table 11/19/2013
OB Adverse Events• Partnership for Patients: 2012 – 2013
• Early Elective Delivery Prior to 39 Weeks• Episiotomy• Safe Deliveries Roadmap
• Partnership for Patients: 2014• Early Elective Delivery Prior to 39 Weeks• Episiotomy• Safe Deliveries Roadmap• Pre-eclampsia• Hemorrhage
Presented at Washington State Hospital Association Safe Table 11/19/2013
Submission rates for most recent quarter:CLABSI: 93.8%VAP: 93.9%CAUTI: 93.8%SSI: 94.4%Falls: 57.8%Pressure Ulcers: 90.3%EED: 84.1%VTE: 85.2%Readmission: 100.0%ADE: 31.2%Leadership, Patient and Family: 79.6%
Goal 40%
Goal 20%
Below the Line is Better
OBCLABSI VAP CAUTI SSI ADEReadmissionsPressure
UlcersFalls
32%
89%
18%
46%
90%
12%
Baseline2010
VTE*
Based on submitted data through Q2 2013 for CLABSI-ICU, CAUTI-ICU, SSI, and VAPBased on submitted data through Q1 2013 for Falls, OB, OB-Episiotomy, Pressure Ulcers, and VTEBased on submitted data through Q3 2012 for ReadmissionsBased on submitted data through July 2013 for ADE-Anticoagulants*Current rate is equal to baseline rate
Achieve by December
2013
Harm and Readmissions Reduction Results
54%
Green – Reached GoalYellow – Moving in Right DirectionRed – Work to be Done
11/9/2013
21%
21%
OB-Episiotomy
32%
Presented at Washington State Hospital Association Safe Table 11/19/2013
Progress
To date, Washington State Hospital Association hospitals working together have achieved:• 90% reduction in early elective deliveries – resulting in over 1,900
babies allowed to mature and $5 million in savings• 89% reduction in ventilator-associated pneumonia from baseline –
resulting in two fewer patients experiencing ventilator-associated pneumonia a week, saving $3.5 million
• 43% reduction in stage II, III and IV (or unstageable) pressure ulcers– resulting one fewer patient experiencing a pressure ulcer a week, saving $2.2 million
• 32% reduction in ICU central-line associated bloodstream infections from baseline – resulting in one fewer patient experiencing a central-line associated bloodstream infection a week, saving $1 million
Presented at Washington State Hospital Association Safe Table 11/19/2013
Progress (continued)Washington State Hospital Association hospitals working together have achieved:• 21% reduction in surgical site infections from baseline –
resulting in two fewer patients experiencing a surgical infection each week, saving $2.5 million
• 18% reduction in readmissions from baseline – resulting in over 4,000 fewer patients being readmitted to the hospitals a year, $6 million in savings
• 12% reduction in falls – resulting in one fewer patient falls each week, saving $1 million
Presented at Washington State Hospital Association Safe Table 11/19/2013
NEW!
Clinicians and Hospitals Leading the Way
U.S. NEWS• Volume of deliveries (annual)• Average volume of deliveries per
attending provider (annual)• Availability of an on-site neonatal
intensive care unit• Availability of certain types of
specialists, such as neonatologists• Midwife availability• Rate of elective deliveries prior to 39
weeks gestational age• Risk-adjusted rates of adverse
outcomes (maternal and/or infant)• Risk-adjusted primary Cesarean-
section rate • Risk-adjusted VBAC rate• Episiotomy rate• Breastfeeding rate• Appropriate use of antenatal steroids• Average length of stay• Average cost
Compelling Case• By the age of 44, most U.S. women have given birth. Four million have a
baby every year—virtually all of them in the dark about the quality of care provided by their hospital of choice. Yet available evidence suggests that there are dramatic variations in the care women can expect at different hospitals. In Virginia, for example, primary C-section rates vary from under 14% to above 40%. Rates of episiotomies, regarded by many experts as an unnecessary procedure to expand the birth canal, range from 2.5% to more than 50%.
• We would publish the Maternity Care Indicators on www.usnews.com, the free news-and-information website published by U.S. News & World Report. The U.S. News site receives more than 20 million unique visitors per month (according to Omniture analytics), and our annual publication of "Best Hospitals" rankings in 16 adult and 10 pediatric specialties consistently produce some of the site's highest-traffic days. Based on our experience publishing Best Hospitals, we expect that the online release of the Maternity Care Indicators will result in significant and immediate public readership.
NEW!
Partners
• American Congress of Obstetricians and Gynecologists• Association of Women’s Health, Obstetric & Neonatal Nurses• March of Dimes• Northwest Organization of Nurse Executives• Obstetrics Clinical Outcomes Assessment Program• Rural Healthcare Quality Network• Washington State Department of Health• Washington State Health Care Authority• Washington State Hospital Association – Partnership for Patients• Washington State Medical Association• Washington Perinatal Collaborative
More to Come…..Presented at Washington State Hospital Association Safe Table 11/19/2013
Project Structure and Process
•Monthly meetings•Bulletin board•Newsletters•Data reports
Participating Hospitals
Advisory
Leadership
Measures
LEAPT
Presented at Washington State Hospital Association Safe Table 11/19/2013
Participating Hospitals• Cascade Valley Hospital and Clinics• Central Washington Hospital• Coulee Medical Center• EvergreenHealth• Group Health Cooperative • Harrison Medical Center• Highline Medical Center• Island Hospital• Jefferson Healthcare• Kittitas Valley Healthcare• Lake Chelan Community Hospital• Legacy Salmon Creek Medical Center• Mid Valley Hospital• MultiCare Auburn Medical Center• MultiCare Good Samaritan Hospital• MultiCare Tacoma General Hospital• Newport Hospital• Othello Community Hospital• Overlake Hospital• PeaceHealth Southwest Medical Center• PeaceHealth St. Joseph Medical Center• PeaceHealth Sacred Heart Medical Center, Oregon• PMH Medical Center• Providence Holy Family Hospital• Providence Mt. Carmel Hospital
• Providence Regional Medical Center Everett• Providence Sacred Heart Medical Center & Children’s Hospital• Providence St. Mary Medical Center• Providence St. Peter Hospital• Pullman Regional Hospital• Samaritan Healthcare• Skagit Valley Hospital• St. Elizabeth Hospital• St. Francis Hospital• St. Joseph Medical Center – Franciscan Health System• Sunnyside Community Hospital & Clinics• Swedish/Ballard• Swedish /First Hill• Swedish/Edmonds• Swedish /Issaquah• Three Rivers Hospital • UW/University of Washington Medical Center• UW/Northwest Hospital & Medical Center• UW/Valley Medical Center• Valley Hospital/Rockwood Health System• Walla Walla General Hospital • Whidbey General Hospital• Whitman Hospital and Medical Center• Yakima Valley Memorial Hospital
Presented at Washington State Hospital Association Safe Table 11/19/2013
Project Leaders Tom Benedetti, MD Dale Reisner, MD
Kathleen Simpson PhD, RNC, FAAN Eric Knox, MD
Presented at Washington State Hospital Association Safe Table 11/19/2013
Advisory Group• Amy Bertone RN, Providence Health &
Services• Angela Chien MD, Evergreen Health• Ann Darlington CNM, Retired from Group
Health• Bat-Sheva Stein RN, Department of Health• Bruce Myers MD, Omak• Deborah Castille RN, PeaceHealth• Deborah Saner MD, Legacy Salmon Creek• Douglas Madsen MD, PeaceHealth• Drew Robilio MD, Franciscan Health System• Duncan Neilson MD, Legacy Health System• Ellen Kauffman MD, Foundation For
Healthcare Quality• Frank Andersen MD, Providence Health &
Services• Helen Phillips RN, Legacy Health System
• James Wallace MD, Brewster• Jane Dimer MD, Group Health• Jane Uhlir MD, Swedish• Katy Drennan MD, MultiCare • Lynn Rhett RN, Franciscan Health
System• Molly Parker MD, Port Townsend• Patrick Moran MD, Yakima• Peter Nielsen MD, Madigan• Rita Hsu MD, Wenatchee• Shelora Mangan RN, Legacy Health
System• Suzan Bishop RN, MultiCare• Susan Walker RN, University of
Washington• Tracey Kasnic RN, Central
Washington
Presented at Washington State Hospital Association Safe Table 11/19/2013
Leading Edge Advanced Practice TopicsLEAPT
• Kittitas Valley Healthcare• Legacy Salmon Creek Medical
Center• Overlake Medical Center• PeaceHealth St. Joseph Medical
Center• Providence Holy Family Hospital• Providence Sacred Heart
Medical Center and Children’s Hospital
• Providence St Peter Hospital• Samaritan Healthcare
• Swedish/Ballard• Swedish/Edmonds• Swedish/First Hill• Swedish/Issaquah• Three Rivers Hospital • UW Medicine/Northwest
Hospital & Medical Center• UW Medicine/Valley Medical
Center• Whidbey General Hospital• Yakima Valley Memorial
Hospital
Presented at Washington State Hospital Association Safe Table 11/19/2013
Roll-out
• On-boarding: (July – December)• Education• Readiness assessment
• Testing: (October – December)
• Implementation: (January – December 2014)
AND, THEY’RE OFF!
Presented at Washington State Hospital Association Safe Table 11/19/2013
What we are learning
Since we are charting new waters:• Implementation is messy
• Developing as we go• Changing time-lines• Course corrections
• We need to get more comfortable not having the answers
“If you are not uncomfortable, you are not learning!”
• Safety nets are necessary
Presented at Washington State Hospital Association Safe Table 11/19/2013
Ralph Stacey Matrix
Presented at Washington State Hospital Association Safe Table 11/19/2013
What we are Learning
• Everyone has something to teach/contribute
• Need to be sensitive when determining what can be standardized and what should be customized
Presented at Washington State Hospital Association Safe Table 11/19/2013
“Haters”
“Standardization
Polyannas”
General attitudes towards standardization:Lessons learned from an attitude survey
“Ambivalent”
Courtesy of Dr. Keith Georgeson
Presented at Washington State Hospital Association Safe Table 11/19/2013
What we are Learning
• Goodwill keeps things moving when we hit a wall
UPDATES
Presented at Washington State Hospital Association Safe Table 11/19/2013
Measures
Presented at Washington State Hospital Association Safe Table 11/19/2013
Data SourcesCalifornia Maternal Data SystemObstetrics Clinical Outcomes Assessment Program (OB COAP)Washington State Health Data System
• Criteria• Safe Deliveries Roadmap measures within specified period of time.• Data burden on hospitals• No duplication of data abstraction• Protection from disclosure and discovery – CQIP• Ability to drill down to individual cases for quality improvement• Hospital and system level reports • Costs with• Capability for health systems that cross state boundaries to allow all of their
hospitals to participate.
• Decision - leverage strengths of all three systems• California Maternal Data System – Safe Deliveries Roadmap outcomes• OB COAP – LEAPT project (to be determined)• WA state Health Data System – support infrastructure build for future
HIGHER LOGIC
Medicaid Quality Incentive
Presented at Washington State Hospital Association Safe Table 11/19/2013
Induction AppropriatenessNumerator: number of patients undergoing a medical or non-medical induction with documentation of consent, Bishop score and indication
Denominator: Number of patients undergoing a medical or non-medical induction
• Documentation sources for Bishop score and induction can be taken from the consent, medical record, or checklist available if audited by the Healthcare Authority. Hospitals are encouraged to make a part of the medical record if possible.
Consent:• For written consent the following is required under RCW 7.70.060(1):
• Identification of patient • Name of hospital in which treatment is to be performed • Name of attending physician • Nature, anticipated results, alternatives to and risk of proposed treatment, including nontreatment • When the proposed treatment will be given • Date and time of signing the consent • Signature of patient or patient’s representative • Witness
• If hospital does not use a standard consent for all induction patients, the hospital will conduct an audit of a minimum of thirty records randomly selected to review if all elements of consent are present. Audit must be available for the Health Care Authority to review.
• For hospitals that use on each of their induction patients a standard hospital consent that includes all elements, no audit is needed.
Meeting Schedule 2013• Roadmap Monthly (webcast)
• Thursday, December 5th 7:00 – 8:00 a.m.• LEAPT Roadmap – kickoff
• Thursday, December 5th 7:00 – 8:30 a.m.
2014• Roadmap Monthly (webcast) 7:00 – 8:00 a.m.
• Safe Tables (in-person) 9:00 a.m. – 2:30 p.m.• April 1• July 24• November 20
CANCELED!
January 9February 21March 26April 23May 20June 12
July 23August 19September 18October 21November 26December 18
2014 LEAPT TBA at KickoffPresented at Washington State Hospital Association Safe Table 11/19/2013
Thank You!
Mara Zabari, Director of Integration Partnership for Patients
Safe Deliveries Roadmap Websitehttp://www.wsha.org/0513.cfm%20
Presented at Washington State Hospital Association Safe Table 11/19/2013