MO-11-02-SCIP May 2011This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid

Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy

SCIP/HF Project Results

PrimarisJune 2, 2011

Measures

Heart Failure – 3 SCIP-Cardiac - 2 SCIP-Infection - 1 SCIP-Infection - 2 SCIP-Infection - 3

SCIP-Infection - 4 SCIP-Infection - 6 SCIP-VTE - 1 SCIP-VTE - 2

Best Practices

HF-3: – Auto-alerts for continuing ACE/ARBs at hospital DC (for

those appropriate patients) has been integrated into hospital’s EHR

SCIP-Inf. 1: – Considering performance in SCIP metrics in hospital’s

credentialing process for physicians

SCIP –Card. 2:– Implementation of an EHR integrated “flagging tool” to

improve compliance– Beta blocker use is being flagged, on admission, with

protocol to continue post-op, unless physician over-ruled by exception

Best Practices

SCIP-Inf. 3: – Hospital reports implementing auto-stop alerts for

prophylactic abxs., and integrating it into their hospital comprehensive EHRs

– Hospital has implemented a surgical abx. monitoring program that they call “the Antibiotic Stewardship Program.”

– Process is keyed on an auto-alert type process, using a timing start initiated in hospital E-MAR. Timing process / auto-alert triggers prophylactic abx auto-stop, unless, within 24 hours post; unless over-ridden by the ordering physician.

Best Practices

VTE-1/2:– Using a “rule-out” approach for all admissions– Utilizing their EHR with generated alerts, including

patient risk-related flags, and VTE prophylaxis start/ timing alerts, in time-frame calculated with EHR

– Established the 20th hour as “deadline” to implement VTE intervention with process to auto-start at the 20th hour

Best Practices

VTE-1/2:– Implement steps to educate staff on alerts– Fully implement a “rule-out” approach to VTE

prophylaxis implementation and management for both medical/surgical patients and initiating prophylaxis protocol, unless specifically ordered as contraindication/exception

– Active support of medical staff and nursing services

Teamwork

Focused metric review of performance, barriers, and process improvement opportunities

Discussed metric performance history with cardiology group and provided ongoing performance feedback

Worked closely with nursing leadership and line staff to identify current and potential monitoring/documentation “workarounds” in the hospital’s EHR

Teamwork

Teamed up with nursing education to correct and resolve documentation problems in EHR

Made their medical staff “partners” in the SCIP QI process by providing aggregate, compliance and individual performance reports to staff

Conducted ongoing “concurrent review” to identify potential metric outliers

Promoted hospital-wide recognition of “DVT Awareness month”

Teamwork

Recruited orthopedic surgeon as a physician champion member for the SCIP/HF Project Team

Broke down measures by physician to identify  those that needed reminders and/or official letters

Provided physician report cards to show compliance/performance on pertinent measures

Teamwork

Provided blinded, physician-specific reports at meetings to encourage “friendly competition” with peers

Shared unit and/or team specific data to encourage competition and rewards

Questions?

Visit: www.primaris.org