CCQCreating a Culture of

Quality

How Does DCI Targetat Risk Clinics

Pam HavermannDirector of Quality

Mgt/Education

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Level 3 in Texas

• How could we prevent this from happening in other clinics?

• What were the warning signs we missed?

• What were some of the things that could have been indicators in this clinic that were not related to outcomes?

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Question

Are outcomes the best marker for an at- risk clinic?

– Yes –No

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

• We believe that is too late

• Our goal is to get to the clinic before it affects outcomes

• How do we do that?

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Outcomes

• Hemoglobin 10-12• Hemoglobin <10• Ferritins >= 200• Tsats 30%- 50%• Albumin > 4% • KT/V >= 1.3 • % Treatments with Fistula 2 needles • % Catheters >= 90 days

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Operational

• % Hepatitis B Management on Time• % Leaving Heavy > 1 kg • % Leaving Light > 1 kg• % Early Terminations > 10 minutes• Occurrences or Lack of Occurrences • Missed Treatments • % Hospitalizations • % Hospitalizations where EOC was

recorded in DCI system 3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Operational

• % Treatment flowsheets entered before next treatment

• Care Plans done on schedule • Staff Competencies • Employee Turnover• Monthly Education completion • Use of agency nurses/pcts• Time since last survey

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Soft Indicators

• Patient Satisfaction Surveys- % completed and results

• Change in Leadership • Complaints • “Gut feeling”

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

• Review all areas and decide which clinics to target

• Corporate Nurses/Technicians conduct audit/survey

• Outcome determines level of oversight by corporate office

3/16/2011 A renal community collaboration

CCQCreating a Culture of

Quality

Future plans

• To determine through operational and soft indicators clinics that are at risk before it affects outcomes

3/16/2011 A renal community collaboration