Surgical Care Improvement Project

QSource Hospital Quality Improvement TeamSpring 2008THA Patient Safety Center Reducing Hospital Acquired Infections Collaborative Regional Networking Workshops Knoxville / Nashville / Memphis

The right carefor every person, every time.

CMS Vision StatementFor the National Healthcare Quality Improvement Program

The Right Care

SafeTimelyEffectiveEfficientEquitablePatient-centered

Institute of Medicine

Every Person, Every Time

Medicare Conditions of Participation (CoP) for HospitalsMedical error includes omissionsPerformance improvement requirements increasedEvidence-based medicine is keyReliability all aspects of care for which the patient is eligible

The Surgical Care Improvement Project

Ongoing Gaps in PerformanceDale W. Bratzler, DO, MPHQIOSC Medical DirectorOklahoma Foundation for Medical Quality

Why focus on surgical qualityPatients who experience a postoperative complication have dramatically increased hospital length of stay, hospital costs, and mortalityOn average, the length of stay for patients who have a postoperative complication is 3 to 11 days longerOdds of dying within 60 days increases 3.4-fold in patients with a complication**Silber JH, et al. Changes in prognosis after the first postoperative complication. Med Care. 2005;43:122-131.

Surgical Care Improvement ProjectHospital Voluntary Self-Reporting, Qtr. 2, 2007Benchmark rates were calculated for all HQA reporting hospitals in the US based on discharges using the Achievable Benchmarks of CareTM methodology (http://main.uab.edu/show.asp?durki=14527).

Surgical Care Improvement ProjectHospital Voluntary Self-Reporting, Qtr. 2, 2007Benchmark rates were calculated for all HQA reporting hospitals in the US based on discharges using the Achievable Benchmarks of CareTM methodology (http://main.uab.edu/show.asp?durki=14527).

Ongoing Gaps in PerformanceTennessee, Qtr. 2, 2007Low- and High- Performers represent the average performance of those hospitals caring for 10% of the Tennessee surgical population.

Ongoing Gaps in PerformanceTennessee, Qtr. 2, 2007Low- and High- Performers represent the average performance of those hospitals caring for 10% of the Tennessee surgical population.

Data Source: QIO Warehouse TN Hospital-Generated Data 2004 Discharges

Chart1

0.570.550.260.47

0.60.570.310.5

0.60.550.280.5

HF Collab

Any Collab

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TN

HF-1 Discharge Instructions

HF-1

HF-1: Discharge Instructions

Q1Q2Q3

HF Collab57%60%60%

Any Collab55%57%55%

Non-Collab26%31%28%

TN47%50%50%

HF-1

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TN

HF-1 Discharge Instructions

HF-2

Q1Q2Q3

HF Collab84%86%89%

Any Collab82%84%86%

Non-Collab84%83%75%

TN82%83%85%

HF-2

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TN

HF-2: LVF Assessment

AMI-5

Q1Q2Q3

HF Collab90%88%92%

Any Collab88%90%93%

Non-Collab89%89%88%

TN88%90%93%

AMI-5

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0000

0000

HF Collab

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TN

AMI-5: Beta Blocker at Discharge

AMI-6

Q1Q2Q3

HF Collab87%88%92%

Any Collab85%86%89%

Non-Collab85%81%78%

TN85%85%86%

AMI-6

0000

0000

0000

HF Collab

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TN

AMI-6: Beta Blocker at Arrival

PNE 5

Q1Q2Q3

PNE Collab48%53%62%

Any Collab49%53%58%

Non-Collab47%48%32%

TN49%52%57%

PNE 5

0000

0000

0000

PNE Collab

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Non-Collab

TN

PNE 5(2): Pneumococcal Vaccination

PNE 6

Q1Q2Q3

PNE Collab65%73%77%

Any Collab63%75%73%

Non-Collab48%57%50%

TN59%70%66%

PNE 6

0000

0000

0000

PNE Collab

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TN

PNE 6(4): Adult Smoking Cessation

SIP 1

Q1Q2Q3

SIP Collab66%85%87%

Any Collab70%81%78%

Non-Collab71%69%85%

TN70%81%78%

SIP 1

0000

0000

0000

SIP Collab

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TN

SIP 1: Prophylactic Antibiotic Received w/in 1 Hour prior to surgical incision

SIP 2

Q1Q2Q3

SIP Collab90%93%93%

Any Collab89%93%92%

Non-Collab81%93%92%

TN89%93%92%

SIP 2

0000

0000

0000

SIP Collab

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Non-Collab

TN

SIP 2: Prophylactic Antibiotic Selection

SIP 3

Q1Q2Q3

SIP Collab51%59%66%

Any Collab55%60%57%

Non-Collab50%50%37%

TN55%60%55%

SIP 3

0000

0000

0000

SIP Collab

Any Collab

Non-Collab

TN

SIP 3: Prophylactic Antibiotic Discontinued w/in 24 Hours after Surgery End Time

Integrating the Johns Hopkins 4Es Model with the PDSA Cycle and the IHI Model for Improvement

Unit-Based, Small-ScaleTests of Change Ideas

Learn how to adapt the change idea to the conditions in your local environmentDocument how much improvement can be expected from the changeMinimize resistance when implementing the change on a wider scale

Monthly Project Reporting Expectations

Team Check-up Tool

Quality Measure Rates

Helpful Interventions

Leadership engagementFront line staff involvementPhysician ChampionsPeer to Peer discussions of the medical evidenceIndividual, comparative data feedbackConcurrent care managementCross-functional multidisciplinary teamsLessons learned from the aviation industry

Peg Game Exercise

The Peg Game

EMBED Pagis.Document

_954620509.tiff

PDSA for the PEG Exercise

Next Steps / Evaluation

Aim Statement - LeadershipTeam FormationEngage and EducateSelect and test change ideasDisplay the Teams story / journey

Next Regional Networking Workshops August 2008

Thank you!

Judy Weddle901-273-2613jweddle@tnqio.sdps.org

Lesley Hays901-273-2616lhays@tnqio.sdps.org

This presentation and related materials were prepared by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department for Health and Human Services. Contents do not necessarily reflect CMS policy.

The session following lunch can be tough, so lets take a little break and play a game. First we will simulate the game and then we will talk about the behind the scenes issues/instructions.Were combining this game with dessert, so grab your candy!This game is probably very familiar to most of you and will bring back childhood memories of eating at Cracker Barrel.Turn to page 245 in Section X for the game board.The object of the game is to leave as few game pieces remaining (goal=1) by moving/jumping, in any direction, the game piece over one piece into an empty or unoccupied space on the game board.Everyone give it a shot. Raise your hand if you had more than 3 pegs remaining (record on flipchart), 3 pegs, 2 pegs, 1 peg. 1 peg=Expert or best practice team - Have them share. Replay.Now that we have great ideas from our experts we can try this again and get much better results.Hearing from the experts was not enough. Lets try the Model for Improvement.-Now, each person or group run PDSA cycle---may be best to pair up--key is have to collect data--show them 2-9, 9-7 a few steps-Record histogram againhave a couple ones-Have 1 read of steps and have rest of group do it--implementation-Do histogram again on flip chart --pretty much everybody at one

KEY POINT- COLLABORATIVES