OHA exists to collaborate with member hospitals Spring 2017 and health systems to ensure a healthy Ohio. Hospital Insights HOSPITAL IMPROVEMENT COLLABORATIONS

OVERVIEW

OHA Quality Programs Save Lives, Costs 5 YEAR FOCUS AREAS TO REDUCE HEALTH with Focus on Prevention, Care Transition CARE ACQUIRED The Ohio Hospital Association's quality programs team collaborated with CONDITIONS nearly 100 Ohio hospitals plus community partners from 2012 to 2016 • Acute kidney injury improving hospital health care outcomes for patients and saving an estimated • Adverse drug events— $8.5 billion (based on Centers for Medicare & Medicaid 2016 calculator) in opioids, anticoagulants, and costs statewide by preventing more than 1.9 million health care acquired hypoglycemic agent conditions. • Central line-associated blood stream infections With support of federal contracts, OHA's encounters. Those encounters comprise 24.9 health care improvement campaign focused million outpatient, 1.5 million inpatient and • Catheter-associated urinary tract on infection prevention and transitions of 6 million treated and released from infections patient care projects. Participating hospitals emergency departments. • Clostridium difficile (C.diff) included small, rural and critical access Patients traveled to Ohio for health care in • Culture of safety—integration of hospitals, urban and large teaching 2015 from all 50 states, the District of patient and worker safety institutions and one long-term acute care Columbia, Puerto Rico, the U.S. Virgin hospital. Islands and numerous countries abroad. • Injury from falls and immobility As the nation’s first state hospital Today, through OHA’s Institute for Health • Pressure ulcers association, OHA was one of the first to focus Innovation, the association leverages our • Obstetric trauma member hospitals, staff and resources on long-standing legacy of quality improvement improving health care quality. In 2015, Ohio strategies through statewide and regional • Obstetrical adverse events— hospitals had 32.4 million patient hospital collaboratives. early elective deliveries • Sepsis and septic shock • Surgical site infections Leading Data Analytics, Educational • Venous thromboembolism Programming for Quality Improvement • Ventilator-associated events— infection-related ventilator- Using a robust data services and quality implemented evidence-based educational associated complication and improvement strategies, OHA provided seminars for nurses, physicians and hospital ventilator-associated condition intensive technical assistance and various administrators. training events and learning sessions for Education programs were delivered in The program targeted reductions of 40% participating hospitals, focusing on the top face-to-face meetings, conference calls, in health care acquired conditions and areas of opportunity for each hospital. OHA 20% in readmissions. Continued Page 2 "

Quality Initiatives Timeline

Partnership for Patients Hospital Leading Edge Advanced Hospital Engagement Hospital Improvement and Engagement Network (68 hospitals) Practice Topics (27 hospitals) Network 2.0 (86 hospitals) Innovation Network (105 hospitals)

2012 2013 2014 2015 2016 2017 2018 2019 (Optional)

Hospital Insights | 1 OVERVIEW OHA Quality Programs Save Lives, Costs with Focus on Prevention, Care Transition (CONTINUED) systems to effectively identify appropriate dimensions of pre-op scrubs, AMERICAN HOSPITAL ASSOCIATION and analyze key quality data participating hospitals reduced surgical metrics to provide benchmarks site infections for knee, colon and hip Dick Davidson for progress. procedures by 51 percent. Hospitals that adjusted their pre-op and PATIENTS BENEFIT post-op cleansing with CHG-chlorhexidine FROM IMPROVEMENTS gluconate wipes, conducted more hand Quality During the campaign, hygiene and frequent glove changes, and Milestone Award participating hospitals altered the surgical suite traffic patterns, significantly reduced probable contributing to the reduction of these FOR ALLIED ASSOCIATION LEADERSHIP ventilator-associated incidents. 2016 HONORABLE MENTION pneumonia incidents by 68 A reduction of pressure ulcers by 59 percent at their institutions by percent was achieved through the implanting the OHA-developed enhancement of hospital wound teams and patient-centered infection care designation of unit skin care champions. bundle. Hospitals provided new patient beds with The bundle included oral care pressure-reducing mattresses, consulted that was modified to be with their respiratory therapy teams for ear conducted every two hours, and nose ulcers, implemented an improved 101 Ohio hospitals have participated in the hand hygiene improved maintenance of a skin assessment process upon patient program since August 2010. During a quality improvement initiative from 2012 to 2014, hand hygiene compliance almost doubled, resulting in a closed circuit system, better admission and deployed a new shift rotation. % decrease of hospital- extubation techniques (removal Participating hospitals were able to 48 acquired infections of the endotracheal tube), reduce falls by 43 percent. Fall intervention at participating hospitals. incorporating a physician is a team process and appropriate

82 hospitals participated to reduce Early Elective Deliveries, intensivist on the care team to communication of fall risk was necessary including ‘39+ Weeks is Good4Baby’, resulting in a follow ventilator patients, daily with transition from unit to unit or between % decrease in Early 35 Elective Deliveries rounding, and using a c-pap and facilities. Results showed that falls were through implementing policies and practices to promote the bi-pap whenever feasible. preventable with increased rounding, benefits of waiting until pregnancies are 39 weeks. By reviewing and modifying patient and family education and improving surgical bundles, deploying response time of hospital staff to address modified surgical preparation patients’ needs. solutions and ensuring Continued Page 3 " Continued from Page 1 " webinars and online, with materials developed for providers and patients. New improvement occurs through the sharing of effective practices and lessons learned promoting safety, reducing infections, improving health care quality and avoiding preventable readmissions. Participating hospitals achieved improvement by focusing on health literacy of patients at discharge and improvement of patient education materials. Hospitals that engaged community partners to provide patient resources and services reduced readmissions. Hospitals’ engagement with pharmacists also improved readmission rates through medication instruction and reconciliation for patients. OHA tracks, monitors and analyzes hospital data through our statewide clinical database that collects all 32.4 million annual hospital encounters. By compiling hospital specific, real-time information, OHA is able to work directly with hospitals and health

Hospital Insights | 2 OVERVIEW OHA Quality Programs Reduce EED, Readmissions and Improve Worker Safety (CONTINUED) Continued from Page 2 " Hospitals engaged community partners to INTEGRATING WORKER, provide patient resources and services to PATIENT SAFETY prevent readmissions. Hospitals’ OHA is leading a special project to improve engagement with pharmacists also STEPS TO SUCCESS safety culture, specifically focusing on improved rates through medication infant mortality in ohio reducing OHIO’S Infant Mortality is defined as the death of a baby before their first Ohio’s National Rankings integrating worker and patient safety. This instruction and reconciliation for patients. birthday. The infant mortality rate (IMR) is the number of babies who died in the first year of life, per 1,000 live births. This rate is INFANT MORTALITY RATE considered an important indicator of the overall health of a society. 2012 2013 project involved member hospitals that In the readmission health literacy Most infant deaths occur when babies are born too small and too early (preterm births are those before 37 weeks gestation), born with a serious birth defect, victims of Sudden Infant Death 46 45 utilized worker compensation claims data to assessment project, hospitals that were able Syndrome (SIDS), Sudden Unexpected Infant Death Syndrome (SUIDS), affected by maternal complications of pregnancy, or victims of injuries (e.g. suffocation). These five leading causes Ohio’s overall infant mortality analyze four major focus areas related to to move their assessment tool to the of infant mortality together accounted for 77 percent of all infant rate has improved in the first deaths in Ohio in 2012. Some risk factors, such as smoking, may year of the state’s initiatives. lead to more than one of the conditions in the list above. It is estimated that 23-34 percent of SIDS and 5-7 percent of preterm- worker safety: safety patient handling, electronic health records and add a field for related deaths are attributable to prenatal smoking in the nation. 2012 2013

There are also many non-medical contributors to the death of babies, including poverty, lack of education, under-resourced 50 45 injuries from lifting and moving a patient, the “teach back” option for discharge neighborhoods, poor nutrition and race. Ohio hospitals are ideal partners to help address the state’s infant mortality rate and engage patients and the community with effective clinical and Ohio’s African American infant being struck by or other injuries caused by instruction in the EHR showed improved professional resources. mortality rate has improved as well. patients, slips, trips, falls, and needle sticks compliance rates and enhanced Ryan Everett, MPH contact Director, Population Health Ohio Hospital Association and sharps incidents. Patient handling denominator abstraction for audits. [email protected] 614.221.7614 www.ohiohospitals.org/infantmortality improvement included a 20 percent Reducing preventable readmissions reduction in incidence and claims. A 40 allows patients to recover and return to their Hospitals’ improved results by assembling percent increase in reporting of aggressive families and jobs more quickly. Reducing staff after incidents to determine cause and patient incidences was achieved. readmissions is a complex undertaking improvement, if necessary. because not all readmissions can or should Participating hospitals reduced sepsis at READMISSIONS be prevented; indeed, some are planned as their institutions by implementing early Participating hospitals decreased part of sound clinical care. warning system fields and processes, sepsis preventable readmissions by focusing on order sets for different departments and health literacy for patients at discharge and reports for ease of auditing were necessary through patient education materials. for complete implementation and evaluation From 2015 to 2016 OHA worked with 68 of the sepsis program. There was a 32 hospitals to achieve a 33 percent reduction percent reduction reported in sepsis in 30-day all-cause, all-payer readmissions. mortality among participating hospitals between 2013 and 2016.

INFANT MORTALITY—ELIMINATING EARLY ELECTIVE DELIVERIES An early elective delivery (EED) is defined as Hospital Readmissions Decline in Ohio scheduled vaginal delivery or cesarean section between 37 and 39 completed weeks of gestation. Reducing the rate of early elective deliveries is one of the OHA Institute’s many Wednesday, Sept. 21, 2016 efforts to reduce infant mortality. The hospital-led 39 Weeks is Good4Baby "The rate of 30-day hospital readmissions decreased 10.6 percent from 2010 to 2015 initiative focuses on adopting scheduling in Ohio. Ohio tied with New York for the sixth-fastest decline in readmissions and practices that align with eliminating EEDs; is one of only 11 states that saw readmission decline by more than 10 percent over promoting physician accountability, the past five years." transparency and discussion; and providing patient and community education. Hospitals receive access to online resources, awareness tools and public recognition as a participating hospital. Hospitals agree to: Friday, Sept. 23, 2016 • Designate a champion and compile baseline data "The rate of hospital readmissions in Ohio fell dramatically over the past five years, • Standardize the process for approving corresponding with Affordable Care Act initiatives designed to reduce avoidable early deliveries—including hospital stays, new federal data shows. From 2010 to 2015, the 30-day hospital consideration of “Hard Stop” policy readmission rate tracked by Medicare fell by 10.6 percent in Ohio, which tied with • Promote transparency and accountability New York for sixth-fastest decline in readmissions and is one of only 11 states that • Educate and engage staff and physicians saw readmission decline by more than 10 percent over the past five years, • Provide consumer and community according to figures from the Centers for Medicare & Medicaid Services." education

Hospital Insights | 3 OVERVIEW Participating Hospitals of OHA Hospital Engagement Network  Central Berger Health System Diley Ridge Medical Center Fairfield Medical Center Fayette County Memorial Hospital Knox Community Hospital Licking Memorial Hospital Memorial Health Mount Carmel East Mount Carmel New Albany Mount Carmel St. Ann’s Mount Carmel West OhioHealth Doctors Hospital OhioHealth Dublin Methodist Hospital OhioHealth Grady Memorial Hospital OhioHealth Grant Medical Center OhioHealth Riverside Methodist Hospital The Ohio State University James Cancer Hospital

 Northeast Acuity Specialty Hospital—Ohio Valley Affinity Medical Center Ashtabula County Medical Center Aultman Hospital Aultman Orrville Hospital Cleveland Clinic Akron General Lodi Hospital Cleveland Clinic Akron General Medical Center Cleveland Clinic Euclid Hospital Cleveland Clinic Fairview Hospital Cleveland Clinic Hillcrest Hospital Cleveland Clinic Lutheran Hospital Cleveland Clinic Main Campus Cleveland Clinic Marymount Hospital Cleveland Clinic Medina Hospital Cleveland Clinic South Pointe Hospital East Liverpool City Hospital Lake Health Tripoint Medical Center Firelands Regional Medical Center Holzer Gallipolis Lake Health West Medical Center Fisher-Titus Medical Center Holzer Medical Center—Jackson Mercy Hospital of Defiance Galion Community Hospital Marietta Memorial Hospital Mercy Medical Center Grand Lake Health System—Joint Township OhioHealth O’Bleness Hospital Mercy St. Anne Hospital District Memorial Hospital Selby General Hospital Mercy St. Charles Hospital Mary Rutan Hospital Mercy St. Rita's Medical Center Mercer Health Mercy St. Vincent Medical Center  Southwest Mercy Health Allen Mercy Tiffin Hospital Mercy Regional Medical Center Adena Greenfield Medical Center Mercy Willard Hospital Mercy St. Elizabeth Boardman Hospital Adena Pike Medical Center MetroHealth System Mercy St. Elizabeth Youngstown Adena Regional Medical Center OhioHealth Mansfield Hospital Mercy St. Joseph Warren Hospital CMH Regional Health System—Clinton OhioHealth Shelby Hospital Mercy Medical Center Memorial Hospital Pomerene Hospital OhioHealth Hardin Memorial Hospital King’s Daughters Medical Center Ohio Salem Regional Medical Center OhioHealth Marion General Hospital Mercy Health Anderson Southwest General Health Center ProMedica Bay Park Hospital Mercy Health Clermont St. Vincent Charity Medical Center ProMedica Defiance Regional Hospital Mercy Health Fairfield Summa Akron City Hospital ProMedica Flower Hospital Mercy Health Jewish Hospital Summa Barberton Hospital ProMedica Fostoria Community Hospital Mercy Memorial Hospital Trumbull Memorial Hospital ProMedica Lima Memorial Health System Mercy Springfield Regional Medical Center Union Hospital ProMedica Memorial Hospital Mercy West Hospital University Hospitals Elyria Medical Center ProMedica Toledo Children’s Hospital Mercy Lourdes Hospital (KY) University Hospitals Samaritan Medical Center ProMedica Toledo Hospital Premier Health Atrium Medical Center Western Reserve Hospital St. Luke’s Hospital Premier Health Good Samaritan Hospital The Bellevue Hospital Premier Health Miami Valley Hospital  Northwest ValleyCare Health System of Ohio - Northside Premier Health Miami Valley South Medical Center Premier Health Upper Valley Medical Center Blanchard Valley Hospital Van Wert County Hospital Southern Ohio Medical Center Bluffton Hospital Wood County Hospital The Christ Hospital Bucyrus Community Hospital The Medical Center at Elizabeth Place Community Hospitals & Wellness Centers— TriHealth McCullough-Hyde Memorial Hospital Bryan Hospital  Southeast UC Health West Chester Hospital Community Hospitals & Wellness Centers— Belmont Community Hospital Wayne HealthCare Montpelier Coshocton Regional Medical Center Wilson Health Community Memorial Hospital East Ohio Regional Hospital

Hospital Insights | 4 NEXT STEPS OHA, Members Committed To Collaborating For A Healthy Ohio

Moving forward, OHA is committed to the Services. The components of OHA’s network are strategic priority of patient safety and Under this HIIN initiative, OHA invited all comprised of developing data sharing quality, and to leading innovative and member hospitals and health systems to join networks, developing mechanisms to creative strategies to deliver the best patient the new collaborative focused on the support peer-to-peer training among experience for those treated in Ohio coordination of improving health care hospitals, conducting conference calls, hospitals. OHA’s quality team will continue quality and patient safety. OHA and webinars and site visits to participating to work with hospitals, health care participating hospitals will further their hospitals. organizations and other partners to commitment to fostering a culture of safety Through 2019, the OHA HIIN will work to understand and deploy game changing and improving health care quality as part of achieve a 20 percent decrease in overall techniques and technology to assure a a continuum of care. patient harm and a 12 percent reduction in vibrant, sustainable health care system and Additionally, OHA will engage the broader 30-day hospital readmissions as a ensure a healthy Ohio. health care community to develop population-based measure (readmissions OHA is leading a new quality improvement appropriate strategies that are well-tested, per 1,000 people) from the 2014 baseline. network for Ohio hospitals and health evidence-based, and measured best systems through a new 2-year (with an practices. OHA also provides technical optional third year) contract—Hospital assistance to participant hospitals to ensure Improvement Innovation Network (HIIN)— that methods proposed to improve health from the Centers for Medicare & Medicaid care quality are accurately implemented.

2017 GOALS OHA HOSPITAL IMPROVEMENT INNOVATION NETWORK 7% 10% 11% 12% 15% REDUCTION REDUCTION REDUCTION REDUCTION REDUCTION

Preventable Adverse drug events Sepsis and Pressure ulcers Catheter association readmissions septic shock urinary tract Central infections line-associated bloodstream Venous infections thromboembolism

Clostridium difficile

Falls

Iatrogenic delirium

Surgical site infections

Ventilator-associated events

Hospital Insights | 5 OHA Collaborates with Quality Initiatives for a Healthy Ohio

OHA’s Board of Trustees declared patient safety "The ability to have an outside observer who can objectively, without bias, view the hand and quality one of the association’s three hygiene practices in our facility has led us to focus on continuing improvement to strategic initiatives. The Board’s Clinical Advisory become a leader in patient safety." Committee has developed a multi-faceted set of —Shirley Floyd, Mount Carmel St. Ann's Hospital initiatives to impact change at the hospital level for the state’s most pressing issues in addition to the work carried out by the hospital engagement "In our continued efforts to eliminate patient harm through proper hand hygiene, programs. Memorial Health has found the OHA and its hand hygiene compliance program a valuable partner." —Victor Trianfo, DO, Memorial Health System

Formed in 2015, the OHA Institute for Health Innovation combined the work of long-standing efforts of the Research and Educational OHA launched the Good4Baby initiative in April Foundation and the Foundation for Healthy 2014 to impact change at the hospital level and to Communities to focus the efforts and resources of support member hospitals working in their local OHA to: communities to address Ohio’s infant mortality a. Accelerating Health Care Quality: Ohio crisis. hospitals and health systems establish and The key initiatives deployed are safe sleep sustain a culture of safety and unrelenting education, elimination of early elective deliveries quality. OHA is taking the lead to decrease the number of and promotion of breastfeeding. Eighty-five sepsis deaths in Ohio by 30 percent by the end of percent of Ohio’s maternity are hospitals b. Integrating Transition of Patient Care: 2018 by increasing early recognition of the signs of participating in at least one of the initiatives. Ohio hospitals will collaborate with other sepsis and early intervention. care providers to deliver integrated, Sepsis is the most expensive condition to treat patient-centric care. in the entire U.S. health care system accounting for $24 billion in annual costs, or 6.2 percent of all hospital costs. Through the first 16 months of the c. Advancing Community Health: Ohio program, 123 hospitals have joined the initiative OHA partnered with Battelle to launch WayFinder, hospitals lead efforts to improve the health and achieve an 11 percent statewide reduction in of their communities. an advanced analytics tool that helps hospitals sepsis mortality, saving 1,313 lives. identify preventable adverse events and readmissions. Through predictive modeling, WayFinder software allows hospitals to evaluate their performance on the Agency for Healthcare Research and Quality Patient Safety and Quality Indicator scores up to 21 months sooner than previously available. OHA’s hand hygiene initiative features an iPad The Ohio Patient Safety Institute, founded tool designed by OHA staff to allow for same-day by OHA, the Ohio State Medical Association and access to hospital compliance data. Data are the Ohio Osteopathic Association, is a leader in unit- and provider-specific, allowing for developing and transforming health care into a identification of areas for focus and improvement. reliable, safe delivery system. OPSI was This product is very successful and has been designated by the Agency for Healthcare implemented with OHA’s quality program efforts Research and Quality as a Patient Safety to improve health care quality. Organization in February 2009.

CONTACT Amy Andres James Guliano, MSN, RN-BC, FACHE Rosalie Weakland, MSN, RN, CPHQ, FACHE Senior Vice President, Quality and Data Vice President, Quality Programs Senior Director, Quality Programs Ohio Hospital Association Ohio Hospital Association Ohio Hospital Association [email protected] [email protected] [email protected]

155 E. Broad St., Suite 301 • Columbus, OH 43215-3640 • t 614-221-7614 • f 614-221-4771

ohiohospitals.org : /helpingohiohospitals : @ohiohospitals

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