Hospital Insights HOSPITAL IMPROVEMENT COLLABORATIONS
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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.