Great Things are Happening in Virginia Hospitals 2015-2020 Five Years of Shared Learning and Improving Executive Message Colleagues, Great things truly are happening in Virginia hospitals. That simple statement is more than a slogan. It’s a distillation of everything that occurs within the four walls of hospitals around the Commonwealth, as well as outside of hospitals through direct engagement with the communities they serve. Virginia hospitals are leading the way to improve the quality and safety of care for patients. They are at the forefront of advancements in medical research, and in partnering with state officials on efforts to improve public health, address ma- ternal mortality, provide wraparound services to victims of violence in high-need communities, and even in the develop- ment of skilled labor job-training programs. Hospitals are also involved in the response planning and preparation for un- thinkable emergencies, and in the training of future doctors and nurses to meet the growing health care treatment needs of an aging population. Working through the VHHA Board of Directors, Virginia’s hospitals and health systems in 2010 established a shared strategic goal to demonstrate top-tier health care quality and safety performance based on nationally-accepted perfor- mance measures. Since then, improvements have been achieved in several key metrics, including a steady decline in cen- tral-line associated bloodstream infections, a reduction of readmission rates, and improvement in patient satisfaction scores. To facilitate that work, the VHHA Center for Healthcare Excellence was established in 2015 to help foster the coordination of hospital-based improvement efforts. Five years into this journey, considerable progress has been made. For several years running, Virginia has been national- ly ranked as one of the top states on health care quality and patient safety performance in the Leapfrog Group Hospital Safety Grade scores (third overall in the Fall 2019 scores, second overall in the Spring 2019 rankings, and third overall in Fall 2018). Virginia received recognition as one of the most improved states in the 30th Anniversary edition of the America’s Health Rankings annual report issued by the United Health Foundation, rising from 20th among states in 2018 to 15th in the 2019 edition of the report that assesses an array of health metrics to determine rankings. The Commonwealth also earned an “A” grade in the 2019 State-by-State Report Card on Access to Palliative Care in our Nation’s Hospitals from the Center to Advance Palliative Care and the National Palliative Care Research Center. And in the Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, Vir- ginia is among the states ranked as a high-performer on a three-tier measure of states’ preparedness to protect public health during an emergency. In 2018, VHHA earned the HRET HIIN Quality Award presented by the American Hospi- tal Association (AHA) and the Health Research & Education Trust (HRET) in recognition of a state hospital association that demonstrates exemplary dedication and leadership in advancing the quality and safety of health care for patients. And in 2017, Virginia was ranked as a top 10 state for health care safety and quality by the federal government. Our work continues in pursuit of a Virginia health care delivery system that is top-tier in quality, provides exceptional experience and a safe environment for patients, families, and staff, achieves zero harm for patients, incorporates high reliability principles and best-practices in its operations, and promotes accountability. This document highlights some of the great things happening in Virginia hospitals as reflected in key metrics illustrating the progress made as we pursue excellence in health care quality and safety. On behalf of the VHHA Board of Directors, we extend our thanks to the leaders of Virginia’s 110 hospital members and the more than 132,000 health care providers and staff at Virginia hospitals for their ongoing engagement and collabora- tion in this work. It is our honor and privilege to support the work of making Virginia the healthiest state in the nation. Deborah W. Davis Sean T. Connaughton VCU Health Chief of Strategic Initiatives VHHA President and CEO Advisory Council Chair, VHHA Center for Healthcare Excellence Advisory Council Five-Year Quality Trend Report In 2015 the VHHA Board of Directors identified three statewide quality, safety, and service improvement priorities: C. Difficile infections, hospital readmission rates, and patient experience as measured by HCAHPS. During the past five years, metrics in all three priority areas have shown improvement. C. difficile infection rates declined from a standard infection ratio of .965 to .653, moving from a fourth quartile to a top quartile national ranking. Metrics pertaining to four of the condition specific 30-day readmission rates placed Virginia in the fourth quartile nationally as of 2015. All have improved since then, with three registering in the third quartile and one in the second quartile. Patient experience scores as measured by HCAHPS have improved from the third quartile nationally to the second quartile. The VHHA Center for Healthcare Excellence extends its sincere thanks and gratitude to Virginia hospitals for actively engaging in the collabo- rative improvement opportunities facilitated by the Association over the past five years. Those hospital-based efforts, and the positive results they have yielded, are a testament to the power of collaboration. Metric 2015 Rank Q2 2015 Q2 2016 Q2 2017 Q2 2018 Q2 2019 2019 Rank Change CLABSI 23 of 51 .75 .553 .757 .769 .691 17 of 51 CAUTI 27 of 51 1.09 .577 .985 .970 .923 34 of 51 C. Difficile 42 of 51 .965 1.014 .991 .808 .653 4 of 51 EED 10 of 51 3 2 1 1 1 2 of 51 PSI 14 of 51 .77 .861 .993 .971 .957 12 of 51 Readmissions- 46 of 51 17.2 17.1 16 15.7 15.3 20 of 51 AMI Readmissions- 38 of 51 5.3 4.9 4.4 4.1 3.9 26 of 51 HF Readmissions- 46 of 51 17.5 17.8 17.3 16.9 16.6 28 of 51 PN Readmission- 49 of 51 5.3 4.9 4.4 4.1 3.9 26 of 51 HK Mortality- 35 of 51 14.2 14.2 13.4 13.1 12.7 26 of 51 AMI Mortality-HF 28 of 51 11.8 11.9 11.5 11.2 10.9 13 of 51 Mortality-PN 28 of 51 11.6 16.7 16.1 15.8 15.6 30 of 51 Patient 35 of 51 69 70 71 72 72 23 of 51 Experience • CLABSI: central line-associated bloodstream • Readmissions HF: heart failure 30-day readmission infection [ICU and select wards] (lower is better) rate (lower is better) • CAUTI: catheter-associated urinary track infections • Readmission HK: elective total hip/knee surgery 30- [ICU and select wards] (lower is better) day readmission rate (lower is better) • C. Difficile: Clostridium Difficile (lower is better) • Mortality AMI: acute myocardial infarction 30-day mortality rate (lower is better) • EED: elective delivery prior to 39 completed weeks of gestation (lower is better) • Mortality HF: heart failure 30-day mortality rate (lower is better) • PSI 90: patient safety indicator 90, 2015-2017; complication/patient safety for selected eight • Mortality PN: pneumonia 30-day mortality rate indicators, 2018-2019; patient safety and adverse (lower is better) events, composite of 10 (lower is better) • Patient Experience: HCAHPS overall rating (higher • Readmission AMI: acute myocardial infarction (AMI) is better) 30-day readmission rate (lower is better) Member Organizations Augusta Health EncompassHealth Riverside Shore Memorial Hospital Encompass Health Rehabilitation Riverside Tappahannock Hospital Ballad Health Hospital of Fredericksburg Riverside Walter Reed Hospital Dickenson Community Hospital Encompass Health Rehabilitation Johnston Memorial Hospital Hospital of Northern Virginia Sentara Healthcare Lonesome Pine Hospital Encompass Health Rehabilitation Sentara CarePlex Hospital Mountain View Regional Hospital Hospital of Petersburg Sentara Halifax Regional Hospital Norton Community Hospital Encompass Health Rehabilitation Sentara Heart Hospital Russell County Hospital Hospital of Richmond Sentara Leigh Hospital Smyth County Community Hospital The Rehabilitation Hospital of Sentara Martha Jefferson Hospital Southwest Virginia Sentara Norfolk General Hospital Bath Community Hospital Sentara Northern Virginia Medical HCA Virginia Center Bon Secours Health System CJW Medical Center Sentara Obici Hospital Bon Secours DePaul Medical Center Dominion Hospital Sentara Princess Anne Hospital Bon Secours Mary Immaculate Henrico Doctors’ Hospital Sentara RMH Medical Center Hospital John Randolph Medical Center Sentara Virginia Beach General Bon Secours Maryview LewisGale Hospital Alleghany Hospital Medical Center LewisGale Hospital Montgomery Sentara Williamsburg Regional Bon Secours Memorial LewisGale Hospital Pulaski Medical Center Regional Medical Center LewisGale Medical Center Bon Secours Rappahannock Reston Hospital Center Sheltering Arms General Hospital Spotsylvania Regional Sheltering Arms Physical Bon Secours Richmond Medical Center Rehabilitation Hospital - Memorial Community Hospital StoneSprings Hospital Center Regional Campus Bon Secours St. Francis Sheltering Arms Physical Medical Center Inova Health System Rehabilitation Hospital - St. Francis Bon Secours St. Mary’s Hospital Inova Alexandria Hospital Campus Southampton Memorial Hospital Inova Fair Oaks Hospital Southern Virginia Regional Inova Fairfax Hospital Universal Health Services Medical Center Inova Loudoun Hospital Cumberland Hospital for Children Southside Regional Medical Center Inova Mount Vernon Hospital