Clinical Improvement Studies

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Clinical Improvement Studies

• QI Showcase
• March 12, 2008
• Fairmont Hot Springs

2
2007 Studies

• Peri-Operative Care closed
• PIN-Alliance Stroke Project closed
• Continue to support data submission to State
• PIN-wide Stroke Project re-measuring
• ED Transfer re-modeling

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Peri-Operative Care- Improvements
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Peri-Operative Care- Opportunities
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Alliance Stroke- Improvements
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Alliance Stroke- Improvements
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Alliance Stroke- Opportunities
In addition, ongoing public education in early
recognition of signs symptoms of stroke and
rapid transport to the ED continues to be a
significant community opportunity to improve
outcomes.
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PIN-Wide Stroke Study

• Re-measuring Jan-Mar 2008
• Data due at the PIN April 2008
• Final reports due out June 2008

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ED Transfer Study
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ED Transfer Study
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ED Transfer Study
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ED Transfer Remodeling

• Trauma study
• Clinical Benchmarking
• CMS Outpatient Measures
• Nov 2008

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Study Development for 2008

• CIS Development Committee
• Began meeting Sept 2007
• Scoring matrix
• Recommendations to CI Panel Nov 2007
• Clinical Improvement Panel
• Study priorities for 2008
• Are admissions related to long-term diabetes
  complications a problem in CAHs, either as
  primary diagnosis or a co-morbid condition?

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New for 2008

• Patient Safety
• Prevent pressure sores
• Prevent harm from high-alert medications
• Choose your focus
• Launching March 2008
• Trauma
• Performance improvement requirements for State
  Trauma Designation
• Linda Matranga and Dr. Dan Downey
• In collaboration with State Trauma Advisory
  Council
• Launching Sept 2008

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Why Patient Safety?

• To Err is Human, IOM 1999
• Crossing the Quality Chasm, IOM 2003
• National Patient Safety Goals for CAHs
• IHI 5 Million Lives Campaign
• Low-volume facility participation
• Medical Staff buy-in

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Patient Safety Project 2008

• April 30 Q1 08 Baseline Data Collection
• June 30 Baseline reports out
• July-Dec Performance Improvement
• 1Q 2009 Re-measurement

Same timeline for both pressure ulcers and
high-alert medications
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Prevent Pressure Ulcers

• Performance measures adapted from IHI
• Include acute, intensive care, swing bed patient
  and obs greater than 24 hrs admissions
• Exclude all cases with a length of stay less than
  24 hours (ie, exclude ED, SDS, obs less than 24
  hrs) also exclude newborns and hospice patients.
• Tool available in paper, excel, and hopefully,
  web-based data entry

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Pressure Ulcers- Measures

• Incidence and prevalence
• Risk assessment on admission
• Present on admission
• Use of Braden Scale
• Re-assessment
• Appropriate interventions

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High-Alert Medications

• Performance measures adapted from IHI
• Include acute, intensive care, newborns, hospice
  swing bed and obs greater than 24 hrs patient
  admissions
• Exclude all cases with a length of stay less than
  24 hours (ie, exclude ED, SDS, obs less than 24
  hrs patients)
• Tool available in paper, excel, and hopefully,
  web-based data entry

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High-Alert Medications

• 5 Medications under study
• Coumadin (warfarin)
• Heparin (not low-molecular weight heparin)
• Insulin (subcutaneous or IV only)
• Narcotics
• Sedatives (exclude versed in CS procedures)
• Choose 2 of the 5, or more, if you want to
  participate in this focus

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High-Alert Meds- Measures

• Has a protocol for using this med been adopted by
  the organizations med staff?
• Definition of protocol facility- specific
• If so, is it implemented?
• What is the rate of adverse patient events
  associated with use of the medication?
• Are adverse patient events recognized and
  reported as adverse drug events (ADEs)?
• Definition of ADE facility-specific

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Patient Safety- Abstracting

• Maximum of 10 cases per month
• All cases if less than 10 qualifying admissions
• Note that if patient is admitted to acute, then
  to swing, that counts as 2 admissions
• If admitted to IC, then acute, then swing, that
  counts as 3 admissions
• If more than 10 admissions a month, do a random
  sample- even distribution across days shifts
• Abstract Jan, Feb and March 2008 cases

Same process for both pressure ulcers and
high-alert medications
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CIS Update

• Questions?
• Practice Abstracting
• Special thanks to
• Jim and Janine Clavadetscher, Madison Valley
• Chris Cockrell, Clark Fork Valley Hospital
• Linda Matranga, Pioneer Medical Center
• Alida Merritt, Marcus Daly Memorial Hospital
• Kitty Strowbridge, St Luke Community Hospital
• Marsha Vanderhoff, Livingston Healthcare