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Clinical Improvement Studies

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In addition, ongoing public education in early recognition of signs ... Kitty Strowbridge, St Luke Community Hospital. Marsha Vanderhoff, Livingston Healthcare ... – PowerPoint PPT presentation

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Title: Clinical Improvement Studies


1
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

3
Peri-Operative Care- Improvements
4
Peri-Operative Care- Opportunities
5
Alliance Stroke- Improvements
6
Alliance Stroke- Improvements
7
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.
8
PIN-Wide Stroke Study
  • Re-measuring Jan-Mar 2008
  • Data due at the PIN April 2008
  • Final reports due out June 2008

9
ED Transfer Study
10
ED Transfer Study
11
ED Transfer Study
12
ED Transfer Remodeling
  • Trauma study
  • Clinical Benchmarking
  • CMS Outpatient Measures
  • Nov 2008

13
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?

14
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

15
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

16
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
17
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

18
Pressure Ulcers- Measures
  • Incidence and prevalence
  • Risk assessment on admission
  • Present on admission
  • Use of Braden Scale
  • Re-assessment
  • Appropriate interventions

19
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

20
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

21
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

22
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
23
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
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