Title: Clinical Improvement Studies
1Clinical Improvement Studies
- QI Showcase
- March 12, 2008
- Fairmont Hot Springs
22007 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
3Peri-Operative Care- Improvements
4Peri-Operative Care- Opportunities
5Alliance Stroke- Improvements
6Alliance Stroke- Improvements
7Alliance 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.
8PIN-Wide Stroke Study
- Re-measuring Jan-Mar 2008
- Data due at the PIN April 2008
- Final reports due out June 2008
9ED Transfer Study
10ED Transfer Study
11ED Transfer Study
12ED Transfer Remodeling
- Trauma study
- Clinical Benchmarking
- CMS Outpatient Measures
- Nov 2008
13Study 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?
14New 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
15Why 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
16Patient 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
17Prevent 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
18Pressure Ulcers- Measures
- Incidence and prevalence
- Risk assessment on admission
- Present on admission
- Use of Braden Scale
- Re-assessment
- Appropriate interventions
19High-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
20High-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
21High-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
22Patient 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
23CIS 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