Utilizing the Patient Safety Indicators for Improvement

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Utilizing the Patient Safety Indicators for
Improvement

• Anita Gottlieb, MA, APN, CPHQ
• St. Josephs Mercy Health System
• Hot Springs, Arkansas

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• Great things are not done by impulse, but by a
  series of small things brought together

Vincent Van Gogh
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The process Beginning Steps

• January 2005 began reviewing PSI indicators using
  an interdisciplinary team
• Leadership focused on data
• -Quality Committee of the Board, Hospital
  Board and System Board
• Focused on areas where we exceeded the AHRQ
  population rate as areas for improvement

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PSI Data January 2005
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PSI 03 Decubitus Ulcer
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PSI 03 Decubitus Ulcer

• Reviewed all cases listed in PSI for Decubitius
  Ulcer and found that present on admissions were
  not excluded especially for nursing home patients
• Even with exclusion of present on admission we
  still frequently exceeded the AHRQ rate
• Improvement Plan
• - Six Sigma Project
• - Clinical Skin Team

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Lowdown on Skin

• Projects purpose Prevent Nosocomial Decubitus
  Ulcers
• Nosocomial Decubitus Ulcers patients have a
  longer length of stay than those patients that do
  not acquire a Decubitus Ulcer while hospitalized
• Length of Stay was the common Metric
• Medicares Geometric Length of Stay for each DRG
  was the standard that we used to compare both the
  Ulcer Group and the Non-Ulcer Group

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Low Down on Skin Six Sigma Project

• Xs causing most of our variation
• Daily Performance of Braden Scale
• Pressure Ulcer Risk Level at Admission

Graphical Analysis of Xs
Means appear in Red Medians appear in Blue
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Before After Pilot Comparison
By using the Braden Scale, we compared the
Gold Standard auditors scores to how the RNs
rated the Patients. We noted a significant
improvement with the changes we implemented.

29 Improvement in Accuracy of the Braden Scale
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Improvement strategy
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What are the Financial Results?

• There cost reduction after the Six Sigma project
  and it was directly associated with the length of
  stay.
• The reductions relates to both direct cost and
  supplies.

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Prevalence
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PSI 11 Post Operative Respiratory Failure
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PSI 11 Post Operative Respiratory Failure

• Reviewed all cases listed in PSI for Respiratory
  Failure
• Definition of respiratory varied per physician
• Coders were given exclusion PSI criteria and
  implemented use of documents Review Specialist
  for querying the physicians
• Education provided to physicians regarding
  definitions of Respiratory Failure

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PSI-13Postop Sepsis
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PSI-13Postop Sepsis

• Reviewed all cases and diagnosis for sepsis were
  not meeting the Surviving Sepsis Campaign
  definition and guidelines
• - Our facilities rate for Sepsis over all was
  greater than other hospitals in our System
• - Determined some of Sepsis cases were being
  admitted to the acute units not ICU
• Previous Sepsis Six Sigma Project on Sepsis had
  been focused on Length of Stay

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Hot Springs Six Sigma Sepsis LOS

• Solutions
• Standardized processes for referral and
  evaluation for transfer to SNF/LTAC/Hospice
• Implemented providing antibiotics within three
  hours
• Removed barrier to tubing blood cultures and
  implemented tracking of times
• Impact
• Reduced LOS by .92 days
• Improved time for blood cultures to lab by 126
  minutes
• Potential financial benefit X

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PSI Data January2009/ 2005
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Lessons Learned

• Work on Present on Admission prior to October
  2008 was impactful
• Six Sigma tools have impacted positively on cost
  savings and quality of care
• Must take small steps it will take time and
  must continue monitoring to sustain

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Questions

• Ones destination is never a place but rather a
  new way of looking at things.
• Henry Miller