Volume II • Summer 2014
INSIDE
PAGE 3 Methodist Medical Center puts whole heart into AMI initiative
Are you on board for Premier’s PAGE 4 Sprinting to the hip and knee finish line
Performance Improvement 2004? T
he list of hospitals enrolled in Premier’s Performance Improvement 2004 campaign is growing steadily. If you haven’t signed up yet, please don’t delay. Don’t miss your opportunity to take advantage of our shared resources and expertise to help your hospital make significant clinical improvements by June 30, 2004.
PAGE 6 St. Luke’s pneumonia team passes Premier top quartile target
MORE INFORMATION Program summary . . . . . . . 2 Participating hospitals . . . . 7
It’s easy to take part in PI 2004. Simply contact your RMVP, then select one to three clinical focus areas (see page 2 for the program summary and clinical areas). You’ll set cost and quality
improvement targets in each area, and the work you do can become part of your performance improvement plan for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Premier’s board of directors has adopted a strategic priority – to align and adapt resources to support improved core clinical processes, leading to breakthroughs in quality, cost, and safety. We share the responsibility and accountability to make that priority a reality. Let’s get started.
per-fi-ci-o to achieve, perfect, or accomplish
Performance Improvement 2004:
Program summary Goals • June 30, 2002: 250 hospitals have agreed to participate, selected one to three clinical focus areas. • August 30, 2002: Hospitals set cost and quality improvement targets for each focus area. • June 30, 2003: 50 percent of those participating have met their targets. • June 30, 2004: 80 percent have met their goals. Hospital agrees to: • Participate in one to three clinical focus areas and integrate those targets into your JCAHO performance improvement plan. • Set specific improvement targets, including the quality and cost indicators that Premier monitors. • Involve Premier staff, as appropriate, in your performance improvement process for those clinical focus areas. • Submit data to Perspective™ database on a scheduled basis. • Attend regional performance improvement meetings.
Premier agrees to: • Make resources available to the appropriate performance improvement teams. • Provide recognized and regular comparative data and other proven metrics (JCAHO, the Leapfrog Group, etc.). • Facilitate networking. • Provide best practices and direction to help facilitate plans. • Provide regional performance improvement meetings. • Share accountability for cost and quality improvement targets. Next steps: • Obtain other information and resources the hospital needs to evaluate this goal. • Get executive team approval to participate. • Select one to three clinical focus areas in which to collaborate. • Identify performance improvement champion(s) for each clinical focus area. • Complete sign-up process with RMVP by June 30, 2002. • Set improvement targets for each clinical focus area by August 30, 2002. • Implement ongoing collaborative efforts with performance improvement team(s).
Clinical focus areas Focus area
Cost indicator
Quality indicator
Hip and knee replacement
Inflation and severity-adjusted total cost/case
Complication rate
CABG (coronary artery bypass graft)
Inflation and severity-adjusted total cost/case
Risk-adjusted mortality rate
Ischemic stroke
Inflation and severity-adjusted total cost/case
Risk-adjusted mortality rate
CHF (congestive heart failure)
Inflation and severity-adjusted total cost/case
30-day readmission rate
AMI (acute myocardial infarction) with non-surgical reperfusion
Inflation and severity-adjusted total cost/case
Risk-adjusted mortality rate
CAP (community-acquired pneumonia)
Inflation and severity-adjusted total cost/case
30-day readmission rate
Adult ICU
Inflation and severity-adjusted ICU cost/case
Severity-adjusted average days on mechanical ventilation
Acute pediatric respiratory conditions
Inflation and severity-adjusted total cost/case
30-day readmission rate
Mental health (psychoses)
Inflation and severity-adjusted total cost/case
30-day readmission rate
Pain management
Inflation and severity-adjusted total cost/case
Percentage of four-hour intervals with a pain score < 3
Adverse drug event (ADE) reduction
Inflation-adjusted cost/case for defined subset of patient population with high rates of ADE (APR-DRGs)
Reduction of ADE rate among defined subset of patient population with high rates of ADE (APR-DRGs)
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“I know I can always reach back and touch Premier for information.” Pat Johnson, Manager of Cardiology Services Methodist Medical Center
missing some of the more current practices," Johnson explained. "Our goal was to capture as much information in one place as possible." Another vital step was staff training on proper patient education, including a video produced by the nurse manager of the cardiac care unit, the cardiac rehabilitation supervisor, and the clinical coordinator of the emergency department. Next comes a video for patients.
Methodist Medical Center puts whole heart into AMI initiative
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n April 2001, clinicians at Methodist Medical Center (Dallas, TX) were concerned about the treatment that heart attack patients received in their facility. Their concerns included response time in the cardiac catheterization lab and the time it took for patients to receive thrombolytics ("clot buster" drugs).
• The average smoking cessation rate rose from 50 to 89 percent. • Door to EKG time decreased from 11 to 9.5 minutes. • The use of ACE inhibitors increased from 73 to 91 percent. • Current administration of aspirin stands at 96 percent.
Those issues prompted Methodist Medical Center to enroll in Premier’s Clinical Performance Initiative (CPI) in acute myocardial infarction. At the initiative’s final learning session, held during the April 2002 Breakthroughs in Performance Improvement conference, Methodist was able to show significant results:
"Methodist Medical Center is now highly aware of AMI patients, and their treatment is something we’re all trying to improve," said Pat Johnson, R.N., manager of cardiology services. One important step the hospital took was revising emergency department and nursing documentation forms. "Ours were 3
Now that three-fourths of patients are completing the first phase of cardiac rehab, the hospital is experiencing a culture change of sorts. Labels are used to remind physicians about the rehab initiative, and staff members take it upon themselves to make reminder calls to doctors and floor nurses. "We were hitting and missing before," said Johnson. "It’s much more consistent now." Jacque Borel, M.S., R.Ph., vice president of cardiology, said participation in the Premier initiative has brought great value to Methodist Medical Center. "It’s forced us to collect and look at data in ways we haven’t before, and it’s engaged a lot of our people in the care of AMI patients. "The support that I’ve seen from other physicians and nurses in the collaborative is very encouraging," he adds. "You get tunnel vision working alone. Working with others who are having similar issues is always helpful." Johnson agrees. "What Premier provided was focus. It gave us an excellent blueprint of what to follow. We know we’re going to stay on the path. I know I can always reach back and touch Premier for information."
Sprinting to the hip and knee finish line with Premierâ&#x20AC;&#x2122;s Clinical Performance Initiative More than 250,000 procedures are done annually in the United States.
W
ith the general population aging, hip and knee replacement surgery is becoming increasingly prevalent. Providing those orthopedic patients with high quality, cost-effective care is a growing challenge for hospitals.
Several Premier hospitals shared measurable strides theyâ&#x20AC;&#x2122;ve made at the second learning session of the Clinical 4
Performance Initiative (CPI) on hip and knee replacement. The session took place at Premierâ&#x20AC;&#x2122;s Breakthroughs in Performance Improvement conference in San Diego in April. Each hospital in the initiative works to achieve individual goals as well as global aims that comply with standards set by the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) and the Centers for Disease Control and Prevention (CDC). The global aims are: • 100 percent of hip and knee replacement patients will receive prophylactic antibiotics within one hour before incision. • 100 percent of hip and knee replacement patients will have a documented pain assessment per hospital protocol. Robert Krushell, M.D., associate director of the Center for Hip and Knee Replacement at Baystate Medical Center in Springfield, MA, and Jan Fitzgerald, clinical practice manager, explained how they gave the center the internal designation as a “program of distinction.” As a result of that focus, total joint replacement (DRG 209) – while no longer part of the organization’s top 10 financial improvement opportunities – continues as an area for service improvement to patients. Baystate focused on DRG 209 because: • More than 250,000 procedures are done annually in the United States, and that number is expected to increase as the population ages. • DRG 209 is the most common procedure reimbursed by Medicare. • Existing therapy has proven to greatly increase quality of life and functionality. Baystate also participates in the CMS Surgical Site Infection Project, a national healthcare quality improvement project sponsored by The Centers for Medicare and Medicaid Services (CMS) and the CDC. The goal of the project is to reduce post-operative infection rates as well as morbidity and mortality rates caused by these infections. Krushell calls his approach “pre-habilitation.” Patients learn what to expect during their stay and may take advantage of the “good night program.” That program allows a patient to come in the night before, become accustomed to the surroundings, and have dinner with family members. The patient is officially admitted at 12:01 a.m. Cost for the patient is $35 out of pocket.
Because of the center’s reputation, there is a waiting list for potential employees. Krushell attributes his success to incentives for staff, an environment that facilitates purchasing decisions outside usual administrative constraints, and a feeling of team ownership.
types of medication, labs, diagnostics, and supplies. Marty Ledbetter, manager of orthopedic patient care services at East Alabama Medical Center in Opelika, AL, concurred. “We’re ahead of the curve because Perspective will do all of the work for you. Where we started and where we are now are miles apart.” Ledbetter noted that his challenge is trying to do surgery early in the week. “The bulk of our resources are not there on Saturday and Sunday,” he explained. “We need to find a way to do total joints on Monday, Tuesday, and Wednesday.”
“We’re ahead of the curve because Perspective will do all of the work for you.” Marty Ledbetter, Manager of Orthopedic Patient Care Services, East Alabama Medical Center
Krushell’s team has implemented several strategies to control costs, including negotiating for implants, standardizing pain control methods, and using Perspective™, Premier’s database of detailed clinical and financial information.* Perspective’s mapping of the charge master, for instance, eliminates miscellaneous billing and captures all costs. Krushell says Perspective also gives Baystate access to better clinical analysis that provides specifics on
Ledbetter also promised to enter data in Premier’s Idea Database, which offers online access to implemented practices, subject matter experts, discussion areas, presentations, and an automated project tracking system. “Marty and Jan are two wonderful examples of the power of collaboration,” says Premier Project Director Colleen Vetere, R.N., M.P.H. “Their willingness to share their successes and the paths they took to get there are instrumental in helping these organizations achieve the improvements they seek. In the end, everyone benefits, especially the patients.”
*Perspective provides cost and resource comparisons for any DRG, 3M™ APRDRG, service line, or department. It also offers executive-level reporting, JCAHO core measures, evidence-based information, patient satisfaction data, and strategic hospital market data.
Upcoming events Frontiers in Clinical Innovations conference October 16-19, 2002 Hyatt Regency San Antonio on the Riverwalk
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Premier Award for Quality 2002 Application for annual award available on www.premierinc.com/qualityaward Deadline: July 31, 2002
St. Luke’s pneumonia team passes Premier top quartile target E
mployees at St. Luke’s Hospital and Health Network in Bethlehem, PA, take performance improvement seriously – as evidenced by a rewritten vision statement and revised performance evaluations that focus on documented improvement.
keeping with its aim of maintaining low cost of care. The hospital is also well on the way to meeting a project goal of getting blood cultures before antibiotics are administered. In February 2002, St. Luke’s had reached 89 percent of its 100 percent target.
“What impressed us is that they rewrote their vision statement to be nationally recognized for excellence, not just regionally – which is the aim of many hospitals,” says Premier Project Director Leslie McCombs, R.N., Ph.D. “That’s just very ambitious.”
“The keys to success have been having a physician as a co-leader on the project with me and his comfort in addressing individual profile data with physicians,” says Sabol. “Of equal importance is looking at concurrent data. We monitor length of stay biweekly in a control chart distributed to the COO, the CAP team, and pulmonary service line members. We make rounds daily to make sure all of our patients are on the pathways.
Another indication of that commitment is St. Luke’s participation in Premier’s Clinical Performance Initiative (CPI) for community-acquired pneumonia (CAP). The initiative was prompted in part by data from the Centers for Disease Control and Prevention showing that some 600,000 Medicare patients are hospitalized every year because of the disease. The 40hospital group met and presented case studies during Premier’s Breakthroughs in Performance Improvement conference in San Diego in April. Donna Sabol, R.N., M.S.N., is St. Luke’s director of performance improvement. She says when her team began studying data on pneumonia, they found variances in a number of areas including length of stay, coding, blood culture timing, compliance with recommended antibiotics, and smoking cessation documentation.
“The entities of St. Luke’s Hospital and Health Network will be nationally recognized for excellence in clinical outcomes, costeffective care, and patient satisfaction.”
“What’s important is real-time learning, knowing what’s working and what isn’t,” she added.
Vision statement St. Luke’s Hospital and Health Network
In addition to facility-specific goals, participants in the CAP CPI share common goals focusing on:
As a result, the team developed a pneumonia pathway with recommended antibiotics; implemented standard orders; conducted a length of stay variance analysis; and provided home IV therapy coverage.
• Timing of the initial antibiotic dose. • Blood cultures prior to antibiotic administration. • Oxygenation assessment documented within 24 hours of arrival. • Appropriateness of antibiotic regimen (ICU vs. non-ICU). • Vaccination status screening/vaccination administration (flu/pneumococcus). • Smoking cessation screening/counseling.
St. Luke’s cost per discharge for adult community-acquired pneumonia is now lower than Premier top quartile – in
Adult community-acquired pneumonia Adjusted cost per discharge
*Includes DRG 89 SOURCE: Finance; provided by SLB Performance Metrics - E. Gulick
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Currently enrolled hospitals We hope you join these hospitals in making a commitment to Performance Improvement 2004: Adventist Health System, Florida Hospital East Orlando Adventist Health System, Florida Hospital Adventist Health System, Florida Hospital Apopka Adventist Health System, Florida Hospital Kissimmee Adventist Health System, Florida Hospital Celebration Health Adventist Health System, Winter Park Memorial Hospital Adventist Health System, Florida Hospital Altamonte Alamance Regional Medical Center Alegent Health, Alegent - Bergan Mercy Medical Center Alegent Health, Alegent - Immanuel Medical Center Anderson Area Medical Center Avera Health, Avera McKennan Hospital Avera Health, Avera Holy Family Health Avera Health, Avera Queen of Peace Hospital Avera Health, Avera St. Luke’s Hospital Baptist Health Systems of South Florida, Baptist Hospital of Miami Baptist Health Systems of South Florida, Homestead Hospital Baptist Health Systems of South Florida, South Miami Hospital BayCare Health System, Mease Countryside Hospital BayCare Health System, Mease Dunedin Hospital BayCare Health System, Morton Plant Mease Health Care BayCare Health System, North Bay Hospital BayCare Health System, South Florida Baptist Hospital BayCare Health System, St. Anthony’s Hospital BayCare Health System, St. Joseph’s Hospital BayCare Health System, St. Joseph’s Women’s Hospital Bayfront Health System, Bayfront - St. Anthony’s Health Care Baystate Health System, Baystate Medical Center Blount Memorial Hospital, Inc. Bon Secours Health System, Inc., Bon Secours - DePaul Medical Center Bon Secours Health System, Inc., Bon Secours - Maryview Health Corp. Bon Secours Health System, Inc., Bon Secours Mary Immaculate Hospital Bon Secours Health System, Inc., Bon Secours - Memorial Regional Medical Center
Bon Secours Health System, Inc., Richmond Community Hospital Catawba Memorial Hospital Central DuPage Health System Community Memorial Hospital Conway Hospital Cumberland County Health System, Cape Fear Valley Medical Center Danville Regional Medical Center East Alabama Medical Center Eisenhower Medical Center Grenada Lake Medical Center Halifax Regional Medical Center Heartland Health, Heartland Regional Medical Center Indian River Memorial Hospital Jefferson Health System, Bryn Mawr Hospital Jefferson Health System, Thomas Jefferson University Hospital Johnston Memorial Hospital Kettering Medical Center, Grandview Hospital and Medical Center Kettering Medical Center Kettering Medical Center, Sycamore Hospital Kettering Medical Center, Southview Hospital & Family Health Center Legacy Health System, Emanuel Hospital Legacy Health System, Good Samaritan Hospital and Medical Center Lenoir Health Services, Inc., Lenoir Memorial Hospital LifeBridge Health, Sinai Hospital of Baltimore Margaret R. Pardee Memorial Hospital McLaren Health Care Corporation, McLaren Regional Medical Center McLeod Regional Medical Center Memorial Health, University Medical Center Mercy Hospital and Medical Center Methodist Healthcare, University Hospital Methodist Medical Center of Illinois Mission - St. Joseph’s Health System Mississippi Baptist Medical Center Mountain States Health Alliance, Indian Path Medical Center Mountain States Health Alliance, Johnson City Medical Center Mountain States Health Alliance, Sycamore Shoals Hospital Murray-Calloway County Hospital NCH Healthcare, Naples Hospital NCH Healthcare, North Collier Hospital New Hanover Health Network, Cape Fear Hospital New Hanover Health Network, New Hanover Regional Medical Center
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North Broward Hospital District, Broward General Medical Center North Broward Hospital District, Coral Springs Medical Center North Broward Hospital District, Imperial Point Medical Center North Broward Hospital District, North Broward Medical Center North Carolina Baptist Hospitals, Inc. North Shore-Long Island Jewish Health System, Doctors Hospital of Staten Island North Shore-Long Island Jewish Health System, Franklin Hospital Medical Center North Shore-Long Island Jewish Health System, Hillside Hospital North Shore-Long Island Jewish Health System, Huntington Hospital North Shore-Long Island Jewish Health System, Long Island Jewish Hospital North Shore-Long Island Jewish Health System, North Shore University Hospital at Forest Hills North Shore-Long Island Jewish Health System, North Shore University Hospital at Glen Cove North Shore-Long Island Jewish Health System, North Shore University Hospital at Plainview North Shore-Long Island Jewish Health System, North Shore University Hospital at Syosset North Shore-Long Island Jewish Health System, North Shore University Hospital at Manhasset North Shore-Long Island Jewish Health System, Schneider Children’s Hospital North Shore-Long Island Jewish Health System, Southside Hospital North Shore-Long Island Jewish Health System, Staten Island University Hospital North Site North Shore-Long Island Jewish Health System, Staten Island University Hospital South Site Northeast Health, Albany Memorial Hospital Northeast Health, Samaritan Hospital Norton Healthcare, Kosair Children’s Hospital Norton Healthcare, Norton Audubon Hospital Norton Healthcare, Norton Hospital Norton Healthcare, Norton Southwest Hospital Norton Healthcare, Norton Suburban Hospital Palmetto Health Alliance, Palmetto Richland Memorial Hospital Palomar Pomerado Health System, Palomar Medical Center Continued on back
Currently enrolled hospitals Continued from page 7 Palomar Pomerado Health System, Pomerado Hospital Providence Services, Benefis Healthcare Providence Services, Deer Park Hospital Providence Services, Holy Family Hospital Providence Services, Mount Carmel Hospital Providence Services, Sacred Heart Medical Center Providence Services, St. Joseph’s Hospital Providence Services, St. Mary’s Medical Center Providence Services, St. Patrick Hospital Randolph Hospital Seagate Alliance, Arnot Ogden Hospital Seagate Alliance, Clifton Springs Hospital Sharp HealthCare, Sharp - Chula Vista Medical Center Sharp HealthCare, Grossmont Hospital Sharp HealthCare, Sharp Memorial Hospital South Central Regional Medical Center Southcoast Health System, Charlton Hospital Southcoast Health System, St. Luke’s Hospital Southcoast Health System, Tobey Hospital
2320 Cascade Pointe Blvd. Charlotte, NC 28208
Southeast Alabama Medical Center Southeastern Regional Medical Center Spartanburg Regional Healthcare System St. Francis Hospital St. Luke’s Hospital and Health Network, St. Luke’s Hospital - Allentown St. Luke’s Hospital and Health Network, St. Luke’s Hospital - Quakertown St. Luke’s Hospital and Health Network, St. Luke’s Hospital - Bethlehem St. Mary’s Health Care System, Inc. Stanly Memorial Hospital Texas Health Resources, Arlington Memorial Hospital Texas Health Resources, Harris Methodist Erath County Texas Health Resources, Harris Methodist Ft. Worth Texas Health Resources, Harris Methodist HEB Texas Health Resources, Harris Methodist Northwest Texas Health Resources, Harris Methodist Southwest Texas Health Resources, Presbyterian Hospital of Dallas
Texas Health Resources, Presbyterian Hospital of Kaufman Texas Health Resources, Presbyterian Hospital of Plano Texas Health Resources, Presbyterian Hospital of Winnsboro Texas Health Resources, Walls Regional Hospital Thomas Memorial Hospital Twin County Regional Healthcare Vantage Health Group, Meadville Medical Center Vantage Health Group, St. Vincent Health Center Vantage Health Group, Warren General Hospital Watauga Medical Center, Inc. Wayne Memorial Hospital, Inc. Wilson Memorial Hospital Winter Haven Hospital, Inc., Lake Wales Medical Center Winter Haven Hospital, Inc., Regency Medical Center Yankee Alliance, Berkshire Medical Center Yankee Alliance, St. Joseph Hospital