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Patient Care Quality Outcomes

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McKesson helps improve health care quality and patient safety while reducing health care costs. …

McKesson helps improve health care quality and patient safety while reducing health care costs.
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  • 1. Patient Care and Quality Outcomes Deborah Bulger, CPHQ Paul Gartman Vice President, Product Management Vice President, Product Management Performance Management Enterprise Visibility
  • 2. Learning Objectives Determine how IT can support an organization’s quality performance goals Understand the difference between departmental capacity management and patient flow issues that affect the entire organization Learn how advanced care planning tools can help address an initiative of the IHI: Transforming Care at the Bedside 2
  • 3. “Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process measures.” Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007 3
  • 4. Crossing the Evidence Bridge Strategic direction Tactical implementation Effective care Safety planning technology and culture Visible Constituent communication based analysis to all stakeholders 4
  • 5. Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar… The higher the bar, the greater the opportunity the greater the opportunity! 64% 63% 55% 41% December 2007 IHI National Forum 92 responses MD, RN, QA, Board Mistake Proof Optimize Adopt Whole Transform Your Patient Flow System Care at the Processes Measures Bedside 5
  • 6. Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity 64% 63% 55% “No single tool can solve every 41% problem; often, the answer will lie in the discovery, implementation, and execution of several tools.” Grout J. Mistake-proofing the design of health care processes. AHRQ Publication No. 07-0020. May 2007. Mistake Proof Optimize Adopt Whole Transform Your Patient Flow System Care at the Processes Measures Bedside 6
  • 7. Mistake Proofing Your Processes Recognition and Prevention of Failure Points % of “No” Responses The higher the bar, the greater the opportunity Online allergies and med history Automated med 74% for each patient reconciliation Rapid reporting of critical lab Visiblility to values 54% changes in pt “Five rights” barcoding status 51% Patient safety attributes Barcode 73% scanning 7
  • 8. Removing a Failure Point Barcode Scanning Technology Quantifiable results Bedside barcode scanning of meds 99.7% compliance with bar-code ─ scanning 39% increase in reporting of ─ medication errors and near misses 33% decrease in percentage of errors ─ causing harm 48% decrease in missed doses ─ 73% decrease in extra doses ─ Rapid adoption of technology 63% decrease in wrong doses ─ Enhanced charge capture ─ Increased clinician satisfaction and ─ retention Increased productivity and efficiency ─ ─ $300,000 savings in transcription fees ─ And on… and on… 8
  • 9. “Dockside to Bedside” 100% Barcoded Medication Management 9
  • 10. Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity 64% 63% 55% “A hospital is a great example of a complex adaptive system. You have a number of people who are 41% making day-to-day, even minute-to-minute, decisions in their own microsystem … that impact hospital-wide patient flow, and they are making these decisions without access to information about the macro view, or what is going on in the rest of the hospital.” Kirk Jensen, MD, MBA, FACEP, IHI faculty member and co-author, Leadership for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved Bottom Line Mistake Proof Optimize Adopt Whole Transform Your Patient Flow System Care at the Processes Measures Bedside 10
  • 11. Optimize Patient Flow System-wide Visibility to Patient Status % of “No” Responses The higher the bar, the greater the opportunity Real time 35% One-to-one paper, verbal census communications create delays Real time Departmental “micro-delays” 61% discharge affect system-wide throughput orders Lack of capacity impacts 29% Observation organizational success ALOS <24 hrs Average ED 38% hold time <4 hrs 11
  • 12. Visual Controls in Everyday Life 12
  • 13. Visual Controls in Healthcare 13
  • 14. Addressing the Challenge of Capacity and Throughput Management Beds are full – supply & demand misaligned ED diversions ─ Medical cases crowd out more profitable surgical cases ─ New Joint Commission standards around patient flow Patient bed space ─ Efficiency and safety ─ Support service processes ─ Late rounding, late test Mid-day bed crunch due results, charts to misalignment of incomplete, poor admissions, discharges. discharge planning etc. 6a 7a 8a 9a 10a 11a 12a 1p 2p 3p 4p 5p 6p 7p 12a Peak Admission Period Peak Discharge Period Source: Advisory Board interviews and analysis, 2006. 14
  • 15. Enterprise Visibility Platform 15
  • 16. Reading the Display Board Transport alert Case manager alert Pending discharge Results Observation notification patient Isolation Scheduled discharge Cleaning in Medications process ready Patient location (radiology) Patient safety alert Hold room for Bed reserve Orders maintenance communication notification 16
  • 17. One Hospital’s Success $5.5M revenue increase within 6 months Improves bed turns by 19% ─ Expands overall acute care capacity by ─ 12% Reduce ED diversions by up to 60% ─ Reduce EVS staff by up to 20% ─ Return on Investment analysis conducted by the Advisory Board - published June 2006 17
  • 18. Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity 64% 63% 55% “By looking at macrosystem and microsystem measures frequently— 41% daily, weekly, or monthly—the organization can better monitor its performance, find improvement opportunities, and prevent quality levels from eroding without anyone noticing.” Whole System Measures, IHI, 2007 Mistake Proof Optimize Adopt Whole Transform Your Patient Flow System Care at the Processes Measures Bedside 18
  • 19. Adopt Whole System Measures Meaningful Information to Sustain Improvement % of “No” Responses The higher the bar, the greater the opportunity Data rich, information poor Automated data 65% IT investment should decrease collection manual collection – but doesn’t 46% quot;Are we getting Increasing regulatory better?quot; requirements 74% Constituent based metrics Single quot;source 72% of truthquot; 19
  • 20. Removing Data Silos Source data Data warehouse & Publication & analysis of integration healthcare applications results Information transparency Medication safety HIS analysis Surgical cost & Financial DSS quality Dashboards Productivity and Payroll Scorecards profitability Med administration Patient safety Radar Charts Graphs Grouping and Patient experience reimbursement Actionable insight Departmental Surgery IS initiatives Control charts Document links Hospital-wide Laboratory IS initiatives Action Triggers Work lists 20
  • 21. Constituent-based Metrics C Suite, Board Highest level, composite metrics Month-over-month trends Links to accountable staff Nursing Executive Drill by unit, caregiver, drug, date, time, etc., so manager can take immediate action Metrics updated after each shift Principled action triggers Quality Manager Criteria-based review lists Streamlined case review 21
  • 22. Perfect Care Assessment Identifying the Opportunity % of “No” Responses The higher the bar, the greater the opportunity 64% 63% 55% “Patients say ‘They give me exactly 41% what I want (need) exactly when I want (need it).” Rutherford, et al, Transforming Care at the Bedside, IHI, 2004 Mistake Proof Optimize Adopt Whole Transform Your Patient Flow System Care at the Processes Measures Bedside 22
  • 23. Transform Care at the Bedside Evidence-based, Interdisciplinary Care Delivery % of “No” Responses The higher the bar, the greater the opportunity Automated plans that drive care delivery Visible care 55% plan Integrated orders, documentation, assessments, etc. Access to 64% Prioritize activities based on evidence at patient progress bedside Care plans 46% integral to pt management > 70% of time in 54% direct pt care 23
  • 24. Care Process Alerts Core Measure - Patient Monitoring Pneumonia Patient Antibiotic 22 min. Overdue 24
  • 25. “Evidence bridge: pathways that derive estimates of clinical outcomes from changes in process measures.” Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007 25
  • 26. Thank you! How does your organization measure up? Take the Quality Care Assessment in McKesson booth #3035 ─ Feb. 25-28 at HIMSS Deborah Bulger deborah.bulger@mckesson.com Paul Gartman paul.gartman@mckesson.com 26