Slow and Steady Brings Success

410 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
410
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Slow and Steady Brings Success

  1. 1. TriHealth’s Slow & Steady Progress to Success Good Sam Bethesda Georges Feghali, MD Sr. VP, CMO, COO
  2. 2. Driven by Mission, Vision and Values <ul><li>Mission </li></ul><ul><ul><li>To improve the health status of the people we serve </li></ul></ul><ul><li>Vision </li></ul><ul><ul><li>To be where people want to work, physicians want to practice, and most importantly, where the community wants to go for the best quality, service, safety, and value in healthcare </li></ul></ul>
  3. 3. Driven by Mission, Vision and Values <ul><li>Values </li></ul><ul><ul><li>Respect for all people </li></ul></ul><ul><ul><li>Service excellence for all customers </li></ul></ul><ul><ul><li>Respect for our spiritual heritage </li></ul></ul><ul><ul><li>Stewardship </li></ul></ul><ul><ul><li>Responsive to community needs </li></ul></ul><ul><ul><li>Valuing differences </li></ul></ul>
  4. 4. The “Tri” in TriHealth <ul><ul><li>TriHealth represents the triad of hospitals, physicians and the community working together to improve health and wellness. </li></ul></ul><ul><ul><li>We focus on patient care, teaching and research </li></ul></ul>
  5. 5. How We Are Organized
  6. 6. A Few Facts and Figures • Two acute-care hospitals with nearly 900 beds (898) • Good Samaritan (GSH) has the highest market share in TriHealth’s four-county area, and Bethesda North (BNH) is #2 • Over 11,000 births per year: GSH is #1 in Ohio; BNH is # 6 • Largest robotic surgery program in the U.S. • Over 50 outpatient service locations • Over 2,500 independent physicians (active & courtesy) & greater than 200 employed physicians • Over 10,000 employees
  7. 7. TriHealth Inc. Prides itself on being able to handle multiple initiatives and set overall organizational initiatives Avoids focusing on “flavor of the month” – what is the hot topic everyone is concerned about Our goal is quality across the organization defined as “ Doing the right thing, at the right time for the right patient EVERYTIME”
  8. 8. Evidenced Based Care <ul><li>Employ over 30 hospitalists between the two hospitals – part of role to collaborate on core measures. Measure Adherence to Order Sets </li></ul><ul><li>Created a VP of Medical Affairs at both hospitals </li></ul><ul><ul><li>Champions specific clinical initiative </li></ul></ul><ul><ul><li>Serves as resource for complex, high LOS cases </li></ul></ul><ul><li>Extended role of care coordinator to include review of core measures </li></ul>
  9. 9. Evidenced Based Care <ul><li>CDMP works with physicians to assure appropriate documentation </li></ul><ul><li>Incorporated into performance evaluations </li></ul>
  10. 10. EBC: Pneumonia <ul><li>Pneumonia core team of physicians: Pharmacy, ED, Hospitialist, Clinical Quality, Pulmonologists </li></ul><ul><li>Developed a Selection Sheet for appropriate antibiotic selection </li></ul><ul><li>Vaccine protocol created which does not require a physician order </li></ul><ul><li>Smoking cessation hard-stops and education built into electronic clinical documentation </li></ul>
  11. 11. EBC: Pneumonia <ul><li>Receive weekly exception reports of missed opportunities </li></ul><ul><ul><li>Sends a core measure alert email to managers to review </li></ul></ul><ul><ul><li>Managers help educate staff </li></ul></ul><ul><li>Hardwired so everyone get info on smoking </li></ul><ul><li>Developed “Pneumo News” to send out updates to managers </li></ul><ul><li>Use pyxis system to remind nursing about blood cultures prior to antibiotic administration </li></ul><ul><li>Modified order sets </li></ul>
  12. 12. Pneumonia-Results 3Q 2008- BNH Pneumonia     PN All-or-None Composite Score 88% PN-2: Pneumococcal vaccination 92% PN-3b: BC performed in the ED prior to Initial Abx Rc'd in hospital 96% PN-4: Adult smoking cessation advice/counseling 100% PN-6: Initial abx selection for CAP immunocompetent pts 89% PN-7: Influenza Vaccination  
  13. 13. Pneumonia – Results 3Q 2008 -GSH PN All-or-None Composite Score 90% PN-2: Pneumococcal vaccination 91% PN-3b: BC performed in the ED prior to Initial Abx Rc'd in hospital 95% PN-4: Adult smoking cessation advice/counseling 100% PN-6: Initial abx selection for CAP immunocompetent pts 97% PN-7: Influenza Vaccination  
  14. 14. EBC: AMI <ul><li>AMI multidisciplinary task force at both facilities </li></ul><ul><ul><li>Cardiologists </li></ul></ul><ul><ul><li>Care managers </li></ul></ul><ul><ul><li>Educators </li></ul></ul><ul><ul><li>Clinical Quality </li></ul></ul><ul><ul><li>Documentation abstractors </li></ul></ul><ul><ul><li>ED Physicians </li></ul></ul><ul><ul><li>Cath Lab & ED management and staff </li></ul></ul><ul><li>Committed to never stop meeting and ongoing review of progress </li></ul>
  15. 15. EBC: AMI <ul><li>Significant learnings regarding nuisances of documentation </li></ul><ul><ul><li>A number of cases with excellent times were excluded because of documentation related to EKG – learned better ways to document </li></ul></ul><ul><ul><li>Sharing of information and data on continuous basis both from educational perspective and missed opportunities </li></ul></ul><ul><ul><li>Added the new VP of Medical Affairs to the group </li></ul></ul>
  16. 16. AMI – Results Q3 2008-BNH Acute Myocardial Infarction   AMI All-or-None Composite Score 91% AMI-1: Aspirin at arrival 99% AMI-2: Aspirin prescribed at discharge 100% AMI-3: ACEI or ARB for L VSD 96% AMI-4: Adult smoking cessation advice/counseling 100% AMI-5: Beta-blocker prescribed at discharge 97% AMI-6: Beta-blocker at arrival 95% AMI-7a: Fibrinolytic agent within 30 min of hospital arrival   AMI-8a: Primary PCI within 90 min of hospital arrival 83%
  17. 17. AMI – Results Q3 2008-GSH AMI All-or-None Composite Score 93% AMI-1: Aspirin at arrival 97% AMI-2: Aspirin prescribed at discharge 100% AMI-3: ACEI or ARB for L VSD 100% AMI-4: Adult smoking cessation advice/counseling 100% AMI-5: Beta-blocker prescribed at discharge 100% AMI-6: Beta-blocker at arrival 85% AMI-7a: Fibrinolytic agent within 30 min of hospital arrival   AMI-8a: Primary PCI within 90 min of hospital arrival 88%
  18. 18. EBC: Heart Failure <ul><li>Similar group as AMI but includes Pharmacy </li></ul><ul><li>Took our Heart Failure story on the road and went to Internal Medicine & Family Practice </li></ul><ul><li>Share missed opportunities on regular basis </li></ul><ul><li>Developed preprinted progress notes with best practice for physician </li></ul>
  19. 19. EBC: Heart Failure <ul><li>Discovered device patients were being discharged before CDMP was able to conduct a concurrent review- so Cath Lab now reviews charts & flags pertinent ones </li></ul>
  20. 20. HF – Results Q3 2008 - BNH Heart Failure     HF All-or-None Composite Score 98% HF-1: Discharge Instructions 100% HF-3: ACEI or ARB for LVSD 95% HF-4: Adult smoking cessation advice/counseling 100%
  21. 21. HF – Results Q3 2008 - GSH HF All-or-None Composite Score 88% HF-1: Discharge Instructions 90% HF-3: ACEI or ARB for LVSD 90% HF-4: Adult smoking cessation advice/counseling 100%
  22. 22. EBC: SCIP <ul><li>Part of management goals & incorporated into our electronic balanced scorecard </li></ul><ul><li>Multidisciplinary meets weekly (monthly GSH) </li></ul><ul><li>Use missed opportunities reports – not available like other specialties due to quantity of indicators, volume & methodology to collect data </li></ul>
  23. 23. EBC: SCIP <ul><li>Concurrent review done which team then identifies areas that make a difference in care (both inpatient & outpatient data) </li></ul><ul><li>Data available on intranet to monitor progress </li></ul><ul><li>Challenges: </li></ul><ul><ul><li>Data in obtaining data from vendor </li></ul></ul><ul><ul><li>Indicators have potential to change quarterly </li></ul></ul>
  24. 24. SCIP- Results Q3 2008 - BNH Surgical Care Infection Prevention   SCIP-INF All-or-None Composite Score 85% SCIP-INF-1a: Prophylactic abx rec'd w/i 1 hr prior to surgical incision 96% SCIP-INF-2a: Prophylactic abx selection for surgical pts 99% SCIP-INF-3a: Prophylactic abx discontinued within 24 hours after surgery end time/48 hours for CABG or Other Cardiac Surgery 95% SCIP-VTE-2: Surgery pts who rec'd appropriate VTE prophylaxis w/i 24 hours prior to surgery up to 24 hours after surgery end time 84%
  25. 25. SCIP- Results Q3 2008 - GSH SCIP-INF All-or-None Composite Score 88% SCIP-INF-1a: Prophylactic abx rec'd w/i 1 hr prior to surgical incision 94% SCIP-INF-2a: Prophylactic abx selection for surgical pts 99% SCIP-INF-3a: Prophylactic abx discontinued within 24 hours after surgery end time/48 hours for CABG or Other Cardiac Surgery 94% SCIP-VTE-2: Surgery pts who rec'd appropriate VTE prophylaxis w/i 24 hours prior to surgery up to 24 hours after surgery end time 95%
  26. 26. Mortality <ul><li>Started years ago when community initiated sharing of comparison data </li></ul><ul><li>Realized to fair well we need document conditions & co-morbidities that drive severity adjustments & co-morbidities </li></ul><ul><li>Also driven by insurance such as Anthem soliciting participation in improving care in key areas such as open heart </li></ul>
  27. 27. Mortality <ul><li>Clinical documentation management program put in place with extensive education </li></ul><ul><ul><li>Helps us to identify factors </li></ul></ul><ul><li>Premier Safety initiatives </li></ul><ul><li>Development of clinical pathways/ order sets </li></ul><ul><ul><li>Based on research through ZYNX </li></ul></ul><ul><ul><li>Updated on regular basis </li></ul></ul><ul><ul><li>Helps us keeps our eye on the ball of best practices </li></ul></ul><ul><ul><li>Critical involvement of physicians </li></ul></ul>
  28. 28. Mortality Results - BNH  
  29. 29. Mortality Results-GSH
  30. 30. Cost of Care <ul><li>High cost areas targeted for improvement teams </li></ul><ul><ul><li>Cardiology stents, devices, implants </li></ul></ul><ul><ul><li>Perioperative supplies </li></ul></ul><ul><ul><li>Gloves, trays,etc </li></ul></ul><ul><ul><li>Orthopedic joint implants </li></ul></ul><ul><ul><li>Spine </li></ul></ul><ul><li>Implemented Point of Use for charge capturing </li></ul><ul><li>Premier Safety initiatives </li></ul>
  31. 31. Cost of Care <ul><li>Established Efficiency of Care group </li></ul><ul><ul><li>Membership: CMO, CNO, DSS, Care Management, Clinical Documentation, Nursing & other adhoc areas </li></ul></ul><ul><ul><li>Targeted approach: Used Premier Clinical Advisor and internal databases to identify areas for improvement </li></ul></ul>
  32. 32. Cost of Care <ul><ul><li>Conducted chart review of patients with LOS of 5 days and Level 1 severity </li></ul></ul><ul><ul><li>Push learnings back to appropriate pt care areas through opportunities </li></ul></ul><ul><ul><li>Continue to slice data more refinely even though we look good </li></ul></ul><ul><ul><li>Look at both cost and quality </li></ul></ul>
  33. 33. Cost of Care - BNH Cost of Care             Time Period: 2008Q4   Number of Entities Reported for Baseline Period*: 163                 Measure Results: Performance Hospital Total Inpatient Cost per Case Mix Adjusted Discharge Variation from Top Performance Threshold Top Performance Threshold   Total Discharges Teaching and >=375 Beds       $6,540       Teaching and <375 Beds  $4,940 -$1,250 $6,190     6,263 Non-Teaching and >=175 Beds       $5,400       Non-Teaching and <175 Beds       $5,170                           Note: Cost of Care data is considered preliminary until calculated Case Mix Index is available.
  34. 34. Cost of Care - GSH Cost of Care             Time Period: 2008Q4   Number of Entities Reported for Baseline Period*: 163                 Measure Results: Performance Hospital Total Inpatient Cost per Case Mix Adjusted Discharge Variation from Top Performance Threshold Top Performance Threshold   Total Discharges Teaching and >=375 Beds  $5,770 -$770 $6,540     7,117 Teaching and <375 Beds       $6,190       Non-Teaching and >=175 Beds       $5,400       Non-Teaching and <175 Beds       $5,170                           Note: Cost of Care data is considered preliminary until calculated Case Mix Index is available.                        
  35. 35. Summary <ul><li>Incorporate processes into existing work processes </li></ul><ul><li>Emphasis collaboration between disciplines </li></ul><ul><li>Timely ongoing review </li></ul><ul><li>Never satisfied with “good” - continue to drill down to find other opportunities to become better </li></ul><ul><li>Better to be a “tortoise” making slow and steady progress </li></ul><ul><li>“ Do the right thing, at the right time for the right patient EVERYTIME” </li></ul>
  36. 36. Summary Good Sam Bethesda Finish Line

×