The document summarizes various quality improvement initiatives across multiple levels - hospital, city-wide, and state-wide - aimed at reducing infections and improving care outcomes in Memphis, Tennessee. It outlines initiatives at Baptist DeSoto Hospital that reduced ventilator-associated pneumonia rates by 67.56% through the use of evidence-based bundles. It also describes the Memphis Quality Initiative, a city-wide collaboration of medical professionals, and the Healthy Memphis Common Table, a community partnership working to reverse obesity and diabetes trends. Finally, it mentions Tennessee-wide and national quality improvement groups and initiatives.

1. Remaking Healthcare in Memphis Manoj Jain MD MPH Baptist DeSoto Hospital- Chairperson Infection Control Memphis Quality Initiative – Coordinator of Physician Team Healthy Memphis Common Table – Coordinator of Council Partner QSource, Tennessee’s QIO- Medical Director

3. Hospital Level Initiative DESOTO ICU and FLOOR

6. Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

7. VAP Rate in ICU 67.56% Decrease FY 02-FY04YTD

8. Nosocomial Infection Rates FY 2001-FY 2004 YTD

9. Statistical Significance

10. BMH-DeSoto HSMR (Health System Mortality Ratio)

11. ICU Cost Per Workload Unit (Patient Day) 13.5% Decrease

12. ICU ALOS Per Episode

13. Average Cost Per ICU Episode 15.6% Decrease 8.6% Decrease

15. Crucial Care Model 12/09/2003 C RUCIAL C ARE ED ICU Step Down Acute Care Quality Mgt. Access OR PACU FTC Core Measure Cohort Mobile Registration Flow Specialists MET Asthma Clinic Chest Pain Center Infection Control Protocol Patients

18. City wide Initiative Memphis Quality Initiative

21. Quality Quality Quality Quality Quality Quality

22. Quality Quality

23. Quality Quality Quality

26. MQI M A QI M P QI M N QI M QID QI M PH QI M IT QI

27. MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative M PH QI M IT QI

28. MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative M PH QI M IT QI

29. MQI M A QI M P QI M N QI M QID QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative M PH QI M IT QI

30. MQI M A QI M P QI M N QI M CQO QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MQIDQI Memphis Chief Quality Officers Quality Initiative MPRQI Memphis Pharmacists Quality Initiative M PH QI M IT QI

31. MQI M A QI M P QI M N QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative MNQI Memphis Nursing Quality Initiative M PH QI M IT QI M CQO QI MQIDQI Memphis Chief Quality Officers Quality Initiative

32. MQI M A QI M P QI M N QI MPQI – Memphis Physicians Quality Initiative MAQI Memphis Administrators Quality Initiative MPRQI Memphis Pharmacists Quality Initiative MNQI Memphis Nursing Quality Initiative M PH QI MITQI Memphis Information Technologists Quality Initiative M IT QI What a ride!!!! M CQO QI MQIDQI Memphis Chief Quality Officers Quality Initiative

33. City wide Community Initiative Healthy Memphis Common Table

34. 1 st Initiative: Reversing the trends in obesity & diabetes in Shelby County! Healthy Memphis Common Table

35. Bottom 6% in exercise Average BMI is 27.3 (25+ is overweight) Below average for healthy eating 2002 SELF magazine: Memphis is “ The Unhealthiest City in the Nation” *2003: Minor improvement reported but long way to go! 168/200

36. “ America's Unhealthiest City for Men” Men’s Health magazine, 2003 In 2003

42. Mission The Healthy Memphis Common Table is a 501(c)(3) non-profit organization whose mission is to support and encourage people working together to improve the health of everyone in our community.

43. Our “ BAG ” (Big Audacious Goal) By 2008, we will REVERSE the growth of Diabetes and Obesity in Shelby County. Not SLOW the trend, or STOP it. REVERSE THE TREND . The graphs head DOWNWARD !

44. “ BAG ” Benchmarks for the Greater Memphis Area 2002

45. “ BAG ” Benchmarks for the Greater Memphis Area 2002

46. “ BAG ” Benchmarks for the Greater Memphis Area 2002

50. For board members: Sharepoint "Team Site" For board members: Sharepoint "Team Site" Slide for home page of website

55. Hospitals Baptist Memorial Health Care Baptist Memorial Health Care, Diabetes Services Baptist Women's Hospital Methodist Healthcare Methodist Healthcare, Cafeteria Methodist LeBonheur Methodist LeBonheur, Coordinated School Health St. Francis Hospital The MED The MED, Community Health Education Other Providers Christ Community Health Services Church Health Center Delta Medical Center Hope & Healing Center Memphis & Shelby County Health Dept., Health Loop Clinics Memphis Health Center Midtown Mental Health Center Pediatric Lifestyle Clinic The Endocrine Clinic, PC Univ. of TN, College of Nursing, Center for Health Evaluation & Lifestyle Promotion UT Medical Group UT Medical Group, Child Health UT Medical Group, Endocrinology UT Medical Group, Pediatric Endocrinology UT Medical Group, Pediatrics

56. Payers & Quality Improvement Organizations Medical Outcomes Management Memphis Managed Care Corp. (TLC) OmniCare Health Plan Qsource, Center for Healthcare Quality Colleges & Universities Southern College of Optometry Southwest TN Community College, Hotel Management Program Univ. of Memphis Univ. of Memphis, Center for Healthcare Economics Univ. of Memphis, Dept. of Anthropology Univ. of Memphis, Dept. of Health & Sport Sciences UT: Children's Foundation Research Center UT: Dept. of Medicine UT: Dept. of Pediatrics UT: Dept. of Preventive Medicine UT: College of Nursing UT: Dept. of Telemedicine UT: Extension Service, Nutrition UT: Institute for Women's Health UT: Reference Library

57. Fitness Centers & Youth Groups Camp Body Rock / Inside Out Gym DeSoto Athletic Club Elite Personal Fitness Girls Inc. of Memphis YMCA Faith-Based Organizations African American Pastors Association Calvary Episcopal Church Memphis Healthy Churches Metropolitan Inter-Faith Association (MIFA) Shelby County Inter-Faith Coalitions, Medical Advocacy & Support Groups American Diabetes Association Angels Support Group Bluff City Medical Society Memphis Minority Health & Community Development Coalition Women's Foundation of Memphis Pediatric Wellness Roundtable Tennessee on the Move Individuals, Businesses, & Business-oriented Groups Access MD / Isys Technology Commercial Appeal (newspaper) Creative Foodworks Individual (Creative Director / Marketing) Individual (Writer) International Paper LHS, Inc. (Charitable Foundation) Memphis Business Group on Health Memphis Light, Gas & Water (Utilities) Methodist Healthcare, Web Services Novo Nordisk Pharmaceuticals Pfizer Inc. UT Medical Group, Human Resources Dept. Univ. of TN Pharmacy Walgreens WREG-TV

59. State Level TENNESSEE

60. Year 2000 Baseline Performance Variability Among the 16 Largest TN Hospitals

64. National Initiative Institute of Healthcare Participant Institute of Medicine Participant