Patient Care and Quality Outcomes

Deborah Bulger, CPHQ Vice President, Product Management Performance Management

Paul Gartman Vice President, Product Management Enterprise Visibility

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

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“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

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Crossing the Evidence Bridge
Strategic direction
Effective care planning

Tactical implementation
Safety technology and culture

Constituent based analysis

Visible communication to all stakeholders

4

Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity

The higher the bar… the greater the opportunity!

63%

64% 55% 41%

December 2007 IHI National Forum 92 responses MD, RN, QA, Board

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity

63%

64% 55% 41%

“No single tool can solve every 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 Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Mistake Proofing Your Processes
Recognition and Prevention of Failure Points
% of “No” Responses
The higher the bar, the greater the opportunity

Automated med reconciliation Visiblility to changes in pt status Patient safety attributes Barcode scanning

74%

Online allergies and med history for each patient Rapid reporting of critical lab values “Five rights” barcoding

54%

51%

73%

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Removing a Failure Point
Barcode Scanning Technology
Bedside barcode scanning of meds

Quantifiable results
─ ─ ─ ─

Rapid adoption of technology

─ ─ ─ ─ ─

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 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…

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“Dockside to Bedside” 100% Barcoded Medication Management

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Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity

63%

64% 55% 41%
“A hospital is a great example of a complex adaptive system. You have a number of people who are 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 Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Optimize Patient Flow
System-wide Visibility to Patient Status
% of “No” Responses
The higher the bar, the greater the opportunity

Real time census Real time discharge orders Observation ALOS <24 hrs Average ED hold time <4 hrs

35%

One-to-one paper, verbal communications create delays
61%

Departmental “micro-delays” affect system-wide throughput Lack of capacity impacts organizational success

29%

38%

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Visual Controls in Everyday Life

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Visual Controls in Healthcare

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Addressing the Challenge of Capacity and Throughput Management
Beds are full – supply & demand misaligned
─ ─

ED diversions Medical cases crowd out more profitable surgical cases Patient bed space Efficiency and safety Support service processes
Late rounding, late test results, charts incomplete, poor discharge planning etc.

New Joint Commission standards around patient flow
─ ─ ─

Mid-day bed crunch due to misalignment of admissions, discharges.

6a

7a

8a

9a 10a 11a 12a 1p
Peak Admission Period

2p

3p

4p

5p

6p

7p

12a

Peak Discharge Period

Source: Advisory Board interviews and analysis, 2006.

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Enterprise Visibility Platform

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Reading the Display Board
Pending discharge Case manager alert Transport alert

Results notification

Observation patient

Scheduled discharge

Isolation

Cleaning in process

Medications ready

Patient location (radiology) Patient safety alert Bed reserve communication Hold room for maintenance

Orders notification

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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

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Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity

63%

64% 55% 41%

“By looking at macrosystem and microsystem measures frequently— 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 Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Adopt Whole System Measures
Meaningful Information to Sustain Improvement
% of “No” Responses
The higher the bar, the greater the opportunity

Automated data collection "Are we getting better?" Constituent based metrics Single "source of truth"

65%

Data rich, information poor IT investment should decrease manual collection – but doesn’t Increasing regulatory requirements

46%

74%

72%

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Removing Data Silos
Source data integration HIS Financial DSS Payroll Med administration Patient experience Surgery IS Laboratory IS Data warehouse & healthcare applications
Medication safety analysis Surgical cost & quality Productivity and profitability Patient safety Grouping and reimbursement Departmental initiatives Hospital-wide initiatives
Control charts Document links Graphs Radar Charts Scorecards

Publication & analysis of results
Information transparency

Dashboards

Actionable insight

Action Triggers

Work lists

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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

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Perfect Care Assessment
Identifying the Opportunity
% of “No” Responses
The higher the bar, the greater the opportunity

63%

64% 55% 41%

“Patients say ‘They give me exactly what I want (need) exactly when I want (need it).”
Rutherford, et al, Transforming Care at the Bedside, IHI, 2004

Mistake Proof Optimize Your Patient Flow Processes

Adopt Whole System Measures

Transform Care at the Bedside

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Transform Care at the Bedside
Evidence-based, Interdisciplinary Care Delivery
% of “No” Responses
The higher the bar, the greater the opportunity

Visible care plan Access to evidence at bedside Care plans integral to pt management > 70% of time in direct pt care

55%

64%

Automated plans that drive care delivery Integrated orders, documentation, assessments, etc. Prioritize activities based on patient progress

46%

54%

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Care Process Alerts Core Measure - Patient Monitoring
Pneumonia Patient

Antibiotic 22 min. Overdue

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“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

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Thank you!
How does your organization measure up?

Take the Quality Care Assessment in McKesson booth #3035 Feb. 25-28 at HIMSS

Deborah Bulger Paul Gartman

deborah.bulger@mckesson.com paul.gartman@mckesson.com

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