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Henry Ford Health System’s ‘No Harm Campaign’ Reduces Harm and Saves Lives

The “No Harm Campaign” at Henry Ford Health System (HFHS) in Detroit integrates national, local, and homegrown efforts into one system-wide initiative to reduce harm. With an ambitious goal to decrease harm events system-wide by 50% from 2008-2013, the No Harm Campaign focuses on enhancing the culture of safety, improving the quality and clarity of clinical communications, identifying top causes of harm overall and at individual points on the continuum of care, and redesigning care to eliminate common causes of harm.

HFHS uses a broad definition of harm: any unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization or that results in death. Such injury is considered harm whether or not it is considered preventable, resulted from a medical error, or occurred within a hospital.

Harm reduction is measured by a comprehensive set of 27 measures across six categories: infection-related, medication-related, procedure-related, care delivery, employee, and other types of harm. These harm measures, comprised of hundreds of medical codes, combine to create a unique aggregate global harm score. The global harm score for each hospital overall and by category is transparent to all stakeholders within the system in an effort to create and spread best practices for harm reduction across the system.

From January 2008 through December 2011, the combined inpatient harm rate system-wide decreased by 31% and system-wide mortality rate decreased by 18%. This reflects a reduction of 169 harm events/month even while adding a new hospital and increasing the total number of patient days in the period measured. Cost-savings of the No Harm Campaign are estimated to total $10 million over a 4-year period, a savings of 8-9% each year in costs.

Read More

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Henry Ford Task Force Reduces Catheter-related Bloodstream Infections in Hemodialysis Patients

The Henry Ford Medical Group in Detroit has a large dialysis program with high-risk patients; about 80 to 100 of these patients per month use a hemodialysis catheter for vascular access. Despite attempts to reduce catheter-related bloodstream infections (CRBSI) over a 3-year period, rates remained well above the national benchmark of 3.1/100 patient months. To address this issue, the Catheter Bacteremia Task Force was formed, involving Nephrology, Pharmacy Services, Infectious Diseases, Infection Control, and the Dialysis Administrator. This Task Force included the expertise and key leadership needed to make any potential intervention successful. The protocol involved instilling a gentamicin/trisodium citrate solution into the catheter lumen after each patient’s dialysis session.

Use of the antibiotic lock protocol decreased the average rate of CRBSI by almost 85%, avoiding an estimated 69 infections. The protocol was spread to three other dialysis units, resulting in a 24.5% reduction in mortality for dialysis patients. This improvement initiative reduced infections to below the national benchmark and reduced hospitalizations and unnecessary vascular access procedures which also translated into significant cost-savings.

For this innovative work, Henry Ford Health System won the Innovations in Healthcare Award in recognition of excellence in chronic kidney disease prevention and treatment.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Virginia Mason Provider-Employer-Payer Collaboratives Target Common Medical Conditions

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value. To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive.


Excerpted from:

At Virginia Mason, Collaboration Among Providers, Employers, and Health Plans to Transform Care Cut Costs and Improved Quality, by C. Craig Blackmore, Robert S. Mecklenburg, and Gary S. Kaplan

http://content.healthaffairs.org/content/30/9/1680.full.html

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value.

The initial task of the first marketplace collaborative was to define quality. After much deliberation, the collaborative participants decided that quality related to five key factors: patient satisfaction; the practice of evidence-based care; rapid access to care by patients; patients’ rapid return to functioning; and cost. Once the definition of quality was determined, the next step was to identify the optimal, evidence-based care for low back pain, the focus of the first collaborative. Each subsequent marketplace collaborative has selected a different condition to target for improvement. Called “clinical value streams,” these standardized clinical pathways ensure that best practices are followed and unnecessary test and treatments are eliminated.

To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive. For instance, the headache clinical value stream focused on patients with uncomplicated headache in which no other symptoms of concern were present, such as head trauma or fever. These patients typically do not require expensive imaging tests, but many were receiving them anyway. Through the collaborative process, Virginia Mason decreased the use of MRIs by 23 percent, so delays in seeing a doctor because of pending test results were minimized. New policies were implemented that allowed patients to get in to see a doctor the same day as their headache developed in 95 percent of cases. The result has been that patients with headache now score their care at an impressive 91 in terms of patient satisfaction.

At Virginia Mason, collaborative efforts among providers, payers, and employers have lead to improved care delivery according to a common definition of quality. By developing and implementing evidence-based care pathways, quality parameters are being achieved by a decrease in unnecessary care and costs, and with high patient satisfaction and rapid access.

Keywords: access, evidence-based care, clinical pathways, headache, large joint pain, low back pain, quality improvement, payer collaboration, employer collaboration, clinical value streams, marketplace collaborative, Virginia Mason Medical Center, Seattle, Washington.

FOR MORE INFORMATION:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

Intensive Primary Care Program Achieves Better Outcomes for Virginia Mason Patients

Patients with complex health needs such as diabetes, hypertension, coronary artery disease and other chronic health conditions require specializied medical attention. Care for such patients is typically uncoordinated, which often results in costly and frequent services. Recognizing this, Virginia Mason Medical Center developed an innovate primary care program for this population that has resulted in better health outcomes and increased satisfaction at a lower cost.


Longer version:

Virginia Mason developed an innovative primary care program for patients with complex health needs such as diabetes, hypertension, coronary artery disease and other chronic health conditions. The Intensive Primary Care program provides focused, coordinated care for patients, resulting in better health outcomes and increased satisfaction at a lower cost. Certain patients may choose to participate, receiving care from their primary care physician, nurse care manager, and supporting care team members who provide proactive outreach, continuity of care, and support to participants via e-mail, phone, and in-person visits.

Care for patients with chronic and complex conditions is typically uncoordinated, which often results in costly and frequent services. This program provides a highly individualized and accessible form of enhanced primary care, based on treatment goals specific to each patient.

The program had its origins in a pilot, initiated by The Boeing Company, that Virginia Mason and Regence BlueShield participated in from 2007 to 2009. The pilot achieved positive results in patients’ health, functional status, and satisfaction with care. It also helped reduce health costs by more than 20 percent, primarily by decreasing hospital admissions and emergency room visits. The pilot focused on 750 Boeing employees who suffered from complex health issues, such as hypertension, diabetes, heart problems and depression.

Virginia Mason and Regence BlueShield recognize the need for health care reform, and believe that many of the answers lie in partnerships such as this. By working together, this helath care provider and insurer are demonstrating that positive change is possible — that the quality of the health care experience for patients can be improved by providing the appropriate treatments at the right time at the right cost.

The program is based on research and design work conducted by national health care improvement specialists and draws from similar new primary care models advocated by the American College of Physicians and the American Academy of Family Practitioners.

Keywords: care teams, complex health needs, chronic care management, Intensive Primary Care program, Boeing, Regence BlueShield, hospital readmissions, increased patient satisfaction, treatment goals, value, Virginia Mason Medical Center, Washington

For More Information:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

Virginia Mason’s Hospital Team Reduces Bedsores and Costs

Hospital-acquired pressure ulcers (HAPU), commonly known as bedsores, are increasingly common in hospitalized patients. To address this issue at Virginia Mason, the Zero Hospital-Acquired Pressure Ulcers team was established. The team reviewed guidance materials and brainstormed how to improve the HAPU program already in place at VM. They used the tools of the Virginia Mason Production System. They streamlined the display of the wound/skin assessment forms on the electronic medical record so a patient’s skin status is more apparent. VM recently celebrated 298 days since its last incidence of Stage 3-4 HAPU (the most serious form of bedsore), and their work met the Leapfrog Group’s high standards for reducing preventable medical errors in hospitals.


Virginia Mason’s Hospital Team Reduces Bedsores and Costs

Despite great technological and pharmacological leaps in health care in recent years, hospitals continue to struggle with the problem of hospital-acquired pressure ulcers (HAPU), commonly known as bedsores. These wounds are increasingly common in hospitalized patients, with approximately 600,000 acute care patients dying each year of HAPU complications at an estimated cost of $11 billion.

To address this issue at Virginia Mason, the Zero Hospital-Acquired Pressure Ulcers team was established. The need to reduce the incidence of pressure ulcers at Virginia Mason Hospital was clear. In 2007, the organization reported five Stage 3-4 HAPUs (the most serious type) to the Washington State Department of Health and treated many more Stage 1-2 HAPU with expensive therapies and extra days of hospitalization. The work began in the highest-risk setting for HAPU, the Critical Care Unit. The team implemented a systematic approach to identifying patients at risk of developing HAPU and established standard actions for at-risk patients. As these standards proved successful they were spread to other units. As a result, VM now stands in the top-performing group nationally for averting HAPU injuries.

How it was done.The team began by reviewing guidance materials from national groups and brainstormed how to improve the HAPU program already in place at VM. They used the tools of the Virginia Mason Production System. They streamlined the display of the wound/skin assessment forms on the electronic medical record (Cerner) so that a patient’s skin status is more apparent, which helps staff more easily identify at-risk patients who need more frequent position changes and meticulous skin care.

The team’s key strategy focused on enhancing the inspection process of patients. Inspection can lead to early, preventive action such as implementing a SKIN bundle (Surface, Keep turning, Incontinence, Nutrition) or asking for help from a wound/skin expert. In addition to developing all nurses’ HAPU-prevention competencies, the team also made advanced wound expertise more readily available on units. VM recently celebrated 298 days since its last Stage 3-4 HAPU.

Keywords: Bedsores, care teams, costs of HAPU, Cerner CPOE, Critical Care Unit, electronic medical record, EMR, hospital-acquired pressure ulcers, HAPU, Leapfrog Group, preventable medical error, skin inspection, Stage 3-4 HAPU, value, Virginia Mason Production System

For More Information:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

Improving Quality and Reducing Waste: The Virginia Mason Production System

The Virginia Mason Production System (VMPS) is a management method that seeks to continually improve how work is done within the medical center. Using this method, Virginia Mason (VM) identifies and eliminates waste and inefficiency in the many work processes that are part of the health care experience, making it possible for VM staff to deliver the highest quality and safest patient care. By streamlining repetitive and low-touch aspects of care delivery, staff members are freed to spend more time talking with, listening to and treat­ing patients. Using this methodology, VM has successfully implemented many improvements in their medical center.

The patient safety alert system at Virginia Mason, for example, has created a culture in which safety problems are quickly identified and addressed, increasing patient safety at the medical center and decreasing medical claims.VM nursing teams used VMPS to redesign their flow of work so they could focus more on patient care, and hospital emergency staff created a process that allows the team to treat more patients faster and with more efficiency.


Longer version:

Adopting VMPS in 2001 required a paradigm shift from thinking errors, inefficiencies and defects are to be expected, to believing that achieving zero defects in health care is not only possible, but also urgently necessary. VMPS uses a variety of strategies to accomplish the elimination of defects and waste, but all begin with an understanding that the medical staff who do the work know what the problems are and have the best solutions. Staff work together in one- to five-day workshops and events to brainstorm, test and implement improvement ideas. Long-term follow up ensures that changes are ingrained into the work and are actually used by the staff. Successes include:

Patient Safety Alert System.
VM used VMPS principles to develop a Patient Safety Alert (PSA) system requiring all staff who encounter a situation likely to harm a patient to make an immediate report and “stop the line” (i.e., cease any activity that could cause further harm). Since the PSA system was implemented, patient safety at VM has increased, and medical claims have dropped.

Getting Back to Nursing.
VM nursing teams used VMPS to redesign the flow of work so they could focus more on patient care. Instead of caring for patients throughout a unit, nurses now work as a team with a patient-care technician (PCT) in “cells” (groups of rooms located near each other). The cell model made it easier for nurses to monitor patients and quickly attend to needs, and communicate with each other. This reduced the number of steps walked per day from 10,000 to roughly 1,200.

Express Treatment in the Emergency Department.
Emergency departments are a major entry point for hospitals and can be a bottleneck. ED patient care is typically more expensive and involves longer wait times. Using VMPS, the ED team at Virginia Mason learned to predict appropriate staffing levels for times of greatest demand. A “team sort” process using standard clinical assessment tools to quickly identify and sort patients’ care needs was implemented. Those requiring minimal services receive express treatment and are discharged without going to patient-care beds, creating capacity for patients who require more extensive services. This work helped Virginia Mason decrease the number of hours the ED was closed and unable to receive new patients by more than 90 percent over two years. In 2011, VM will move its ED into more efficient space and the team sort process will allow the team to care for more patients.

Keywords: Care teams, ED care, eliminating waste, emergency room care, patient safety alert, prevention, safety, value, Virginia Mason Medical Center, Virginia Mason Production System, work process improvement, zero defects

For More Information:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

TeleStroke: Using Technology to Facilitate Care

Approximately 60 percent of stroke patients access their initial medical care within three hours of the onset of symptoms. The TeleStroke program of Cleveland Clinic is a distance health application that will address the issues surrounding time-critical therapeutic intervention.

TeleStroke uses videoconferencing and image transfer to connect Cleveland Clinic stroke specialists with stroke patients located within a 200-mile radius of Cleveland. The TeleStroke program provides 24/7 professional consults to bedside physicians at outlying hospitals for diagnosis and recommendation for treatment and/or transfer. When necessary, these consults — in coordination with existing staff and critical care transport — may result in transfers to Cleveland Clinic for a range of stroke interventions not available at most regional hospitals.

The well-coordinated operations between specialists at Cleveland Clinic and the frontline physicians at regional hospitals are key to the program’s success.Stroke is a significant medical burden, ranking as the third leading cause of death in the U.S. and the leading cause of long-term disability, with more than 700,000 strokes in the U.S. per year. However, significant barriers slow treatment to a large number of patients with non-hemorrhagic stroke: emergency room physicians and non-stroke neurologists are reluctant to administer the proper medicine due to potential complications; and a shortage of neurologists delays acute and consultative care. Therefore, TeleStroke provides an urgent and compelling alternative to having a stroke neurologist always present at the bedside for treatment of acute strokes.

Keywords: access,coordinated care, Cleveland Clinic, Ohio, stroke, telemedicine

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org

Reclaim Your Health: Cleveland Clinic’s Lifestyle 180 Program

Lifestyle choices that include poor nutrition and a lack of physical activity are key contributors to the development of chronic illnesses, such as heart disease, diabetes and cancer. Furthermore, these two lifestyle choices – in addition to tobacco use – account for 40 percent of all health care expenses in the United States.

Cleveland Clinic’s innovative Lifestyle 180 program was designed to halt or reverse the effects of several common chronic diseases by teaching lifestyle changes through stress management, yoga, nutrition, exercise and hands-on cooking instruction. The program accepts patients with metabolic disorders (hypertension, hyperlipidemia, obesity, and diabetes), active surveillance breast and prostate cancer, multiple sclerosis, Crohn’s disease, ulcerative colitis and fatty liver disease (NASH).

Lifestyle 180 is a year-long program consisting of 18 sessions conducted at the Cleveland Clinic Wellness Institute in Lyndhurst, Ohio. The program begins with a six-week immersion phase consisting of twice-weekly four-hour group sessions. The remaining six sessions occur at periodic intervals throughout the year.

The Lifestyle 180 pilot class was launched in October 2008. Since then, more than 300 participants have successfully completed the program. Preliminary outcomes show that patients experience a decrease in LDL and insulin levels, and waist circumference. In addition, many patients have experienced a significant reduction in medications, an increase in mobility and energy, improved stress management skills, and an overall adoption of healthier habits including increased exercise and physical activity, healthy cooking, relaxation and healthy food choices.

Another unexpected but significant outcome of Lifestyle 180 is the “multiplier effect.” Participants in the program are taking the skills learned back to their spouses, children, family, and friends which is improving the health of others as well.

Keywords: care team, chronic care, chronic disease, coordinated care, Cleveland Clinic, Lifestyle 180, prevention, lifestyle, Ohio, wellness

For more information, go to:
http://my.clevelandclinic.org/wellness/reclaim_your_health.aspx

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org

Wenatchee Valley Medical Center’s Listening Well Program Focuses on Better Patient Communication

Wenatchee Valley Medical Center is using a communication model called Listening Well to train physicians and staff to improve the efficiency of doctor/patient communication. The training includes building rapport with the patient, setting the agenda for the visit and acknowledging social or emotional cues. The ultimate goal of Listening Well is not only better communication, but ultimately better patient outcomes and higher patient satisfaction.


Wenatchee Valley Medical Center’s Listening Well Program

Doug Wilson, MD, Family Medicine physician at North Valley Family Medicine, a branch of Wenatchee Valley Medical Center (WVMC), chose an elective during his senior year of medical school that focused on communication skills. “I recognized that communicating with patients is one of the primary tools that we have for helping people to be well,” says Dr. Wilson, “So I chose to do an elective for a month with Larry Mauksch.”

Mauksch, a clinical associate professor in family medicine at the University of Washington Family Medical Center, created a communication model called Listening Well. Dr. Wilson and Mauksch found themselves working together again when WVMC adopted the model in 2006.

Six physicians trained with Mauksch, and in turn became trainers for physicians and staff. Dr. Wilson is the lead physician trainer, joined by Dr. Lisa Stone, Dr. Alan Smith, Dr. Jeff Monson, Dr. Cici Asplund, and Dr. Marcus Kubosumi. Casey Brown, RN and Sarah Battis Johnson of the WVMC Quality & Education department facilitate the trainings along with the physician trainers. They quickly realized that the model applied to all staff, not just physicians. “We saw a lot of similarities between what we were trying to do with standard rooming and standard work,” says Sarah.

The Listening Well model is based on the review of literature over a thirty year period. Three domains emerged that may enhance the efficiency of provider/patient communication:

  • rapport building
  • up-front agenda setting, and
  • acknowledging social or emotional cues

At WVMC, the program is rolled out in three phases. Phase One introduces the basic concepts and model. Training videos (featuring our own physicians and staff) demonstrate key skills and levels of expertise. Peer Observations, where the observer learns to categorize someone else’s behavior, are introduced. Observations help develop an ‘observer self’ in order to reflect on and refine your own communication skills.

Phase Two teaches skills to involve patients in setting a shared agenda at the beginning of the visit. “It’s how to structure a visit,” says Sarah.

“You have to be ready to contain and negotiate the patient’s agenda with them, up front, early in the visit,” says Dr. Wilson.
Between Phase Two and Phase Three there are more observations, but they’re interdisciplinary this time. Physicians observe receptionists, nurses observe physicians, etc. It’s a real team-building process.

Phase Three includes brainstorming and reflection on the entire process: what was learned; what worked well; ideas for continuing and improving communications skills; and implementing them into practice.

Departments have completed the initial training and the observations process is on-going. The ultimate goal of Listening Well is not only better communication, but ultimately better patient outcomes and higher patient satisfaction. Although it may not be directly related to the program, Consumer Reports named Wenatchee Valley Hospital as the number one hospital in Washington State in the area of communications, specifically how well doctors and nurses communicate with patients.

Keywords: care teams, communication, patient support, treatment, Washington, Wenatchee Valley Medical Center

FOR MORE INFORMATION:

Mall Boyd
Wenatchee Valley Medical Center
820 North Chelan Avenue
Wenatchee, WA 98801
tel. 509.663.8711, ext. 5528
mboyd@wvmedical.com
www.wvmedical.com

Tracking, Measuring, Studying and Searching Patient Care Data Over Time

The Cleveland Clinic Knowledge Program allows physicians and researchers to electronically follow, measure, study and search patient health data over time. The program can be used to track individual patient medical histories, as well as broader patient populations, using electronic medical records, a database of anonymous health information, and an innovative search engine. This ability–called the Knowledge Program–creates a complete health biography of each patient, compiling information across specialties and locations (in-patient, outpatient, rehab, etc.), medications, self-assessments, and follow-up.


Tracking, Measuring, Studying and Searching Patient Care Data Over Time
http://my.clevelandclinic.org/neurological_institute/research/knowledgeprogram.aspx

The Cleveland Clinic Knowledge Program allows physicians and researchers to electronically follow, measure, study and search patient health data over time. The program can be used to track individual patient medical histories, as well as broader patient populations, using electronic medical records, a database of anonymous health information, and an innovative search engine. For individual patients, the Knowledge Program creates a complete health biography of each patient, compiling information across specialties and locations (in-patient, outpatient, rehab, etc.), medications, self-assessments, and follow-up. Health status measures are embedded into every patient encounter, fostering customized patient care.

For broader research, the program can access segments of anonymous patient data that can be searched, studied and analyzed to better understand patient outcomes, taking into account the continuum of care — patient health awareness, delivery of care, treatment effectiveness, patient response and quality of life., As a validated approach to care using evidence-based medicine, the program allows physicians to see how patients respond to treatments, both individually and as a larger population.

The Knowledge Program was developed in Cleveland Clinic’s Neurological Institute, which treats more than 14,000 patients annually, making it one of the busiest centers for neurological diagnosis and treatment in the country. Cleveland Clinic is currently rolling out the Knowledge Program across its entire health system. Patients record self assessments in one of three ways: through MyChart (a Cleveland Clinic web-based personal health record), a hand-held electronic tablet or by a caregiver. The Program is a powerful tool when demonstrating improved efficiency and outcomes to payors, government agencies, and the public, while possibly leading to incremental improvements to standard-of-care guidelines.

Keywords: Cleveland Clinic, health information technology, evidence-based medicine, integrated delivery system, multispecialty group practice, Ohio, patient support, treatment, safety, value

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org