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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/