Improving transitions of care from hospital to home is key to reducing readmissions for patients with pneumonia. Learn how Piedmont Healthcare used data to effectively manage care transitions and reduce readmissions in less than one year.
Every year, almost 51,000 patients die from pneumonia with pneumonia ranking as the fourth leading cause of death for the elderly. After implementing a pneumonia care pathway and analytics application, Piedmont Healthcare reduced its pneumonia mortality rate.
Publicly reported measures of healthcare quality includes the Hospital Safety Score Grades which award a letter grade representing performance for 30 evidence-based measures of patient safety. An “A” represents the best Hospital Safety Score, followed in order by “B,” “C,” “D,” and “F.” In the fall of 2014, Piedmont’s Hospital Safety Score Grade for its five hospitals included four “C’s” and a “D.” This demonstrated a need to change its approach to quality improvement and ensure proper resources were allocated and aligned with the value chain, enabling it to efficiently conduct surveillance activities, perform analysis, and facilitate sustained outcomes improvement.
To increase capacity for performing more value-added work, Piedmont leveraged its analytics platform to automate surveillance activities and monitor the effectiveness of quality improvement efforts. These tools helped Piedmont redesign its quality improvement efforts, resulting in a:
35 percent relative reduction in healthcare facility acquired infections per patient day.
50 percent reduction in the time required for peer review.
50 percent reduction in the time to implement improvement projects.
Despite being common, healthcare-associated infections are potentially deadly and carry a significant financial cost. Of healthcare associated infections, catheter-associated urinary tract infections (CAUTI) are one of the most common, despite most instances of CAUTI being preventable.
As CAUTI was determined to be one of the top five influential factors in the publicly report quality scores, Piedmont Healthcare looked to data for more visibility into factors that were contributing to CAUTI rate in an effort to permanently reduce the number of infections. By engaging staff for compliance with CAUTI prevention best practices, Piedmont has seen sustainable improvements.
50.2 percent relative reduction in CAUTI standardized infection ratio (SIR). This translates to 37 fewer patients with infections than expected.
6.7 percent relative improvement in insertion bundle compliance.
Maintenance bundle compliance improved dramatically, with nearly a three-fold increase in the percentage of patients receiving the maintenance bundle.
Increasingly, high-functioning healthcare organizations are recognizing the challenge of sustaining results following successful clinical improvement initiatives. Sepsis is a major driver of mortality in the U.S. In fact, it is estimated that up to half of all hospital deaths are linked to sepsis. After executing a successful strategy to improve outcomes for patients with sepsis, Piedmont Healthcare was determined to sustain those critical reductions in mortality, length of stay, and cost.
The health system “hardwired” process changes into the EHR, monitored performance compliance via a well-developed analytics application, and fostered strong leadership on the frontlines to champion a culture of continuous improvement. In the second year of its latest sepsis improvement effort, Piedmont was able to not only sustain, but also to further improve upon its first-year improvement results.
14.2 percent reduction in mortality for severe sepsis and septic shock translating to 68 lives saved in one year.
30.7 percent improvement in number of patients receiving calculated fluid target.
$1.2 million saved in one year from decreased variable cost.
Up to 50 percent of all hospital deaths in the United States are linked to sepsis. That sepsis mortality statistic was not lost on Piedmont Healthcare, a system of six hospitals and more than 100 physician and specialist offices across greater Atlanta and North Georgia. Sepsis accounted for half of Piedmont’s mortality rate, despite years of progress in sepsis care.
Piedmont leaders recognized that they needed an innovative quality improvement methodology to spread best practices and sustain improvement, supported by an accessible source of timely, reliable, and actionable information. They therefore implemented a “core and spread” team structure to promote enterprise-wide adoption of best practices. The health system also deployed a sepsis prevention analytics application to deliver performance insight to all levels of the organization, and discovered a high correlation between better patient and financial outcomes and the number of bundle elements the patient received. Being able to tie outcomes to interventions, along with the incorporation of nurse driven protocols, resulted in sustained practice change and greater engagement from physicians, nursing and frontline staff, all the way to the Board level.
As a result, Piedmont achieved the following impressive outcomes:
5.8 percent reduction in mortality for all patients with severe sepsis and septic shock, translating to 26 lives saved in one year.
2.5 percent reduction in total inpatient length of stay (LOS).
8.2 percent reduction in variable cost per case, equating to $4.3 million saved in one year.
For patients with the severest form of sepsis, the chance of survival decreases by 7.6 percent for every hour that antimicrobial treatment is delayed. Coordinated team work and the speed with which recognition, diagnosis, and treatment of sepsis occur are critical. Health systems across the country have discovered that by successfully engaging clinicians in driving and maintaining best practice interventions they are able to save lives and improve patient outcomes. At Piedmont Healthcare, the work of educating clinicians on the importance of following sepsis care best practices had been done. The missing pieces were a well-resourced, systemwide improvement team to improve sepsis care, and a concise way to view and give timely feedback on performance based on accurate, trusted data. To fill in these missing pieces, Piedmont created a cross-representative sepsis improvement team and enabled tracking for compliance to best practices with an analytics application from Health Catalyst. Within just three months of deploying the Sepsis Improvement Application, Piedmont has accomplished significant improvements in efficiency—and completely won trust in the data. Piedmont has already identified early indications of patient outcome improvements. Initial achievements of its sepsis improvement team include deploying systemwide visibility into sepsis care performance and best practices compliance, improved acknowledgement of first alert by 19 percent across the system, and a reduction in manual data collection by 97 percent.