Infection Reduction

Nationally, readmission within 90 days after colorectal surgery occurs in about one in four patients, at a cost of approximately $9,000 per readmission. Committed to improving its clinical and financial outcomes, MultiCare, an integrated healthcare delivery system in the Pacific Northwest, decided to focus an improvement effort on elective colorectal surgery when it recognized that patient population had a high opportunity for improvement in both clinical outcomes and cost.
Effectively using its existing quality improvement methodology and Collaborative structure, MultiCare leveraged the work of the Enhanced Recovery After Surgery (ERAS) Society and identified and implemented standardized best practice care routines and interventions that would benefit this population. By using the information in the Enterprise Data Warehouse and analytics applications to monitor clinical outcomes and compliance, and leveraging technology in the EHR to provide decision support and order sets at the point of care, MultiCare was able to significantly improve the clinical outcomes for these patients.
Results:

19 percent reduction in readmission rates.
22 percent reduction in length of stay.
85 percent reduction in infections related to colorectal surgery.

Healthcare organizations are among the most complex forms of human organization ever attempted to be managed, making transformation a daunting task. Despite the challenges associated with change, Texas Children’s Hospital identified that it needed to evolve into a data-driven outcomes improvement organization.
Texas Children’s embarked on a journey to transform care, building a three-systems approach—analytics, best practice, and adoption—designed to develop a data-driven quality improvement organization that could achieve outcomes improvement expediently and at scale across the entire organization. Texas Children’s leadership knew that the foundation for clinical systems integration would be meaningful, actionable data. That realization prompted the organization to implement the Health Catalyst Analytics Platform including a Late-Binding™ Data Warehouse (EDW) and a broad suite of analytics applications.
After deploying the analytics platform supported by multidisciplinary quality improvement teams, Texas Children’s was able to improve patient outcomes related to the following:

35 percent relative decrease in hospital-acquired conditions (HACs).
44 percent relative decrease in LOS for patients with Diabetic ketoacidosis (DKA).
30.9 percent relative reduction in recurrent DKA admissions per fiscal year.

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.
Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.
Results:

Achieved 100 percent of all at risk dollars.
100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.

Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1
Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.
The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:

$1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
23 percent reduction in central line-associated blood stream infections (CLABSIs)
74 percent reduction of pressure ulcers (PUs)
68 percent reduction in venous thromboembolisms (VTEs)

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.
In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.
Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.
Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

92 percent reduction in colorectal surgery SSI rates
28.5 percent reduction in mortality
10.6 percent reduction in 30-day readmissions
4.4 percent reduction in LOS
8.5 percent reduction in cost per case

U.S. hospital stays cost the health system at least $377.5 billion per year. In today’s value-based care environment, hospitals are under increasing pressure to avoid patient harm and maintain quality while also lowering costs. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals.
El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. However, when it came to its goal of reducing LOS, leaders recognized that they faced some major challenges, including:

The complexity of implementing a multi-layered, multi-disciplinary approach to improving the patient discharge process.
Identifying what issues were contributing the most to increased LOS so that they could be addressed.

By implementing analytics and protocols that provide access to actionable data, the LOS reduction team was able to identify patients at high risk for increased LOS so that they could develop and track critical interventions. El Camino’s patient-centered approach to tackling LOS reduction also included multi-disciplinary cooperation, leadership buy-in, and additional resources to enhance discharge care coordination.
This innovative, systematic approach resulted in not only a better than anticipated reduction in ALOS of 7.8 percent, but also:

14.8 percent reduction in readmissions
55 percent reduction in healthcare acquired conditions (HACs)
32 percent reduction in incidence of AHRQ patient safety indicators (PSIs).
$2.2 million projected annual cost savings

One in three pregnant women give birth via cesarean section in the United States, which is more than double the rate the World Health Organization (WHO) recommends. And instead of decreasing, the overall C-section rate in Washington State increased 73 percent from 1996 to 2009. C-section rates are just one area of maternal care where our practice in the U.S. lags behind the science and knowledge of best practice. MultiCare Health System believes that all of its female patients should experience the same high-quality care across its integrated delivery system. The health of the next generation depends on it.
MultiCare recognized that it had to standardize care across its system to meet quality standards, improve its patients’ experiences and outcomes, and maintain its market share. The health system launched a Women’s Collaborative, the sole purpose of which was to improve clinical care and patient outcomes for women’s services systemwide.
By working with clinicians to implement standards of care, and using analytics to measure performance, the Women’s Collaborative achieved the following:

NTSV (low-risk, rst-time mother) C-section rate 9 percent less than the national average and already below the 2022 national goal of 23.9 percent
Six-point increase in market share for inpatient OB/GYN services
Improvements in care delivery:

63 percent reduction in episiotomy rate

11 percent reduction in SSI rate for C-sections
14 percent reduction in 3rd or 4th degree perineal laceration rate
Non medically indicated induction rate consistently less than a quarter of one percent
6.7 percent reduction in the percentage of abdominal hysterectomies

Despite the preventability of healthcare associated conditions (HACs), rates continue to be unacceptably high throughout the country. Developing and implementing best-practice bundles—and tracking providers’ compliance with these bundles—has proven to be highly effective in preventing HACs. However, tracking HAC rates and bundle compliance can present a significant reporting burden. Learn how this healthcare organization has streamlined reporting and is able to identify vulnerable patients sooner, monitor clinicians’ compliance with best-practice bundles, and minimize manual chart reviews to calculate the HAC rates. With increased bundle compliance, their overall HAC rate has decreased by 35% and their CAUTI rate by 50%.

North Memorial Health Care is a 518-bed health system providing healthcare services in the Northwest metro area of Minneapolis-St. Paul, Minnesota, and beyond. The system comprises North Memorial Medical Center, a Level I Trauma Center; Maple Grove Hospital, a community-based hospital; and a network of primary, urgent care and specialty care clinics. North Memorial also operates one of the nation’s largest hospital-based air and ground ambulance services.
According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the most common type of healthcare-associated infection, causing 450,000 annual infections leading to 13,000 deaths, increasing lengths of stay by as many as four days, and increasing healthcare costs by as much as $500 million per year nationally. Seventy-five percent of UTIs are Catheter-Associated Urinary Tract Infections (CAUTIs), and 15-25 percent of hospitalized patients receive urinary catheters during their hospital stay.
To satisfy new proposed Centers for Medicare and Medicaid Services (CMS) reporting requirements, North Memorial Health Care needed to expand its CAUTI monitoring – a time- and labor-intensive process for even one unit – to track patients in all their units across multiple facilities. Their solution: leverage existing Late-Binding™ Enterprise Data Warehouse (EDW) and Patient Injury Advanced Application- CAUTI Module solutions from Health Catalyst.

Adopting an enterprise data warehouse had a number of positive affects for one medical center. Not only did they create way to more effectively discover and treat certain hospital-acquired infections, the organization also developed five steams of quality improvement—infectious disease, population health, cardiovascular, neuroscience and oncology.

Northwest healthcare organization Multicare reduced septecemia by 22 percent, leading to a $1.3 million cost savings in the same period. Now the organization is tackling other areas of improvement. Discover what triggered the improvements — and how these resulted in savings.