Infection Reduction

Successfully Sustaining Elective Colon Surgery Outcome Improvements

For healthcare organizations, sustaining improvements that have been adopted in more than one part of an organization remains a serious challenge. After improvement initiatives have been successfully implemented, it is estimated that less than 40 percent of gains are sustained in the long term. Because improvement initiatives are necessary to maintain a high standard of care, sustaining them so that further improvements can be made remains a top priority for health systems.
MultiCare Health System, a not-for-profit healthcare system serving Washington state, successfully implemented improvement efforts for patients undergoing elective colon surgery, which resulted in significant reductions in 30-day readmission, LOS, and surgical site infections (SSIs). However, without ensuring ongoing engagement, accountability, and visibility into performance, MultiCare was concerned improvements could slip away. By supporting continued monitoring powered by insights gained from relevant data, and by closely listening to provider feedback, MultiCare was able to sustain previous improvements while identifying new opportunities.
Results:

32.7 percent relative reduction in 30-day readmission rate for patients having elective colon surgery.
3.4-day median LOS for patients having elective colon surgery, sustaining previous improvement.
Among patients who had the complete enhanced recovery after surgery protocol implemented for elective colon surgery, there were no surgical site infections—for an entire year.

Collaborative, Data-Driven Approach Reduces Sepsis Mortality by 54 Percent

In the U.S., sepsis impacts more than 1.5 million people annually, of which about 250,000 will die. This accounts for one-third to one-half of all deaths for hospitalized patients. Health Quest focused on identifying ways to improve these outcomes. Despite instituting several evidence-based recommendations, the organization had not succeeded in reducing sepsis mortality to its desired rate.
Health Quest established a multidisciplinary sepsis committee to lead improvement efforts, including the use of analytics to combat sepsis mortality rates and improve patient outcomes, resulting in a:

54 percent relative reduction in sepsis mortality, saving 92 lives in 10 months.
57.1 percent relative reduction in catheter-associated urinary tract infection (CAUTI) standardized infection ratio (SIR).
30.7 percent relative reduction in C. difficile SIR.

Enhanced Recovery Program Improves Elective Colorectal Surgical Outcomes

Contemporary colorectal surgery is often associated with long LOS, high costs, and surgical site infections (SSI) approaching 20 percent. Much of the LOS variation is not attributable to patient illness or complications, but most likely represents differences in practice style. Successfully reducing SSI requires a multimodal strategy under the supervision of numerous providers with high compliance across the spectrum.
Allina Health was using established, evidence-based clinical guidelines, yet clinical variation remained high across pre-arrival, preoperative, intraoperative, and postoperative care areas, leading to substantial variation in LOS, cost of care, and the patient experience. To ensure greater consistency, Allina Health developed an enhanced recovery program (ERP) for patients undergoing elective colorectal surgery, which built standard protocols into the EHR to address elements of care from pre-arrival through post-discharge.
To facilitate the program and monitor performance, Allina Health developed an ERP analytics application with an administrative dashboard to easily visualize first-year results:

78 percent relative reduction in elective colorectal SSI rate.
19 percent relative reduction in LOS for patients with elective colorectal surgery.
82.4 percent utilization of preoperative and postoperative order sets, increasing the consistency of care and reducing unwarranted variation.

Using Data to Spotlight Variation and Transform Total Joint Care

Total Hip (THA) and Total Knee (TKA) Arthroplasty are the most prevalent surgeries for Medicare patients, numbering over 400,000 cases in 2014, costing more than seven billion dollars annually for the hospitalization alone. Today, more than seven million Americans have hip or knee implants, and the number is rising. Furthermore, substantial variation in the cost per case has raised questions about the quality of care. At Thibodaux Regional Medical Center, total joint replacement for hips and knees emerged as one of the top two cost-driving clinical areas with variation in care processes.
To address this, Thibodaux Regional maintained its focus on the IHI Triple Aim while developing organizational and clinical strategies to transform the care of patients undergoing THA and TKA. It commissioned a Care Transformation Orthopedic Team that set multiple outcome goals. Among its many efforts, the team established standard care processes, created an educational program, redesigned order sets and workflows, and deployed a joint replacement analytics application.
Thibodaux Regional reduced variability and decreased costs significantly while maintaining high levels of patient satisfaction:

76.5 percent relative reduction in complication rate for total hip and total knee replacement.
38.5 percent relative reduction in LOS for patients with total hip replacements.
23.3 percent relative reduction in LOS for patients with total knee replacement.
$815,103 cost savings, achieved in less than two years.

Designing Hospital Quality Function Around the Value Chain

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.

Comprehensive Approach to CAUTI Prevention Leads to Dramatic Reduction in Infections

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.
Results:

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.

Standardized Best Practices Improve Elective Colon Surgery Outcomes

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.

Collaborative Partnerships and a Three-System Approach to Driving Healthcare Transformation

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.

Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

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.

Reducing HAC Rates to Keep Kids Safe and Healthy

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)

Evidence-Based Care Process Model Reduces SSIs and Readmissions

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

Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs

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

How an IDS Standardized Care for Women While Increasing Market Share

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

How to Reduce Preventable Healthcare Associated Conditions in Children Using Best Practice Bundles and Analytics

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%.

How to Reduce CAUTI Costs Using a Hospital Enterprise Data Warehouse

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.

Hospital Acquired Infections – How to Reduce Surveillance Waste

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.

How to Reduce Sepsis Mortality Rates by 22 Percent

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.