LOS

Success Stories

Quick Registration Dramatically Reduces Delays in ED Patient Care

Patient registration is an essential step in the emergency department (ED) workflow—it is required to initiate EHR documentation and impacts patient safety. Correctly identifying patients during registration is critical, as caregivers use historical data in the EHR to make treatment decisions.
Mission Health, as part of its ongoing performance improvement work, discovered that its registration process was lengthy—patients were waiting in line for as long as 15 minutes to be checked into the ED to receive treatment.
To improve its registration process, Mission implemented a quick registration process (e.g., asking fewer questions upon patient presentation at the ED) based on frontline staff feedback that, in a little over one year, dramatically reduced delays in ED patient care:

70 percent relative reduction in the time to complete registration, with current performance under one minute.
33 percent relative improvement in time from patient arrival to triage start time.
24 percent relative reduction in median length of stay (LOS) for discharged patients, 15 percent relative reduction for admitted patients, and 42 percent relative reduction in median LOS for behavioral health patients.

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Emergency Department Triage Redesign Dramatically Reduces Wait Times, LOS, and Left Without Being Seen Rates

Overcrowding in the emergency department (ED) has been associated with increased inpatient mortality, increased length of stay (LOS), and increased costs for admitted patients. ED wait times and left without being seen (LWBS) rates—patients who present to the ED but leave before receiving a medical evaluation—are indicators of overcrowding.
Mission Health needed to address overcrowding in its ED. The community hospital system confirmed overcrowding when it determined that approximately 4,000 patients were leaving its ED each year without being seen.
Mission implemented an improvement process to address ED overcrowding. The hospital leveraged its analytics platform to develop an ED analytics application that provided actionable, timely ED performance data to focus improvement efforts on four areas: staffing patterns, registration, triage assessment by the registered nurse (RN), and early access to a qualified medical provider.
Mission achieved significant ED performance improvements:

89 percent relative reduction in LWBS rate, with current performance at 0.4 percent.
85 percent relative reduction in percentage of patients who left before treatment complete, with current performance at 0.58 percent.
75 percent relative reduction in median door to assessment by a qualified provider, with current performance under 15 minutes.

 

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A Data-Driven Systems Approach to Improving Emergency Care

Health systems can directly impact the quality of emergency department (ED) care by reducing the time patients wait between arrival and seeing a qualified medical professional. Long ED wait times can reduce patient satisfaction and put patients at risk.
Mission Health determined that patients in its ED often waited more than 50 minutes to receive qualified medical care. To decrease this wait time, the hospital system sought to improve its ED patient flow. Using data-driven insights provided by use of its analytics platform, Mission could visualize each portion of the ED patient flow, enabling the improvement team to identify and respond to opportunities for process improvement.
Using this strategy, Mission achieved the following:

89 percent relative reduction in the rate of patients who left without being seen (LWBS), resulting in the current performance of 0.4 percent.
29 percent relative reduction in the time from discharge order to ED departure time.
24 percent relative reduction in the median length of stay (LOS) for patients who are discharged.

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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.

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Systematic Improvement of Diabetes Care in the Inpatient Setting

Texas Children’s Hospital is improving the care delivery of its patients with diabetes, one of the most common diseases in school-aged children. How? Powered by dedicated improvement teams and analytics, they have focused on order utilization, timeliness of IV and subcutaneous insulin administration, length of stay (LOS), establishing a diabetic care unit (DCU), educating core diabetic nurses (CDNs), frontline staff adoption, and more.
Care delivery improvements include the following:

94 percent of patients with diabetic ketoacidosis (DKA) are assigned to diabetic care unit.
17 percent relative increase in patients with DKA receiving an evidence-based evaluation and order sets.
19 percent relative increase in patients with DKA receiving IV insulin within one hour of order.
50 percentage point improvement in the percentage of patients transitioning to SubQ insulin in less than four hours after medical readiness.
44 percent relative decrease in LOS for patients with DKA.

 

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Improving Population Health for Children with Diabetes

Diabetes is the most common chronic illness for children living in developed countries. Leaders at Texas Children’s Hospital wanted to take a more data-driven approach to population health management for children with diabetes. They created a Care Process Team (CPT) to pursue outcomes improvements related to diabetic ketoacidosis (DKA) since data from the EDW revealed that 64% of diabetes patients discharged had this life-threatening condition.
After the CPT achieved their initial goal of improving care for patients admitted to the hospital with DKA, they set out to implement larger improvements that would benefit the entire population of diabetes patients.
By empowering CPT members, leveraging data to drive decisions, and implementing new interventions effectively, the Diabetes CPT members have improved population health for patients with diabetes across all settings of care. Below are a few of the most significant results.

44 percent relative decrease in LOS for patients with DKA.
30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
34.4 percent relative improvement in the percentage of patients with diabetes who receive the influenza vaccine.

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From the Boardroom to the Bedside—Using Analytics to Drive a Culture of Continuous Improvement

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.
Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.
Results:

20 percent improvement in compliance with severe sepsis; 32 percent reduction in mortality rates; 58 percent increase in sepsis detection.
7 percent reduction in LOS for bowel surgery patients.
34 percent improvement in heart failure LVEF assessment rates.
20 percent increase in “on time” starts as result of OR dashboard.

 

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Using Value to Prioritize and Guide Analytics Investments

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.
To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.
To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

32 percent reduction in sepsis mortality
20 percent improved compliance with the sepsis care process
7 percent reduction in LOS for bowel surgery patients

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How to Significantly Reduce Sepsis Mortality

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.

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ICU Avoidance: Lowering Costs, Patient Risk, and LOS

A stay in the intensive care unit (ICU) is both costly and risky. In a sobering example of the latter, nearly one third of patients admitted to the ICU experience delirium, a state of cognitive impairment that can increase risk of death in the hospital. Still, many cardiovascular patients need intensive care that can only be provided safely in an intensive care unit, requiring hospitals to assure enough beds and skilled ICU staff for these patients—while quickly identifying which patients can receive care as good or better in another unit.
Allina Health has achieved this dual objective with a concerted ICU avoidance strategy for specific complex sub-populations of cardiovascular (CV) patients. The foundation of this strategy is risk-informed decisions about which patients can avoid the ICU; clinical staff education; and an analytics platform and enterprise data warehouse (EDW) from Health Catalyst that enables CV care leaders to monitor safety metrics for those patients who avoid a stay in the ICU. So far, Allina Health’s efforts have resulted in the following achievements:

636 additional ICU days made available for more critically ill patients by employing ICU avoidance strategies
One-day reduction length of stay (LOS) for Transcatheter Aortic Valve Replacement (TAVR) patients
$589,000 cumulative cost savings

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Nurse-Driven Protocol Optimizes Management of Post Op Afib While Reducing LOS and Costs

Post Operative Atrial Fibrillation occurs in up to 30 percent of all patients after cardiac surgery. This serious complication increases the length of the patient’s hospital stay, and is associated with a twofold increase in the incidence of cerebral infarction and an increased risk of 30-day mortality. Timely and consistent management of Post Op Afib can prevent significant complications and help prevent death. To standardize such an approach to managing Post Op Afib, Allina Health’s Minneapolis Heart Institute created a physician committee to raise consensus on and develop a protocol for Post Op Afib management.
The committee ultimately created a nurse-driven protocol and decision support algorithm linked to the health system’s electronic health record (EHR). Additionally, it uses analytics, supported by Health Catalyst’s Late-Binding™ Enterprise Data Warehouse (EDW), to track physician ordering rate, patient outcomes, and cost. This combination of people, processes, and analytics tools has made a significant difference for Allina and its patients.

Two-day reduction in ICU LOS.
5.9 percentage point reduction in ICU readmission rate.
$1.5 million savings.

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Leveraging Risk Assessment to Decrease LOS and Cost for PCI Patients

Percutaneous Cardiac Intervention (PCI) is a minimally-invasive alternative to open heart surgery—a procedure that approximately 600,000 U.S. patients will undergo this year.
Allina Health, a non-profit health system with 90+ clinics and 13 hospitals with locations throughout Minnesota and western Wisconsin, is a leading provider of the procedure in Minnesota. Allina Health discovered that major bleeding events following PCI procedures (the most common non cardiac complication of PCI), though not affecting mortality, were increasing length of stay (LOS) and cost.
To improve the quality of its PCI procedures and decrease costs, Allina Health recognized the need to accurately assess bleeding risk and then implemented best-practice interventions to prevent major bleeding events.
Already, physicians and patients have seen that these new interventions, which includes a bleeding risk assessment tool, allows clinicians to focus interventions based on risk and reduce complications. The top results from Allina Health’s interventions include:

5.3 percentage point reduction (a 21.7 percent relative reduction) in complication rate.
$1.8M cost savings.
1.4 percentage point reduction (a 36.5 percent relative reduction) in LOS for patients at high risk for bleeding who receive a closure device.

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A Service Line Approach Improves Women’s Health at UPMC

By the age of 60, more than one-third of women in the United States have had a hysterectomy. Healthcare systems across the country are recognizing that a women’s health service line offers a pathway to improving care and decreasing cost for these patients. Having accurate activity-based costing information is necessary to uncover opportunities for clinical practice improvement and cost reduction.
The University of Pittsburgh Medical Center (UPMC) made the decision to organize Women’s Health as a service line across the entire health system. UPMC fortified this approach with strong and collaborative leadership, an enterprise data warehouse, and an activity-based cost management system. The results:

20 percent reduction in inpatient length of stay for hysterectomies (over a three-year time period)
34 percent reduction in open hysterectomies
28.3 percent reduction in 30-day readmissions for hysterectomies

These results were obtained during a time when this clinical service saw a 25 percent improvement in its contribution margin.

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How to Reduce Clinical Variation and Improve Outcomes While Demonstrating a Positive ROI

Clinical variation can be frustrating for patients and their families, often leaving the impression that healthcare team members are not on the same page and don’t agree on the plan for the patient’s diagnosis or treatment. It is also costly—the Institute of Medicine estimates that $265 billion (30 percent) of healthcare spending is waste that directly results from clinical variation.
To reduce unwanted variation, Texas Children’s Hospital invested considerable resources to develop clinical standards tools, including evidence-based order sets; however, demonstrating the effectiveness and utilization of those guidelines, pathways, and order sets had been daunting. To that end, Texas Children’s deployed an analytics platform from Health Catalyst to aggregate and analyze the data needed to perform both of these critical functions.
Results:

$2,401 reduction in cost per patient with order set utilization, and an 8.4-day difference in average length of stay (LOS).
$15 million reduction in total direct variable costs in Fiscal Year 2015, $32 million anticipated reduction in Fiscal Year 2016 at the current order set usage rate, and a potential $64 million annual reduction with a hypothetical 80 percent order set usage rate.
1,629 percent return on investment (ROI).

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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

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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

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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

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Calculating the ROI of Diabetes Care Improvement

Texas Children’s Hospital has dedicated itself not only to successfully improving diabetes mellitus (DM) outcomes, but also to developing a framework for measuring the ROI of its performance improvement efforts. Texas Children’s tackled its DM initiative with a combination of technology investments and new organizational models, including an enterprise data warehouse (EDW) and analytics platform, a clinical care process team model for improving the quality and cost of care, and a diabetic care unit (DCU) staffed by a highly specialized, highly trained group of providers. Health system leaders also worked with the business school at Rice University to develop a model for measuring ROI that focused on easily quantifiable drivers. The results of this effort include substantially improved quality of care for DM patients, an increase in net revenue by a projected $232,000 annually, and an estimated ROI of 53 percent.

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How Allina Saved $13 Million By Optimizing LOS

Like most large healthcare systems throughout the country, Allina Health’s financial health improves dramatically by optimizing inpatient care for the patients it serves.
Allina recognized optimizing length of stay (LOS) was one of the key drivers of its inpatient financial performance and developed the technical infrastructure and analytic capabilities to understand LOS performance by the minute and not the day; adjust LOS to account for patient acuity and compare performance to national benchmarks; make LOS data available to clinicians across the organization in near real-time; and estimate the financial impact of LOS opportunities to enable targeted interventions for improvement.
Allina leveraged its enterprise data warehouse (EDW) and analytics platform and optimized LOS, yielding the following results in the first two years of its improvement efforts:

26,000+ inpatient days saved
$13.4 million in direct operating expenses saved
Hospital capacity (bed availability) created for 5,000+ admissions
Avoided adverse patient events and reduced the total cost of care

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Saving Lives with Best Practices and Improvements in Sepsis Care

Every year, severe sepsis impacts more than 1 million Americans, and an estimated 25 percent die from the condition. Thibodaux Regional Medical Center is committed to driving and keeping its sepsis mortality rate to less than have the national average. How is this health system achieving these outcomes? Thibodaux formed a sepsis improvement team charged with reducing sepsis mortality and lowering costs while improving the patient experience. The team implemented best-practice care protocols, an analytics system, and an adoption approach that engaged clinicians using education and data. Backed by executive leadership and guided by clear goals, the sepsis improvement initiative has achieved impressive results in just six months that include a decrease in sepsis mortality rate to half of the national average, a 3 percent reduction in average variable cost, a reduction in LOS in the ICU by one day, and a 7 percent improvement in patient satisfaction.

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One Healthcare System’s Effective Strategy to Improve Pneumonia Outcomes

MultiCare Health System, an IDS serving communities throughout Washington State, recently undertook an initiative to improve the care of, cost of, and experience for pneumonia patients. This initiative included the building of evidenced-based order sets (and driving their adoption), assigning a team of social workers called “personal health partners” to research and improve patient follow-up and communication, and deploying an analytics application to provide near real-time feedback on compliance and performance while offering a single view of patient-specific data across multiple visits and care settings, such as medication and readmission histories. Through these efforts, MultiCare has realized significant outcome improvements including reducing pneumonia readmissions by 23 percent, a 28 percent reduction in mortality rate, a 2 percent decrease in LOS, and a 6.4 percent reduction in average variable cost per patient.

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How Allina Health Improved Spine Care Variation and Outcomes

Low back pain (LBP) is a common and expensive problem. The annual cost to patients, employers, and insurers collectively exceeds $100 billion in the U.S. alone. Additionally, LBP care treatment variations, impact outcomes. In 2011, Allina Health created the Spine Institute to deliver care that supports the IHI Triple Aim in the treatment of spine disorders and LBP. All clinical disciplines involved in spine care are part of the program, and care providers follow standard spine care and management evidence-based models. Access to quality data enables Allina to measure performance across providers. With this successful spine care coordination program and advanced clinical analytics, Allina has reduced length of stay by 16 percent and post-op complications by 3.6 percent, while projecting $2.7 million in savings.

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How an IDS Improves Outcomes Using a Clinical Collaborative Structure

MultiCare, an integrated delivery system (IDS) in the Pacific Northwest, has established a Clinically Integrated Network (CIN) to serve as a model for value creation that benefits patients, providers, and payers. However, to create a truly integrated network, MultiCare needed to build a system of collaboratives—multidisciplinary, clinically focused teams charged with developing clinical care standards and pathways and then collaborating with operations to get them implemented across the enterprise—to improve outcomes in a growing range of clinical domains including Critical Care, Women’s, Surgery, Medicine, Cardiac, and Pediatric. The outcomes of this collaborative care include a 65 percent reduction in sepsis mortality rate, a 75 percent reduction in time required to approve system-wide care guidelines, and a significant contribution to a system-wide cost savings trajectory of more than $100 million over the last three years.

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Sepsis Mortality and Length of Stay: One Hospital System’s Story

Sepsis, a serious complication that strikes quickly and is often fatal, is the single most expensive condition to treat in the hospital, in part because of the longer than average stay. To reduce sepsis mortality rates, which are between 20 and 50 percent, many hospitals have established evidence based bundles comprised of antibiotic administration, lactate level monitoring and other elements of care. However, without analytics, hospitals rely on manual processes to track sepsis rates and bundle compliance. Learn how Mission Health has streamlined surveillance by 75% while experiencing a 2.6% reduction in sepsis mortality rates and an 18% reduction in length of hospital stay.

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$74M in Healthcare Operational Improvements: How Texas Children’s Hospital Is Delivering on Its Vision

Federal and state funding reductions, along with increased competition, are the latest profitability challenges facing healthcare organizations. Texas Children’s recently faced this challenge head-on when projections indicated they would fall $50 million short of what was needed to build capital reserves and to maintain their bond rating. To improve financial performance and prepare for the future, the leadership team launched a system-wide performance improvement project called “Delivering on the Vision” (DOTV). DOTV would involve increasing accessibility for patients as well as driving healthcare operation savings. Texas Children’s goal, of increasing operating margins over 18 months by achieving $60 million in savings, has been surpassed — realizing $74 million in cost savings to date.

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