Quality & Process Improvements

Success Stories

Health Catalyst

Improving Transitions of Care for Patients with Pneumonia

Nationally, the readmission rate for patients over age 65 with pneumonia is 15.8 percent. Though not all hospital readmissions are preventable, high readmission rates may reflect performance on care quality, effectiveness of discharge instructions, and smooth transitioning of patients to their home or other setting.
Piedmont Healthcare wanted to standardize pneumonia care across its entire system but lacked the data it needed to identify patients who could benefit from additional transition support. Piedmont convened a care management steering committee and deployed analytics tools to generate actionable data for appropriate and effective transitions of care for its Medicare patients with pneumonia. In less than one year, it reduced its readmission rate for patients with pneumonia by 26 percent.

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Standard Approach to Early Induction of Labor Successfully Reduces Unnecessary Cesarean Deliveries

In the U.S., nearly one in three women give birth via cesarean delivery. Rates vary widely by state, ranging from a low of 23 percent to a high of nearly 40 percent. Despite the potential life-saving benefits of a cesarean, this large variation suggests that unnecessary cesarean deliveries are frequently performed and that potentially modifiable factors, such as patient preferences and practice variation among hospitals, systems, and healthcare providers, likely contribute to the high rate.
Gunnison Valley Hospital has a long history of safe obstetric care, delivering more than 150 babies annually, yet the rates of elective early induction (prior to 39 weeks gestation), primary cesarean, and Nulliparous, Term, Singleton, Vertex (NTSV) were somewhat higher than desired. With the help of analytics, Gunnison shined a light on its labor and delivery practices and developed standard procedures aimed at producing better outcomes for patients.
Results:

87 percent relative reduction in the number of elective inductions of labor prior to 39 weeks gestation.
61.1 percent relative reduction in the number of NTSV cesarean deliveries.

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Enabling Informed Surgical Choices for Breast Cancer Through Shared Decision Making

One out of every eight women in the U.S. will develop breast cancer in her lifetime, and men have a lifetime risk of one in 1,000. This year, over 3.1 million women are currently being treated or have finished treatment for breast cancer.
The Virginia Piper Cancer Institute had clear evidence-based practice guidelines that directed recommendations for early breast cancer treatment options. Even with these evidence-based recommendations, however, the organization’s mastectomy rates were higher than expected.
Recognizing the organization could do better, the breast cancer program committee endorsed the spread of shared decision making for patients with early-stage breast cancer to all Virginia Piper Cancer Institute locations. The spread of shared decision making allowed patients to receive evidence-based information early in their course of care and make informed decisions that aligned with their values and preferences.
Within nine months of implementing a standard process for shared decision-making visits, the Virginia Piper Cancer Institute clinics that have completely adopted the process have made significant progress in engaging patients with early breast cancer in the shared decision-making process:

81 percent of eligible patients (207 people) participated in shared decision-making visits.
62 percent of the shared decision-making visits were in person.
27 percent relative increase in surgical decision of lumpectomy over mastectomy.

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Shared Decision-Making Leads to Better Decisions and Improves Patient Relationships

Shared decision-making is the process by which clinicians and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence. Shared decision-making balances risk and expected outcomes with patient preferences and values, empowering patients to make informed decisions.
Project leadership at Allina Health didn’t have a way to know if shared decision-making interventions were being applied. By utilizing its analytics platform, Allina Health was able to track whether or not decision support tools were being used consistently and if shared decision-making conversations were happening, if there was variation in how and when they were being used, and if they were making a difference.
Within nine months of implementing the standard shared decision-making process Allina Health substantially increased the number of patients participating in the program:

749 patients have participated in a shared decision-making visit across the system, including:

69 percent of eligible patients with low back pain.
84 percent of eligible patients with early breast cancer.

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Data-Driven Practice Intelligence Increases Provider Engagement and Strengthens Improvement Efforts

Physicians are under increasing cost pressure from commercial health insurers and government payers. Physician groups that wish to remain independent must embrace the changes associated with the shift to value-based care, adopt new technologies to reduce and streamline costs, and demonstrate ongoing quality improvement.
Acuitas Health is a population health services organization that empowers physicians to make a successful transition to a value-based care delivery system. While the organization has the requisite expertise to provide these services to providers of care, Acuitas Health lacked the timely, actionable data required to effectively engage providers in improvement efforts.
Acuitas Health implemented the Health Catalyst® Data Operating System (DOS™) to support the development of practice intelligence profiles—comprehensive views of partner practices used by the practice intelligence team to increase provider engagement and strengthen improvement efforts.
As a result of the DOS implementation, Acuitas Health improved overall data quality to achieve significant results:

Substantial increase in provider engagement.
90 percent improvement in using data to identify improvement opportunities.
Provider- and practice-specific data, which would have previously taken months to compile, is now available daily.

 

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Dedication to Quality Improvement Delivers on the Triple Aim: Saves Tens of Millions Annually

Unwarranted variation in clinical care is costly: representing as much as $30 million of actionable savings opportunity for a typical organization. Addressing clinical care at Allina Health, however, was challenging—as a large system with limited resources, the organization struggled to standardize work to impact outcomes and reduce costs.
Allina Health’s executive team understood that, due to market and system demands, it needed sharper focus on increasing clinical value to improve financial margins. In response, the organization launched its Clinical Value Program, a systemwide effort to measure and improve clinical value. The program quantifies the value of clinical change work to improve outcomes, while reducing costs and increasing revenue for reinvestment in care.
With a data-driven, multidisciplinary team effort, Allina Health’s Clinical Value Program has improved care and delivered on the Triple Aim, achieving the following results:

More than $33 million positive margin impact by expense reduction and additional hospital in/outpatient revenue.
Identified $13 million in additional opportunities for cost reductions, which have been integrated into the health system budget plan.

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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.

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Activity-Based Costing and Clinical Service Lines Team up to Improve Financial and Clinical Outcomes

Healthcare costs continue to increase at a disproportionate rate relative to gross domestic product, and Americans are becoming increasingly aware that they aren’t getting their money’s worth. To build a sustainable healthcare system, healthcare organizations must identify and address waste and reduce the total cost of care.
UPMC recognized that the common denominator to addressing threats to sustainability is to fully understand and effectively manage costs. It implemented activity-based costing (ABC), facilitated by the Health Catalyst CORUS™ Suite, to deliver detailed and actionable cost data across the analytics environment, and support service line reporting, contract modeling, and clinical process improvement. UPMC has used this approach to effectively drive cost savings and improve clinical outcomes in many of its service lines, including Surgical Services, Women’s Health, Orthopedics, and Cardiovascular. For example:

$3M cost savings/avoidance over 2 years through the implementation of the ERAS program.
Increased insight into cost variation and drivers of inefficiency in the operating room setting.
Improved patient outcomes and quality (readmissions, complications, patient reported outcomes, patient satisfaction, etc.) for patients undergoing joint replacement.

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Application of Analytics to DNFB Improvement Effort Continues to Deliver Impressive Results

Financial challenges rank as the number one issue hospitals face, and hospital CEOs are always looking for opportunities to boost revenue through improved reimbursement. Managing discharged not final billed (DNFB) cases, where bills remain incomplete due to coding or documentation gaps, is one important way hospitals can improve financial performance. However, without analytics to support efforts, meeting a target for DNFB improvement remains a serious challenge.
Thibodaux Regional Medical Center, a 180-bed community hospital in Louisiana, invested in analytics and resources to improve their DNFB rates. By expanding the use of analytics to every aspect of the work, the hospital transformed financial improvement efforts with impressive results.
While some organizations struggle to sustain hard-won financial improvements, two years after Thibodaux Regional launched its initial DNFB improvement effort, it has sustained the initial outcomes, and further reduced AR days by 27.5 percent, while achieving these additional improvements:

$1 million in additional annual reimbursement, attributable to improvements in the accuracy of clinical documentation and CMI.
66.7 percent relative reduction in DNFB dollars, significantly improving cash flow.

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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.

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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.

 
 

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Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million

CMS denies nearly 26 percent of all claims, of which up to 40 percent are never resubmitted. The bane of many healthcare systems is the inability to identify and correct the root causes of these denials, which can end up costing a single system tens of millions of dollars. Yet almost two-thirds of denials are recoverable and 90 percent are preventable.1 Despite previous initiatives, The University of Kansas Health System’s denial rate (25 percent) was higher than best practice (five percent), and leadership realized that, to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.
To effectively reduce revenue cycle and implement effective change, The University of Kansas Health System needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team.
As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months.

$3 million in recurring benefit, the direct result of denials reduction.
$4 million annualized recurring benefit.
Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.

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Advancing Health Equity – Data Driven Strategies Reduce Health Inequities

Health equity means that everyone has an equal opportunity to live the healthiest life possible – this requires removing obstacles to health. The U.S. ranks last on nearly all measures of equity, as indicated by its large, disparities in health outcomes. Illness, disability, and death in the United States are more prevalent and more severe for minority groups. Health inequities persist in Minnesota as well, which motivated Allina Health to take targeted actions to reduce inequities.
Allina Health needed actionable data to identify disparities and to reduce these inequities. This came in the form of REAL (race, ethnicity, and language) data, which Allina Health analysts used to visualize how health outcomes vary by demographic characteristics including race, ethnicity, and language.  To understand the root causes of specific disparities as well as to identify solutions within their sphere of influence as a healthcare delivery system, Allina Health consulted the literature and also consulted patients, employees and community members. Then Allina Health created appropriate interventions based on this information.
As a result, Allina Health created an awareness of the health inequities among its patient populations, as well as effective approaches to breach the barriers that were preventing these patients from getting the care they needed. While much work remains in this long journey to achieve health equity, Allina Health has taken some significant steps forward, including:

Three percent relative improvement in colorectal cancer (CRC) screening rates for targeted populations, exceeding national CRC screening rates by more than ten percentage points.
REAL data embedded in dashboards and workflow to easily identify and monitor disparities.

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Unleashing the Data to Sustain Spine Service Line Improvements

Research shows that despite an increase in the number of improvements in clinical, cost, and operational outcomes, there is a lack of sustained improvements. Some of the key challenges can be access to the data and analytics, and adherence to data-driven clinical standards, things the Allina Health Spine Clinical Service Line (CSL) clinical leadership team experienced.
By providing widespread access to the data and analytics, the Spine CSL at Allina Health has been able to continue its reduction in LOS and further improve its reduction in complications, all while increasing cost savings and achieving pay-for-performance incentives.
Results:

$1 million in pay-for-performance incentives received.
More than $2 million in supply chain savings, a result of data-driven clinical standardization.
31 percent of expected complications avoided.
22 percent relative reduction in surgical site infections.

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Blood Conservation Program Yields Millions of Dollars in Savings

Every three seconds, someone in the United States will need a blood transfusion, which adds up to nearly 17 million blood components transfused annually. Yet, evidence shows that up to 60 percent of red cell transfusions may not be necessary. In 2011, Allina Health, a healthcare delivery system that serves Minnesota and western Wisconsin, had a wide variation in transfusion practices throughout the system and a transfusion rate that was 25 percent above national benchmarks. In an effort to improve outcomes of high-risk transfusions, Allina Health turned to its data to develop an evidence-based blood conservation program aimed at reducing costs and saving valuable blood resources.
Results:

$3.2M decrease in annual blood product acquisition costs since 2011
30,283 units saved annually
111 units of red cells saved per 1000 inpatient admissions

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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.

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Data-Driven Approach Identifies Nearly $33 Million of Savings Annually

Today’s healthcare industry, in which a lack of insight into clinical variation has contributed to increased expenses, has significant opportunities to use data and analytics to improve outcomes and reduce costs. As part of its ongoing commitment to improve clinical value, Allina Health has employed a systemwide process to identify, measure, and improve clinical value. The health system has been able to quantify the value of clinical change work to improve outcomes, while reducing costs and increasing revenue for reinvestment in care.
Allina Health achieved the following meaningful results with this collaborative, data-driven opportunity analysis process:

Identified nearly $33 million in potential cost savings for the first three quarters of 2017.
Achieved over $10 million of confirmed savings during the first three quarters of the year.
Elevated discussions of cost concerns, leading to the development of standard processes, and significantly reducing unwarranted clinical variation.

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Using Data-Driven Insights to Improve Practice Management

Effective practice management includes tracking and reporting patient outcomes, and effectively managing revenue cycle, as well as keeping an eye out for market changes and growth opportunities. Well-managed practices effectively balance supply and demand on a daily, weekly, and long-term basis, actively managing encounter volume, panel size and scope, timeliness of available appointments, and payer mix.
John Muir Health faced challenges in obtaining data that would provide leaders with strategic decision support information that fostered effective practice management. John Muir Health had attempted to use its EHR to obtain this information, but discovered it was unable to meet the complex demand. As a result, the organization relied on burdensome manual work processes, resulting in delays and a backlog of data requests, and limited ability to make well-informed, data-driven decisions.
After leveraging the information within its data warehouse and analytics platform to create a network leadership encounter application, John Muir Health acquired the following capabilities:

All leaders have on-demand access to performance data at multiple levels from the organization-wide performance down to the patient and provider level.
Senior leaders are making data-driven decisions for strategic responses across John Muir Health to shifts in market, growth opportunities, and emerging markets.
The regional management teams are using the application to inform:

Daily operations.
Encounter processing
Patient access
Budget variances.

By leveraging these new capabilities, John Muir Health has achieved:

Transparency of the data and accountability of the regional management teams for key performance indicators
14 percent improvement in completed physician encounters, resulting in faster revenue capture, when compared with the previous year.
Eliminating the encounter-associated report backlog.

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Capturing the Voice of the Patient: Using PROMs Improves Shared Decision Making

Healthcare suffers from an overabundance of metrics, many of which are used to determine payment in several federal healthcare programs. While these metrics are intended to improve the quality of care that patients receive across the country, they provide no insight into how disease and treatment impact patients’ daily lives.
Partners HealthCare recognized that while it had data for patient outcomes such as mortality and morbidity, and an abundance of data for process measures, it did not have data about patient symptoms, function, or quality of life. To improve care, the healthcare system needed to engage patients to understand the impact of treatment on how patient’s felt and functioned following treatment.
Partners implemented a patient-reported outcome measures (PROMs) survey program to collect this data. Partners now has several years of experience collecting PROMs and is gaining insight into how to successfully collect and use the information to improve shared decision making with patients and their providers.

Patients have completed nearly 300,000 questionnaires in more than 20 specialties and over 75 clinics at most of Partners’ hospitals.
Clinicians actively use this data to facilitate shared decision-making with their patients.

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Improving Clinical Processes and Effectiveness of Care through Creation of a Disease-Specific Registry

Multiple Sclerosis (MS) is a disease that affects the central nervous system of about 400,000 people in the United States. With no known cure, current treatment for MS is to slow disease progression, manage symptoms and maintain the patient’s quality of life. Effective treatment of MS requires detailed patient information be readily available.
To better monitor disease progression and long-term patient outcomes, clinicians with OSF HealthCare Illinois Neurological Institute collaborated with researchers at the University of Illinois College of Medicine Peoria (UICOMP) to build a customized database.
The customized MS flowsheet registry resulted in several benefits, including:

20.9 minute reduction (per patient) physician time spent searching for data.
2.2 minute reduction (per patient) support staff time spent searching for data.
300 percent increase in investigator initiated studies.

The success of the customized database suggests possible expansion may improve outcomes in other chronic or specialty care patient populations.

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Clinically Meaningful Quality Metrics Improve the Provider Experience

Nearly half (46 percent) of all physicians report that they suffer from burnout, citing too many bureaucratic tasks as one reason. Providers want to find meaning in their work, and improvement on many current quality metrics do not predict better patient outcomes or experience of care. They are looking for tools to reduce their workload and improve their ability to provide excellent care, including having metrics and registries that are meaningful and informative.
Faced with the challenge of making quality measures meaningful, Partners HealthCare worked to redefine measures to be more relevant, create point-of-care registries to manage an all-payer population, created teams of Population Health Coordinators to support front-line teams in managing the registries, and used its analytics platform to monitor change and explore provider variation in order to improve quality. This resulted in:

85 percent of clinicians surveyed felt that the new metrics helped them take better care of their patients.
Quality improved at an unprecedented rate on an all-payer population five times bigger than the standard pay-for-performance population.
Near real-time measurement using clinical data eliminated months-long delays, while run charts and provider and clinic-comparison views turbo charged quality improvement.
125 percent increase in user adoption of the analytic tool (99 unique users, 674 unique sessions, and rising).

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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.

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Using Analytics and Technology to Improve the ED Patient Experience

Substantial evidence indicates a correlation between a patient’s experience in a healthcare setting and adherence to medical advice, appropriate use of healthcare services, and clinical outcomes. Many organizations evaluate patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey scores.
Mission Health’s patient experience survey scores in the emergency department (ED) were significantly lower than desired. Extended wait times negatively impact patient experience and perceptions of quality of care.
To improve the wait-time experience, Mission changed to a quick registration process, implemented patient notifications via text messaging, and began notifying patients of anticipated delays due to volume surges, thus better managing expectations. Text messaging also improved patient privacy, as did remodeling the waiting room to create a private registration area.
In just over a year, Mission’s ED achieved the highest patient experience ratings it had ever received:

Threefold improvement in patient ranking of:

Overall quality of care.
Provider communication.

29 percent relative reduction in time from discharge order to patient discharge.

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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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