Working Together to Champion Patient Safety Carol Wagner Vice President Patient Safety Washington State Hospital Association Randy Benson Executive Director Rural Healthcare Quality Network

Overview:  Understand how economic turmoil and healthcare reform is making patient safety even more important  Understand how the WSHA Patient Safety Program & RHQN support rural Washington Hospitals

Interactive Session  This will be an interactive session  Please feel free to ask questions  Use of voting

Question:  At Chelan, my favorite event is the: a)Sessions and meetings b)Ice cream social c)Barbeque d)Sitting out on our patio watching the lake

Question:  I have been to this conference ___ times: a)Once, this is the first time b)2-5 times c)6-10 times d)11 or more times

Question:  Your role at your hospital is: a)Community board member b)CEO or administrator c)Physician or nursing leadership d)Other hospital leadership

Question  Is payment for care in your hospital likely to: a)Increase over the next few years b)Stay the same over the next few years c)Go down over the next few years d)I don’t know

Question:  Pressure to increase quality and safety of care is coming in our region the most strongly from: a)Media and community b)Payors c)Regulators d)Hospital staff e)Board members

Question:  Hospitals should be paid for: a)Providing a service (regardless of safety and quality) b)Providing a service safely (did not harm the patient) c)Providing a service, safely with quality (evidence based, timely care with no harm to patient) d)Don’t know

Question:  Critical Access Hospitals are currently paid for: a)Providing a service (regardless of safety and quality) b)Providing a service safely (did not harm the patient) c)Providing a service, safely with quality (evidence based, timely care with no harm to patient) d)Don’t know

Question:  Urban or PPS Hospitals are starting to be paid for: a)Providing a service (regardless of safety and quality) b)Providing a service safely (did not harm the patient) c)Providing a service, safely with quality (evidence based, timely care with no harm to patient) d)Don’t know

Healthcare Reform Philosophies  Payment for quality*, safe care  Don’t pay for harm Readmissions for 30 days Hospital acquired infections Adverse events Hospital compare *care follows the medical evidence Initially impact PPS/urban hospitals

“Rehospitalizations among Patients in the Medicare Fee-for Service Program” New England Journal of Medicine, April 2, 2009  19% of Medicare patients were rehospitalized within 30 days  50% of the 30-day readmissions, there was no physician bill between the discharge and readmission  70% of readmitted surgical patients is for a medical reason  Costing Medicare $17.4 billion a year

*Data Source: DOH Preliminary Revisit File for Q discharges with UB04 reporting. Learning from each other – Sharing best practices

TESTING SPECIFIC STRATEGIES TO REDUCE READMISSIONS Support of Commonwealth Fund and IHI Looking for approximately 10 hospitals to participate Washington Rehospitalizations

Hospital Acquired Infections 100,000 people die from hospital acquired infections each year.

Media response to MRSA and hospital acquired infections has been intense.

Question What is the most effective way that staff can prevent transmission of infection in your hospital? a)Hand hygiene b)Test all patients for MRSA c)Sterilize more equipment d)Keep visitors out so they don’t spread infections

Eliminating Hospital Acquired Infections  Hand Hygiene  Central Lines  Ventilator Associated Pneumonia  MRSA – Multidrug Resistant Organisms  Surgical Site  Urinary Catheter  Staff Immunizations

CEO and Trustee Challenge  Washing hands can reduce hospital acquired infections by 25%

 Soap and Sanitizer Usage  2008 traveled over 1,500 miles conducting “secret shopper” visits and listening to nurses!

Lessons Learned: Nurses liked the focus on hand hygiene- - important to keeping their families safe Soap containers just inside and outside the door were viewed very positively by nurses Staff were positive about seeing their results. Many staff had stories about how they had carried home organisms to their families.

Hand Hygiene on Entry to Hospitals

Sanitizer by Staff and Family Lounges

Sanitizer at Nursing Stations

Hand Hygiene Medical/Surgical Units Top Leaders (Performing at 100%) Intensive Care Units Top Leaders (Performing at 100%)  Harborview Medical Center  Pullman Regional Hospital  Swedish Medical Center - Cherry Hill  Toppenish Community Hospital  Whitman Hospital & Medical Center  Yakima Regional Medical and Cardiac Center  Harborview Medical Center  United General Hospital  Yakima Regional Medical and Cardiac Center Medical/Surgical Units Exceptional Performance Intensive Care Units Exceptional Performance  Othello Community Hospital  Lourdes Medical Center  MultiCare Health System  Providence Mount Carmel Hospital  Sunnyside Community Hospital  St. Joseph Hospital – Bellingham  Swedish Medical Center – Ballard  United General Hospital  Gray Harbor Community Hospital  MultiCare Health System  St. Joseph Hospital – Bellingham  Swedish Medical Center - Cherry Hill As of June 3, 2009

Winners to be announced at the WSHA Annual Meeting! BEST HANDS ON CARE AWARD

Kick-off Meeting  July 15, 2009 Dr. Peter Pronovost Sam Watson Meeting designed specifically to build upon the work Washington hospitals have already done…challenge us to higher levels! Eliminate infections and enhance skills to identify and eliminate defects.

The number of central line-associated blood stream infections varies among Washington hospitals.

Standardization Emergency Code Calls Isolation Precaution Signage Wristbands – if using World Health Organization Surgical Checklist WSHA Board Approved Implementation Goal October 1, 2009

Healthcare Reform Philosophies  Payment for quality*, safe care  Don’t pay for harm Readmissions for 30 days Hospital acquired infections Adverse events Hospital compare *care follows the medical evidence Initially impact PPS/urban hospitals

 Adverse events reported to the DOH are considered public information and can be disclosed to the press. a)True b)False Question:

 An adverse event must be reported to the DOH within what timeframe? a)48 hrs. of their occurrence b)21 days of their occurrence c)48 hours of you knowledge of the event d)21 days of your knowledge of the event Question:

 For every adverse event reported to the state, a Root Cause Analysis (RCA) must be completed. a)True b)False Question:

 Reporting adverse events is optional; a hospital can decide if it is really needed. a)True b)False Question:

 What percent of Washington hospitals have reported an adverse event since 2006? a)0-20% b)21-40% c)41-60% d)61-80% e)81-100% Question:

Adverse Events Support  Provide education concerning recognition of adverse events  External peer review to promote ‘best practice’ and avoid adverse events  Train staff on how to properly conduct a root cause analysis (RCA)  On-site support when RCA occurs

"External peer review, provided by the Rural Healthcare Quality Network, is invaluable to us in maintaining and enhancing quality patient care, preventing adverse events and delivering 'best practice' medicine”. Jon Smiley, CEO Sunnyside Community Hospital

RHQN providing on-site support for quality and survey readiness. Classes for administrators Training for staff Problem resolution Using Lean and Six Sigma 101 – Supporting CAH

Activities Related to Hospital Compare  Facility Education Concerning Smoking Cessation Counseling Provision of training through the Washington State Tobacco Quit Line Provision of brochures and other supplies for patient education  Facility Education Concerning Discharge Planning Documentation

Heart Failure Measures for RHQN Hospitals Q1 07Q2 07Q3 07Q4 07Q1 08Q2 08 HF - 1 Discharge Instruction59%45%62%63% 69% HF - 2 LVF Assess89%91%70%79%81% HF - 3 ACE/ARB89%91%87%90%92%94% HF - 4 Smoking65%55%74%75%69%78% RHQN Target90% Fed Target80%

Carol Wagner (206) Randy Benson (206)