#HASummit14 Session #9: Texas Children’s Hospital: Applying a Three- Systems Approach to Improving Surgical Outcomes Kathy Carberry, RN Pre-Session Poll Question How long does it take to do an appendectomy (the operation itself) at your organization? a)1 to 2 hours b)2 to 3 hours c)4 to 5 hours d)Unsure or not applicable

#HASummit14 Poll Question #2 2 How long does it take for a patient who arrives in the emergency center with appendicitis to get to the OR in your organization? a)2 to 4 hours b)4 to 6 hours c)6 to 8 hours d)8 to 10 hours e)Unsure or not applicable

#HASummit14 About the organization 3 Using technology to provide higher quality, lower cost care Non-for-profit children’s healthcare Improve and streamline appendectomy care

#HASummit14 Industry Background Research has shown that the mean length of stay (LOS) for appendectomy procedures can vary significantly based on a number of factors, including severity of appendicitis, operating room availability, surgeon preferences, nursing policies, and hospital systems. 4

#HASummit14 Pain Points 5 Lack of data and lack of a prospective system for measurement Lack of teamwork and consistency in treatment of appendectomy cases Current methods involve after the fact data collection in postoperative cases No specific guidelines to apply to each appendectomy case

#HASummit14 Our Approach and Results 6

#HASummit14 Goals Improve quality of care while reducing costs Create a streamlined approach to each specific appendectomy case to ensure continuity of care Demonstrate how order sets and variation can change culture 7

#HASummit14 The Tools 8 EDW A late-binding data warehouse platform Population Analytics Advanced Application – Appendectomy Module Permanent, integrated workgroup teams Evidence- based best practices

#HASummit14 Applying a Three Systems Approach… 9 Improves measurement and analytics (an analytics system) Creates permanent cross-functional workgroup teams focused on identifying, deploying, and monitoring the effectiveness of quality improvements (a deployment system) Deploys a data-driven approach to implementing evidence-based best practices (a content system)

#HASummit14 Monitoring Appendectomy 10

#HASummit14 Wound Classification 11

#HASummit14 Appendectomy Dashboard 12

#HASummit14 Results Developed appendectomy population health analytics platform Improved patient outcomes and reduced costs through cultural transformation End-to-end workflow optimization 13

#HASummit14 Measureable Results 14 36% Reduced postoperative length of stay 19%36% 53% 19% Reduced average variable direct costs Increased order set adoption rates Increased the percentage of patients receiving recommended antibiotic as first antibiotic Decreased the time from diagnosis to surgery Increased the accuracy of surgical wound classifications 30%

#HASummit14 Future Plans Surgical hospitalist pilot in EC EC triage protocol based on PAS Same-day discharge from PACU Shared savings program pilot 15 © Used with permission. Texas Children’s Hospital.

#HASummit14 Lessons Learned 16 Cultural transformation takes time It is critically important to build relationships Multidisciplinary teams are critical to success A physician champion is essential Data is essential to know the truth

#HASummit14 Analytic Insights A Questions & Answers 17

#HASummit14 Choose one thing… 18 Write down one thing will you do differently after hearing this presentation

#HASummit14 Thank You 19

#HASummit14 20 Session Feedback Survey 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 2.What feedback or suggestions do you have?

#HASummit14 Upcoming Sessions Breakout Sessions – Wave 2 (2:30 PM – 3:15 PM) 10)Is Big Data a Big Deal…or Not? Dale Sanders, Senior Vice President, Health Catalyst Richard Proctor, General Manager, Global Healthcare & Life Sciences, Hortonworks 11)Partners Healthcare Analytic Strategy for bundled Payments and Risk Management Sreekanth Chaguturu, MD, Vice President for Population Health Management, Partners HealthCare Helen Chan, Senior Manager, Business Planning, Partners HealthCare 12)Sneak Peek: Improving Patient Engagement and Outcomes with Predictive Analytics Gregory A. Spencer, MD, CMO & CMIO, Crystal Run Healthcare Louis G. Cervone, Jr., Director of Business Intelligence, Crystal Run Healthcare 13)How a Pioneer ACO is Using Analytics to Change Heart Failure Spencer H. Kubo, MD, CMO of BioControl Medical, United Heart &Vascular Clinic, Allina Integrated Medical Network 14)Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO, Thibodaux Regional Medical Center Mark F. Hebert, MD, FACS, Surgical Specialist, Thibodaux Regional Medical Center 15)Panel – Children’s Hospitals: “Tike-mares”…Are the Monsters Under the Bed For Real? 21 Location Grand Salon Grand Ballroom A Grand Ballroom D Savoy Murano Venezia