Kathy McGowan Director/Hospital Engagement Network Vice President, Quality & Safety, GHA August 14, 2014 Center for Rural Health Quality in Georgia

2 My Inspiration

3 Hospital Engagement Network Partnership for Patients (P4P) continuation: By the end of 2014, reduce preventable all-cause harm rates by 40% readmissions by 20%

5 Aim for Safety across the Board All preventable harm must be addressed to reach the goal but these are the areas of focus to begin: – Reducing Preventable Readmissions – Adverse Drug Events (ADE) – Catheter-Associated Urinary Tract Infections (CAUTI) – Central Line Associated Blood Stream Infections (CLABSI) – Injuries from Falls and Immobility – Obstetrical Adverse Events (First: Early Elective Deliveries) – Pressure Ulcers – Surgical Site Infections – Venous Thromboembolism (VTE) – Ventilator-Associated Events (VAE)

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7 Safe Care is Not Only Important to Our Patients…. but Crucial to Hospital Success Payment for care is now based on quality not volume Value Based Purchasing – Medicare payment incentives/penalties to promote: Achievement of high quality care Annual Market update increased or reduced beginning October 2102 up to 2% by 2017 – Payment based on quality measures and Patient satisfaction (HCAPHS) – Better scores higher payments, low scores lower payments Nonpayment for Hospital Acquired Conditions – Higher payment withheld if condition not present on admission Payment penalties for readmissions

8 GA HEN’s Innovative Approach Proactive vs. Reactive Friendly Competition Reward and Recognition Results 8

2013 Patient Safety Leader’s Circle 9

New Data: GA HEN ACT Score is now 91! 10

11 March to Rapid Results Project 12.5% Reduction in CAUTI Rate 20% Reduction in Falls with Injury Rate 11

12 March to Rapid Results Winners 12 Bacon County Hospital and Health System Bleckley Memorial Hospital Coffee Regional Medical Center, Inc. Dodge County Hospital East Georgia Regional Medical Center Effingham Health System Elbert Memorial Hospital Emanuel Medical Center Floyd Polk Medical Center Higgins General Hospital

13 March to Rapid Results Winners Jasper Memorial Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital Miller County Hospital Monroe County Hospital Morgan Memorial Hospital Optim Medical Center - Jenkins Optim Medical Center - Screven Optim Medical Center - Tattnall 13

14 March to Rapid Results Winners Phoebe Worth Medical Center Pioneer Community Hospital of Early South Georgia Medical Center - Berrien County Campus Southeast Georgia Health System – Camden Southwest Georgia Regional Medical Center Sylvan Grove Hospital Upson Regional Medical Center Warm Springs Medical Center 14

15 Leading Edge Advanced Practice Topics (LEAPT) Atlanta Medical Center Chatuge Regional Hospital Crisp Regional Medical Center DeKalb Medical Center Doctors Specialty Hospital Effingham Health System Floyd Medical Center Habersham Medical Center 15

16 Leading Edge Advanced Practice Topics (LEAPT) Midtown Medical Center Newton Medical Center Northside Medical Center South Georgia Medical Center Spalding Regional Medical Center St. Mary’s Healthcare System Ty Cobb Regional Medical Center Union General Hospital University Hospital 16

17 Leading Edge Advanced Practice Topics (LEAPT) Five (5) LEAPT TopicsHospital Lead(s) SepsisBrandon Reece, Floyd Medical Center Heidi Nelson & Nancy Fulmer, University Hospital C. diffDoug Blomberg, St. Mary’s Health Care System, Inc. Culture of SafetyNancy Curdy, DeKalb Medical Center Teri Newsome, Habersham Medical Center Failure to RescueDawn Ojeda, Spalding Regional Hospital Procedural HarmTina Thomas, Ty Cobb Regional Medical Center 17

18 Quality and Patient Safety Awards CRITICAL ACCESS HOSPITALS 1 st Place Monroe County Hospital CEO: Kay Floyd– PHA Contact: Kathy Louth Patient Fall Reduction 2 nd Place Morgan Memorial Hospital CEO: Ralph Castillo – PHA Contact: Kimberly Miller Admission Medication Reconciliation Completion 3 rd Place Mitchell County Hospital CEO: LaDon Toole – PHA Contact: Robin Hayes Our Journey To Core Measure Success

19 Quality and Patient Safety Awards HOSPITALS WITH LESS THAN 100 BEDS 1 st Place Grady General Hospital CEO: LaDon Toole – PHA Contact: Crystal Ramm CAUTI: Striving for Zero 2 nd Place Habersham Medical Center CEO: Jerry Wise – PHA Contact: Teri Newsome Eliminating Elective Deliveries Less than 39 Weeks 3 rd Place Grady General Hospital CEO: LaDon Toole – PHA Contact: Crystal Ramm We are the Voice of the Unborn Baby: Our Journey to Reduce Early Elective Deliveries

20 Circle of Excellence Awards Grady General Hospital Habersham Medical Center Upson Regional Medical Center

21 Core Measures Honor Roll Chairman’s Honor Roll – Top 5% of all Georgia Hospitals (99.02 to 100) Trustee Honor Roll – Top 15% of all Georgia Hospitals (98.03 to ) Presidential Honor Roll – Top 30% of all Georgia Hospitals (96.9 to 98.02)

Core Measure Honor Roll Chairman’s Honor Roll Top 5 at 100%  Sylvan Grove Hospital  Mitchell County Hospital  Good Samaritan Hospital  Effingham Health System  Mountain Lakes Medical Center Coffee Regional Medical Center, Inc. Colquitt Regional Medical Center Crisp Regional Hospital, Inc. Higgins General Hospital Fannin Regional Hospital Gordon Hospital

Core Measure Honor Roll Trustee Honor Roll Miller County Hospital Grady General Hospital Chatuge Regional Hospital, Inc. Phoebe Sumter Medical Center Barrow Regional Medical Center Presidential Honor Roll Evans Memorial Hospital, Inc. Piedmont Mountainside Hospital Jasper Memorial Hospital

24 HCAHPS Comparison 10/1/ /30/

25 Culture of Patient Safety Survey* 25 *Data Source: 41/73 57% of CFRH hospitals reporting over 3 year period via GHA CoPS

26 Overview of Pharmacy Measure Adverse drug events account for 34.2% of all hospital acquired conditions (Partnership for Patients, 2010). One solution to reducing this harm is to utilize appropriate technology to reduce errors. Evidence suggests that processing a prescription drug order through a CPOE system cuts the likelihood of error on that order by 48%. However, technology in and of itself is not the final solution. With a larger goal of increased patient safety and medication management, it is also important to have a pharmacist enter or review the medication orders because they are the medication experts.

27 Pharmacist CPOE/Verification of Medication Orders Within 24 Hours 2 Approaches Preferred approach Numerator: Number of electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours. Denominator: Total number of electronically entered medication orders for inpatients admitted to a CAH (acute or swing-bed) during the reporting period. Alternate Approach Numerator: Number of electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours – based on the pharmacist coverage hours. Denominator: Total number of electronically entered medication orders for inpatients admitted to a CAH (acute or swing-bed) during the reporting period.

28 Seamless Care: Safe Patient Transitions Between Facilities Ensuring appropriate and timely care beyond organizational silos is essential to transforming health care.

29 Phase 3 Quality Measures: ED Transfer Communication Measures: – Administrative communication – Patient information – Vital signs – Medication information – Physician information – Nurse information – Procedures and tests

30 TeamSTEPPS Implementation  Improved team processes (e.g., Capella, et al., 2010)  Improved patient safety culture (e.g., Thomas & Galla, 2013)  Improved team performance (e.g., Weaver, et al., 2010)

31 Summary – Hospital Goals for

32 Go Georgia!! We Have Saved So Far….

Marching Forward in Days! Success Needs to Spread and Accelerate! We are up to the challenge! 33