1. Georgia Hospital Engagement Network Patient and Family Centered Safe Care Putting Patients First 40/20 by ‘13 Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012

2. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 2 The GHAREF HEN Team 2

3. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 3 Objectives Discuss Year One Results for the Georgia Hospital Engagement Network Describe the anticipated Positive Net Forward Eliminating Preventable All Cause Harm Approach Outline how your organization will implement an all cause harm approach to eliminating preventable patient harm. 3

4. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 4 Outline Welcome & Introduction State of the HEN from the National View Year 1 Results – State of the State HEN Report – Education Snapshot – Learning Collaboratives EED HAC HAI Readmission – Small Rural and Critical Access Hospital Learning Community Positive Net Forward Energy 2013 4

5. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 5 Introduction 5

6. Where We Started 6

7. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 7 Partnerships Essential to Success HEN Partners – HEN Hospitals – Community Partners – State Agency Partners – Healthcare Partners – Professional Society Partners – National Affinity Groups – Quality Improvement Partners – Other HENs 7 If we are not working together, we are not doing our job!

8. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 8 State of the GA HEN 8

9. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 9 Financial Impact: Baseline 2010 to July 2011 - June 2012 Hospital Acquired ConditionCost Per Incident Incidents ReducedCost Savings PSI3: Pressure Ulcers $109,869* 11$1,208,566 PSI12: DVT PE $64,476* 65$4,190,940 PSI 7 Central Venous Catheter-Related Bloodstream Infections $82,147* 107$8,789,729 PSI 17 Birth Trauma-Injury to Neonate $88,000* 46$4,048,000 PSI 18 Obstetric Trauma-Vaginal Delivery With Instrument $90,000* 78$7,020,000 PSI 19 Obstetric Trauma-Vaginal Delivery Without Instrument $96,000* 111$10,656,000 SSI $27,407** 5$137,035 Falls and Trauma $33,894*** 16$542,304 Catheter Associated UTI $1,750***** 26$45,500 Readmission $7,400**** 1,000$7,400,000 Sources: * AHRQ Quality Indicators Tool Kit (February 2012) ** The Joint Commission, The Joint Commission ***Studor Group 2008. - Slide 7Studor Group 2008 ****Report to the Congress: Promoting Greater Efficiency in Medicare. MedPAC, June 2007. *****Saint, el al. Ann Intern Med. 2009 June 16; 150(12): 877–884. 9

10. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 10 Results 10

11. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 11 Education - A Key Element to Promote Change January 4 – November 19 GHA HEN education facts: – 60 Educational Activities – 4,414 individuals participated – 341.25 hours of education – Average evaluation score 4.56 on a scale of 1-5 Topics included: – Evidence Based Leadership – CUSP – Reliable Process Design – Lean Six Sigma – Defects Analysis – Rounding – Transitions of Care Coordination 11

12. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 12 EED - Overview EED Action Group met in April 2012 to review 2009 data regarding EED – Key stakeholders: March of Dimes, Department of Public Health, OB/GYN Society of Georgia Atlanta Chapter, Georgia Nurses Association, and other were in attendance Developed and agreed upon plan to reduce EED’s by 40% – Ultimate overall goal for Georgia: 0% – Timely goal for August 2012: 5% or less Plan: Encourage use of “hard stops”, March of Dimes Toolkit or IHI bundles to empower nurses and schedulers 12

13. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 13 EED - Results There are 83 birthing hospitals in Georgia 58 (70%) of those hospitals turned in data 19 (31%) of the 58 hospitals were already at a 0% EED rate Of the 39 hospitals needing improvement about ½ showed significant gains!! 3 of those hospitals went from a 14% or higher EED rate to a 0% rate sustained for at least 3 months!! 13

14. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 14 EED: The Results 6

15. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 15 EED: Financial Impact According to Managed Care Magazine it costs around $41,000 for a late preterm NICU visit The incidents went from 147 incidents in March 2012 to just 32 in August 2012 That’s a decrease of 117 incidents If even a ¼ of the babies went to NICU, we saved Georgia Healthcare $1,178,750.00 OVER 1 MILLION Dollars!! 15

16. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 16 39 hospitals participated in the HAC LC Quarter 2 2012, 22 of the 39 hospitals had outcome rate above target for at least 1 of 3 conditions: 11 hospitals above target for FALLS 7 hospitals above target for DVT/PE 4 hospitals above target for PRESSURE ULCERS Medication Reconciliation 2013 HAC: Falls, Pressure Ulcers, VTEs 16

17. Learn. Act. Improve. Spread. Keep the Drum Beat Going. PSI3: Pressure Ulcer Rate Q2 - 2012 17

18. Learn. Act. Improve. Spread. Keep the Drum Beat Going. PSI12: Postoperative PE/DVT Rate Q2 - 2012 18

19. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Falls and Trauma (CMS-HAC5) Histogram Q2 - 2012 19

20. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 20 HAI: CLABSI, CAUTI, VAP, SSI First Focus : CLABSI We used what we learned from CUSP to spread to other hospitals and units Created the NICU Affinity Group to address CLABSI in the NICU CAUTI work began Device Utilization Focus – get them out! 2013: – All HAI Prevention – National SUSP Program – VAP to VAE 20

21. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 21 Our CLABSI Outcomes 21

22. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 22 CLABSI – Spread to Other Areas 22

23. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 23 NICU Affinity Group CLABSI 23

24. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 24 CAUTI Improving 24

25. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 25 VAP – Prevention Is Occurring 22 Hospitals with Zero VAP Q2 2012 Move to VAE in NHSN February 2013 25

26. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 26 Readmissions 26

27. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 27 Small Rural & Critical Access Hospitals 27

28. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 28 SMALL RURAL AND CRITICAL ACCESS Nine Learning Community Education Sessions held 60 Small Rural and Critical Access Hospitals participated – 15 Critical Access Hospitals worked on multiple topics – 18 Small Rural Hospitals worked on multiple topics – 1 Small Rural Hospital worked on all ten topics New ideas defined and studied Successful networking Variety of quality improvement topics presented 28

29. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 29 CHALLENGES Communication regarding expectations Knowledge surrounding submitting data Feedback regarding hospital-specific data Information related to participation Time commitment related to participation Physician and Staff Engagement

30. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 30 IMPROVEMENTS Data submission simplified Meeting standardization Evaluations appreciated, comments acted upon All Teach, All Learn Executive Leadership Survey Development of Executive Quality Action Council Refocus on the Voice of the Patient: Patient and Family Centered Safe Care Advisory Action Group Feedback from recognition program reviewed and triggered change

31. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 31 Positive Net Forward Energy 24 Hospitals highlighted in GHA Weekly MailGHA Weekly Mail Georgia Getting National Recognition o HEN Virtual Meeting, May 2012, Dr. William Bornstein, Emory Healthcare o National Rural Health Association Meeting, Rural Affinity Working Group Presentation, July 2012, Norma Jean Morgan, Effingham Health System o Strong Start Webinar November – EED, Lynne Hall, Vi Naylor o QNET, December 2012 Presentations  Sue Bowen, Shepherd Center  Heidi Nelson, University Hospital  Vi Naylor, Georgia HEN 31

32. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 32 Moving to Eliminate “All Cause Harm” Patient and Family Centered Safe Care Culture Emphasis on Hospital Visits and Coaching Enhancing Education opportunities Process Measure Data Submission Continues All Teach, All Learn Member Input Essential 32

33. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 33 Upcoming Educational Opportunities GHA Patient Safety Summit January 9 – 10 GHA Patient Safety Summit GHA Trustees Conference January 11 -13 GHA Trustees Conference February 2013 HEN Kickoff 33

34. Thank You for All You Do to Keep Patients Safe We Look Forward to Working With You in 2013! 34

35. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 35 Contact Information Phone: 770-249-4500 Vi Naylor: vnaylor@gha.orgvnaylor@gha.org Kathy McGowan: kmcgowan@gha.orgkmcgowan@gha.org Joyce Reid: jreid@gha.orgjreid@gha.org Denise Flook: dflook@gha.orgdflook@gha.org Faizah Muheb: fmuheb@gha.orgfmuheb@gha.org Martha Harrell: mharrell@gha.orgmharrell@gha.org Lynne Hall: lhall@gha.orglhall@gha.org Lorna Martin: lmartin@gha.orglmartin@gha.org