Utilizing the Patient Safety Indicators for Improvement (Text Version)

On September 19, 2009, Anita Gottlieb made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (450 KB).

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Slide 1

Utilizing the Patient Safety Indicators for Improvement

Anita Gottlieb, MA, APN, CPHQ

St. Joseph's Mercy Health System

Hot Springs, Arkansas

Slide 2

"Great things are not done by impulse, but by a series of small things brought together"

- Vincent Van Gogh

 

Slide 3

The process: Beginning Steps

• January 2005 began reviewing PSI indicators using an interdisciplinary team
• Leadership focused on data:
  • Quality Committee of the Board, Hospital Board and System Board
• Focused on areas where we exceeded the AHRQ population rate as areas for improvement

 

Slide 4

PSI Data - January 2005

Indicator	AHRQ Rate	Facility Rate	Numerator Cases	Denominator Cases
PSI-03: Decubitus Ulcer	25.75	33.80	12	355
PSI-11: Post-op Respiratory Failure	4.29	43.01	5	147
PSI-13: Postop Sepsis	11.8	20.83	1	48

 

Slide 5

PSI - 03: Decubitus Ulcer

 

Slide 6

PSI - 03: Decubitus Ulcer

• Reviewed all cases listed in PSI for Decubitius Ulcer and found that present on admissions were not excluded especially for nursing home patients
• Even with exclusion of present on admission we still frequently exceeded the AHRQ rate

Improvement Plan

• Six Sigma Project
• Clinical Skin Team

 

Slide 7

"Lowdown on Skin"

• Projects purpose: Prevent Nosocomial Decubitus Ulcers
• Nosocomial Decubitus Ulcers patients have a longer length of stay than those patients that do not acquire a Decubitus Ulcer while hospitalized
• Length of Stay was the common Metric
  • Medicare's Geometric Length of Stay for each DRG was the standard that we used to compare both the Ulcer Group and the Non-Ulcer Group

 

Slide 8

This information from the Six Sigma project demonstrates in the first graph the risk for pressure ulcer in the patients. The second graph represents whether the daily assessment was done on those identified at risk. DMAIC (Define, Measure, Assess, Improve and Control)  was utilized for the project and the I – improve phase is where we have really placed emphasis.

 

Slide 9

Before & After Pilot Comparison

By using the Braden Scale, we compared the "Gold" Standard auditor's scores to how the RN's rated the Patients. We noted a significant improvement with the changes we implemented.

29% Improvement in Accuracy of the Braden Scale
 

 

Slide 10

Improvement strategy

The template presents in detail the action steps to support the reduction in pressure ulcers bases on the me . It is very specific and measurable. These have been implemented and the project has gone house wide.

Slide 11

What are the Financial Results?

• There cost reduction after the Six Sigma project and it was directly associated with the length of stay.
• The reductions relates to both direct cost and supplies.

 

Slide 12

Prevalence

To further exemplify our improvement in this area the data for our 2009 Prevalence study conducted by KCI is included. This slide list our facilities prevalence from 2005 until 2009 and demonstrates a reduction in facility acquired pressure ulcers. hospital. All  patients were assessed on day one and 3 day three of the study.

Slide 13

PSI - 11: Post Operative Respiratory Failure

 

Slide 14

PSI - 11: Post Operative Respiratory Failure

• Reviewed all cases listed in PSI for Respiratory Failure
• Definition of respiratory varied per physician
• Coders were given exclusion PSI criteria and implemented use of documents Review Specialist for querying the physicians
• Education provided to physicians regarding definitions of Respiratory Failure

 

Slide 15

PSI-13: Postop Sepsis
 

 

Slide 16

PSI-13: Postop Sepsis
 

• Reviewed all cases and diagnosis for sepsis were not meeting the "Surviving Sepsis Campaign" definition and guidelines
  • Our facilities rate for Sepsis over all was greater than other hospitals in our System
  • Determined some of "Sepsis" cases were being admitted to the acute units - not ICU

Previous Sepsis Six Sigma Project on Sepsis had been focused on Length of Stay

 

Slide 17

Hot Springs Six Sigma Sepsis LOS

• Solutions
  • Standardized processes for referral and evaluation for transfer to SNF/LTAC/Hospice
  • Implemented providing antibiotics within three hours
  • Removed barrier to tubing blood cultures and implemented tracking of times
• Impact
  • Reduced LOS by .92 days
  • Improved time for blood cultures to lab by 126 minutes
  • Potential financial benefit - X $

 

Slide 18

PSI Data - January2009/ 2005

Indicator	AARQ 2009	Facility 2009	Numerator Cases (09/05)	Denominator Cases (09/05)
PSI-03: Decubitus Ulcer	25.1	11.87	4 (12)	337 (355)
PSI-11: Post-op Respiratory Failure	9.02	23.81	1 (5)	42 (147)
PSI-13: Postop Sepsis	11.44	62.50	1 (1)	16 (48)

 

Slide 19

Lessons Learned

• Work on "Present on Admission" prior to October 2008 was impactful
• Six Sigma tools have impacted positively on cost savings and quality of care
• Must take small steps - it will take time and must continue monitoring to sustain

 

Slide 20

Questions

"One's destination is never a place but rather a new way of looking at things."

- Henry Miller