Quality Quarterly: March 2010
Q Corp Releases Quality Report
The Partner for Quality Care: Information for a Healthy Oregon initiative has released the "Statewide Report on Health Care Quality," which covers the results of consolidated quality measurements for more than 2,200 adult primary care practitioners (PCPs) across Oregon.
Last June, individual practitioners and group practices received confidential "report cards" based on preliminary data, enabling them to compare the care their patients received in 2007 with best-practice standards and with the care provided by their peers in Oregon.
The preliminary report covered 11 nationally endorsed measures, aggregated from claims data for nearly 1.7 million patients insured by eight major health plans. The measures address care for asthma, coronary artery disease, diabetes, and depression, as well as screening for breast cancer, cervical cancer, and Chlamydia. For most measures, the data represent care provided to commercial and some Medicaid managed care patients during 2005–2007.
Partner for Quality Care is an initiative of the Oregon Health Care Quality Corporation (Q Corp). Funding comes from foundations, purchasers, and health plans, including a grant from Aligning Forces for Quality, a national program of the Robert Wood Johnson Foundation. OAHHS is represented on Q Corp's Board of Directors. More information for providers and consumers is available at www.partnerforqualitycare.org.
Joint Commission Urges Zero-defect Care
A new Joint Commission Sentinel Event Alert urges health care leaders to step up efforts to prevent errors by taking the zero-defect approach used in other high-risk industries such as aviation and nuclear energy. The Joint Commission is advocating greater involvement of health care trustees, executives, and physician leaders, contending that the overall safety and effectiveness of a health care facility depends on administrative and clinical leaders who set the tone, create the culture and drive improvements.
To view the alert, visit www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_43.htm.
Free AHA Webcasts Cover Patient Flow
The AHA is cosponsoring a series of complimentary webcasts by the Institute for Healthcare Optimization (IHO), in which hospital operations experts will address hospital-wide patient flow issues. In a unique format, a substantial part of the webcasts will be devoted to Q&A. Participants will be invited to bring forward any patient flow issues for advice from IHO faculty.
The first webcast will be on March 24 and will focus on general patient flow issues. Subsequent webcasts will address patient flow issues from various perspectives, such as inpatient nursing, emergency room and operating room.
For more information, and to register, visit www.ihoptimize.org/news-events-complimentary-webinar.htm.
IHO, founded and led by patient flow expert Eugene Litvak, Ph.D., is a nonprofit organization that focuses on the application of operations management to health care delivery.
AHRQ Offers Free Resources for Patient Education
The U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality is offering hospitals and other medical providers free copies of printed and audiovisual patient education tools. The materials cover effective health care patient guides on the benefits and risks of medications; therapies for inducing labor and for treating gestational diabetes, type 2 diabetes, high blood pressure and other conditions; preventing blood clots; and knowing what the key screening exams are.
AHRQ's free audiovisual products include podcasts and a 10-minute video on the safe and effective use of anticoagulants that can also help hospitals meet the Joint Commission Patient Safety Goal of educating patients and families about these drugs. Most patient education tools are available in Spanish. AHRQ also offers free clinician guides, also based on the results of its comparative effectiveness evidence reviews.
Viewing
To view the effective health care patient and clinician guides, go to http://effectivehealthcare.ahrq.gov and click on "Guides for Patients and Consumers" and "Guides for Clinicians."
To see all current AHRQ patient health education publications audiovisual products, hospitals should go to http://www.ahrq.gov/consumer/. For Spanish, click the link at the bottom of the Web page.
To view the safe use of anticoagulants DVD and pamphlet, go to www.ahrq.gov/consumer/btpills.htm.
Ordering
To order, call or e-mail the AHRQ Publications Clearinghouse at (800) 358-9295 or ahrqpubs@ahrq.gov.
WHO Surgical Checklist Making Oregon Hospitals Safer
Risk of surgical complications in Oregon hospitals is being cut significantly, perhaps by as much as 30 percent overall. This improvement comes because Oregon hospitals are working with a collaborative network of state agencies, health plans, and other health care organizations to adopt a strategy for surgery that is innovative, inexpensive, and effective. In the year since the state network made its commitment, 42 of Oregon's 58 acute-care hospitals that do surgery have begun implementing the World Health Organization Surgical Safety Checklist.
The Surgical Safety Checklist is a simple concept that hospitals worldwide have used to reduce complications from surgery. At certain points during a surgery, team members verify aloud that they are performing the right procedure on the right part of the right patient. Team members also confirm that the team is aware of difficult situations that may come up and that they agree on key issues after the surgery.
The Checklist process is similar to the airline industry's Cockpit (or Crew) Resource Management (CRM). Both represent changes in team communication and collaboration. In the airline industry, studies of fatal accidents showed that flight crews were unwilling to question authority of the pilot, sometimes with tragic results. The 1978 crash of United Airlines Flight 173 in east Portland is often cited in these studies. The CRM protocol made it easier for every flight crewmember to express concerns without fear. While all Oregon hospitals use checklists for surgery, these checklists are quite detailed and usually are discipline-specific. In contrast, the WHO Surgical Safety Checklist emphasizes a smaller number of highly critical items that the surgical team as a whole needs to consider and provides a way to share that information.
The speed with which this innovation is spreading in Oregon is a result of a collaborative effort by the local chapter of the Association of periOperative Registered Nurses (AORN) and the Oregon IHI Network of seven different organizations to support hospitals' adoption of the checklist.
Strong support for checklist adoption helps hospitals and surgical teams rearrange their usual process, which is not a trivial task. They have developed effective and efficient routines, and it takes a while to develop effective and efficient routines using a different process.
Oregon hospitals are already reporting how the Surgical Safety Checklist has made a difference:
- One surgical team realized that the correct blood was not available if needed. They were able to get it before the surgery.
- Another team discovered that the patient was allergic to iodine. They replaced the iodine drape over the patient, preventing a potentially serious allergic reaction.
- A surgeon learned that his patient had a recent knee surgery, so he ordered an antibiotic before a routine procedure that usually does not require one.
Atul Gawande, the Harvard surgeon who directed the Surgical Safety Checklist project for WHO, noted recently that by the end of 2009, 10 percent of American hospitals had adopted the checklist. Clearly, Oregon, with 75 percent of hospitals already adopting the WHO checklist, is among the leaders on this issue. The Oregon IHI Network is continuing to work with hospitals and expects all hospitals to be using the checklist by this time next year.
About the Oregon IHI Network
The Oregon IHI Network is a statewide hospital safety coalition, formed in 2005 in response to the Institute for Healthcare Improvement’s call to action, the 100,000 Lives Campaign. In 2009–2010, the Network’s focus is to spread the use of the World Health Organization Surgical Safety Checklist. The Network consists of Acumentra Health, CareOregon, Oregon Association of Hospitals and Health Systems (OAHHS), Oregon Medical Association (OMA), Oregon Nurses Association (ONA), Oregon Rural Healthcare Quality Network (ORHQN) and the Oregon Patient Safety Commission.
Toolkit Aims to Strengthen Transitional Care
In 2007, the Oregon IHI Network and the Oregon leadership of the Advancing Excellence in America's Nursing Homes campaign formed a Joint Committee to plan and develop cross-setting interventions for transitional care, with an initial focus on pressure ulcers. The Joint Committee convened an Advisory Panel of clinicians, educators, health plan representatives and experts from regulatory and quality improvement agencies to:
- Identify best practices for preventing or minimizing pressure ulcers in hospitals, nursing homes, community-based long-term care and home health agencies
- Develop a handoff data set of pressure ulcer-related information that would accompany patients in transition from one setting to another
These tools, with support materials such as the Braden Scale for predicting pressure ulcer risk, were compiled in a toolkit and then pilot-tested in multiple care settings in four communities. The Joint Committee and its constituent organizations have endorsed the toolkit materials as support for efforts to improve pressure ulcer prevention and care in Oregon.
To access the tool kit, visit www.acumentra.org/provider/initiatives/TC-PU-Toolkit.php.
IHI Presents Multidisciplinary Rounds How-To Guide
With multidisciplinary rounds, disciplines come together, informed by their clinical expertise, to coordinate patient care, determine care priorities, establish daily goals, and plan for potential transfer or discharge.
This patient-centered model of care has proven to be a valuable tool in improving the quality, safety, and patient experience of care. Many hospitals have demonstrated reduced patient days, reduced central line days, and increased coordination of care through the use of multidisciplinary rounds.
IHI will be providing a free call on this topic sometime in April, date TBA. In the meantime, you may want to check out the new guide on the following link: www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/HowToGuideMultidisciplinaryRounds.htm.
Please contact Diane Waldo at 503-479-6016 or email diane.waldo@oahhs.org with any questions about these topics.
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