Patient Care and Quality Outcomes

Deborah Bulger, CPHQ Paul Gartman

Vice President, Product Management Vice President, Product Management
Performance Management Enterprise Visibility
Learning Objectives

f Determine how IT can support an organization’s quality

performance goals
f Understand the difference between departmental
capacity management and patient flow issues that
affect the entire organization
f Learn how advanced care planning tools can help
address an initiative of the IHI: Transforming Care at
the Bedside

2
“Evidence bridge: pathways that derive estimates
of clinical outcomes from changes in process
measures.”

Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges
from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007

3
Crossing the Evidence Bridge

Strategic direction Tactical implementation

Effective care Safety

planning technology and
culture

Constituent Visible
based analysis communication
to all
stakeholders

4
Perfect Care Assessment
Identifying the Opportunity

% of “No” Responses
The higher the bar, the greater the opportunity The higher the bar…
the greater the opportunity!
63% 64%
55%

41%
f December 2007
f IHI National Forum
f 92 responses
f MD, RN, QA, Board

Mistake Proof Optimize Adopt Whole Transform

Your Patient Flow System Care at the
Processes Measures Bedside

5
Perfect Care Assessment
Identifying the Opportunity

% of “No” Responses
The higher the bar, the greater the opportunity

63% 64%
55%

“No single tool can solve every

41%
problem; often, the answer will lie in
the discovery, implementation, and
execution of several tools.”
Grout J. Mistake-proofing the design of health care processes.
AHRQ Publication No. 07-0020. May 2007.

Mistake Proof Optimize Adopt Whole Transform

Your Patient Flow System Care at the
Processes Measures Bedside

6
 Mistake Proofing Your Processes
Recognition and Prevention of Failure Points

% of “No” Responses
The higher the bar, the greater the opportunity

f Online allergies and med history

Automated med 74%
reconciliation
for each patient
f Rapid reporting of critical lab
Visiblility to 54% values
changes in pt
status f “Five rights” barcoding

Patient safety 51%

attributes

Barcode 73%
scanning

7
Removing a Failure Point
Barcode Scanning Technology
Bedside barcode scanning of meds
Rapid adoption of technology
f Quantifiable results
─ 99.7% compliance with bar-code
scanning
─ 39% increase in reporting of
medication errors and near misses
─ 33% decrease in percentage of errors
causing harm
─ 48% decrease in missed doses
─ 73% decrease in extra doses
─ 63% decrease in wrong doses
─ Enhanced charge capture
─ Increased clinician satisfaction and
retention
─ Increased productivity and efficiency
─ $300,000 savings in transcription fees
─ And on… and on…
8
“Dockside to Bedside”
100% Barcoded Medication Management

9
Perfect Care Assessment
Identifying the Opportunity

% of “No” Responses
The higher the bar, the greater the opportunity

63% 64%
55%

“A hospital is a great example of a complex adaptive

41% system. You have a number of people who are
making day-to-day, even minute-to-minute,
decisions in their own microsystem … that impact
hospital-wide patient flow, and they are making
these decisions without access to information about
the macro view, or what is going on in the rest of the
hospital.”
Kirk Jensen, MD, MBA, FACEP, IHI faculty member and co-author, Leadership
for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved
Bottom Line

Mistake Proof Optimize Adopt Whole Transform

Your Patient Flow System Care at the
Processes Measures Bedside

10
 Optimize Patient Flow
System-wide Visibility to Patient Status

% of “No” Responses
The higher the bar, the greater the opportunity

Real time 35%

f One-to-one paper, verbal
census
communications create delays
Real time 61% f Departmental “micro-delays”
discharge
orders affect system-wide throughput

29%
f Lack of capacity impacts
Observation
ALOS <24 hrs organizational success

Average ED 38%
hold time <4 hrs

11
Visual Controls in Everyday Life

12
Visual Controls in Healthcare

13
 Addressing the Challenge of Capacity
and Throughput Management
f Beds are full – supply & demand misaligned
─ ED diversions
─ Medical cases crowd out more profitable surgical cases
f New Joint Commission standards around patient flow
─ Patient bed space
─ Efficiency and safety
─ Support service processes

Mid-day bed crunch due Late rounding, late test

to misalignment of results, charts
admissions, discharges. incomplete, poor
discharge planning etc.

6a 7a 8a 9a 10a 11a 12a 1p 2p 3p 4p 5p 6p 7p 12a

Peak Admission Period Peak Discharge Period

Source: Advisory Board interviews and analysis, 2006.

14
Enterprise Visibility Platform

15
 Reading the Display Board
Pending Case manager alert Transport alert
discharge

Results Observation
notification patient

Scheduled Isolation
discharge

Cleaning in
process Medications
ready

Patient location
(radiology)

Patient safety
alert

Bed reserve Hold room for

Orders maintenance
notification communication

16
One Hospital’s Success
$5.5M revenue increase within 6 months

─ Improves bed turns by 19%

─ Expands overall acute care capacity by
12%
─ Reduce ED diversions by up to 60%
─ Reduce EVS staff by up to 20%

Return on Investment analysis conducted by the Advisory Board - published June 2006

17
Perfect Care Assessment
Identifying the Opportunity

% of “No” Responses
The higher the bar, the greater the opportunity

63% 64%
55%
“By looking at macrosystem and
41% microsystem measures frequently—
daily, weekly, or monthly—the
organization can better monitor its
performance, find improvement
opportunities, and prevent quality
levels from eroding without anyone
noticing.”
Whole System Measures, IHI, 2007

Mistake Proof Optimize Adopt Whole Transform

Your Patient Flow System Care at the
Processes Measures Bedside

18
 Adopt Whole System Measures
Meaningful Information to Sustain Improvement

% of “No” Responses
The higher the bar, the greater the opportunity

f Data rich, information poor

Automated data 65%
collection f IT investment should decrease
manual collection – but doesn’t
"Are we getting 46%
f Increasing regulatory
better?"
requirements
Constituent 74%
based metrics

Single "source 72%

of truth"

19
Removing Data Silos
Source data Data warehouse & Publication & analysis of
integration healthcare applications results
Information transparency
Medication safety
HIS
analysis

Financial DSS Surgical cost &

quality Dashboards

Payroll Productivity and Scorecards

profitability

Med administration Patient safety

Graphs Radar Charts
Grouping and
Patient experience reimbursement Actionable insight

Departmental
Surgery IS initiatives
Control charts Document links
Hospital-wide
Laboratory IS initiatives

Action Triggers Work lists

20
 Constituent-based Metrics
C Suite, Board

f Highest level, composite metrics

f Month-over-month trends
f Links to accountable staff

Nursing Executive
f Drill by unit, caregiver, drug, date, time,
etc., so manager can take immediate
action
f Metrics updated after each shift
f Principled action triggers

Quality Manager
f Criteria-based review lists
f Streamlined case review

21
Perfect Care Assessment
Identifying the Opportunity

% of “No” Responses
The higher the bar, the greater the opportunity

63% 64%
55%

41%
“Patients say ‘They give me exactly
what I want (need) exactly when I
want (need it).”
Rutherford, et al, Transforming Care at the Bedside, IHI, 2004

Mistake Proof Optimize Adopt Whole Transform

Your Patient Flow System Care at the
Processes Measures Bedside

22
 Transform Care at the Bedside
Evidence-based, Interdisciplinary Care Delivery

% of “No” Responses
The higher the bar, the greater the opportunity

f Automated plans that drive care

Visible care 55% delivery
plan
f Integrated orders, documentation,
Access to
assessments, etc.
64%
evidence at f Prioritize activities based on
bedside patient progress
Care plans 46%
integral to pt
management

> 70% of time in 54%

direct pt care

23
Care Process Alerts
Core Measure - Patient Monitoring

Pneumonia
Patient

Antibiotic 22 min.
Overdue

24
“Evidence bridge: pathways that derive estimates
of clinical outcomes from changes in process
measures.”

Kendrick, et. al., “Crossing the Evidence Chasm: Building Evidence Bridges
from Process Changes to Clinical Outcomes.” JAMIA, May/June 2007

25
Thank you!

f How does your organization measure up?

─ Take the Quality Care Assessment in McKesson booth #3035
Feb. 25-28 at HIMSS

f Deborah Bulger deborah.bulger@mckesson.com

f Paul Gartman paul.gartman@mckesson.com

26