Two Hospitals are Co-Winners of Betsy Lehman Patient Safety Award

A Focus on Infection Prevention

Two hospitals within the UMass Memorial Health Care system each received the 2009 Betsy Lehman Patient Safety Recognition Award from the Betsy Lehman Center for Patient Safety and Medical Error Reduction, a program established under the Executive Office of Health and Human Services and housed within the Massachusetts Department of Public Health. UMass Memorial Medical Center and Marlborough Hospital were this year's co-winners.

The 2009 award focused on organizations/healthcare facilities that best demonstrated the promotion of a culture of safety in the reduction of healthcare associated infections. In addition to the primary awards, Certificates of Merit were given to Lahey Clinic's Infection Control Program, Massachusetts General Hospital and the Central Line Infection Reduction Workgroup, and Children's Hospital Boston's Neonatal Intensive Care Unit.

The Betsy Lehman Patient Safety Recognition Award was established in 2005 to recognize leadership and innovation in patient safety including public awareness, education and promotion of systems-based solutions through the implementation of best practices.

Marlborough Hospital's Achievement

At Marlborough Hospital, an interdisciplinary task force of physicians, nurses, managers, and members of the quality, infection control and radiology departments worked diligently evaluating processes, policies and equipment to integrate a series of health care "best practices" to completely eliminate central line blood stream infections in hospitalized patients. For the past 13 months, there were no central line infections at the hospital. The hospital also adopted innovative programs to ensure high levels of performance in critical efforts such as increasing hand hygiene compliance, improving inpatient pneumococcal and influenza vaccination rates, and distribution of appropriate antibiotics to prevent pneumonia in intensive care unit patients.

"We are honored to receive the distinguished Betsy Lehman award," said John Polanowicz, CEO and president of Marlborough Hospital. "We are a community hospital where many talented, highly skilled and compassionate clinical leaders are committed to outstanding quality and safety outcomes for our patients. I thank everyone for their great work and know this will propel us forward to even greater achievements."

UMass Memorial Medical Center's Achievement

UMass Memorial Medical Center's award was presented in recognition of the Division of Cardiac Surgery's accomplishments in building a culture of safety, reducing health care associated infections, enhancing data monitoring resulting in implementation of evidence-based best practices, and focusing on innovative system-based solutions to support ongoing improvement in quality and patient safety. The division has consistently demonstrated lower mortality and infection rates than the state average, and has maintained zero percent incidences of postoperative mediastinitis, a life-threatening health care-associated infection, since 2007.

"By focusing on safety, data and communication, we have established a vision of zero tolerance to any outcome that does not put patient safety first," said Stanley Tam, MD, chief of Cardiothoracic Surgery at UMass Memorial Medical Center.

"Our cardiac surgery team has been recognized as one of the best in the nation and our whole Medical Center continues to set the bar for excellence in quality outcomes and patient safety," said Walter Ettinger, MD, MBA, president of UMass Memorial Medical Center.

This year marks the first occasion that the primary award winners were members of the same health care system. "We are extremely proud to be recognized by the Betsy Lehman Center," said John O'Brien, president and CEO of UMass Memorial Health Care. "Improving quality, safety and the patient experience is paramount throughout the hospitals and physician practices of our system. I thank and congratulate everyone associated with these programs which make such a positive impact to our patients."

About the Betsy Lehman Center

The Betsy Lehman Center was formed in 2002, with the goal of improving patient safety and reducing medical errors through coordinating state agency initiatives, promoting ongoing collaboration between the public and private sectors, coordinating state and federal safety programs, and promoting patient safety through educating both health care providers and patients. The center is named for Betsy Lehman, a Boston Globe reporter who died in 1994 as the result of a chemotherapy overdose. Go to www.mass.gov/dph/betsylehman for more information.

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UMass Memorial Diabetes Scorecard

Tool used to help engage patients in their own care.

One of the biggest challenges with managing diabetes is motivating patients to take an appropriately active role in their health. To help meet this challenge, UMass Memorial Medical Center has launched a pilot program to test an innovative diabetes management "scorecard."

The scorecard contains the patient's diabetes-related health information obtained through UMass Memorial's electronic medical record system. It is presented in an easy-to-comprehend graphical format and is printed prior to each patient's visit so it can be handed to them during the check in process. Together, the doctor and the patient can then review its contents and discuss goals they hope to achieve regarding health measures specific to that patient's diabetes.

Read the full story here.

Winchester Hospital — Reducing IV-associated bloodstream infection

Executive Treatment Urged to Drive Down Infection Rates

By Jane Sherwin

Culture change requires top leadership to get engaged, collaborate with staff

Reducing catheter-related bloodstream infections remains a challenge for many hospitals. In a recent survey by the Association for Professionals in Infection Control and Epidemiology, 40 percent of respondents said their hospitals had been targeting CRBSI reduction for up to 10 years, but nearly half said CRBSI's are at least somewhat problematic at their facility and fewer than one in five reported zero infections.

Hospitals that have reduced their CRBSI rates to zero or near-zero use a straightforward five-step checklist developed by the Michigan Health & Hospital Association and Johns Hopkins University. The Hopkins checklist, as it is commonly referred to now, includes simple steps such as hand washing by all staff, but usually calls for a cultural shift toward greater equality among team members. And that requires executive commitment.

"To succeed in using the checklist, senior management needs to get visibly involved," says Gina Pugliese, R.N., vice president of the Premier Safety Institute. Pugliese suggests making scheduled rounds to the front lines to observe and offer support to staff as needed, especially in cases where physicians may resist the new process. In-house publicity is also important.

Kay Deackoff, infection prevention specialist at Winchester Hospital in Massachusetts, says the hospital went 37 months without a single ICU IV-associated bloodstream infection. "CRBSI reduction is discussed regularly at all leadership meetings and findings are cascaded to the staff level," she says. "Leaders and staff alike are empowered to make changes and implement strategies whenever appropriate for improved patient care."

South Carolina's Georgetown Hospital System reduced catheter-related infections by about five cases annually to near zero. Roy Gilbreath, M.D., vice president of medical affairs, says that CRBSI rates are followed monthly by both the hospital board and the quality council. The board delegated CRBSI reduction oversight to its harm-reduction committee.

Most implementation costs are for redesigning a process: meetings, training and monitoring for compliance, Pugliese says. Costs will vary with the size and complexity of the hospital. Gilbreath estimates Georgetown's first-year equipment expenditures at about $20,000, with half of that recurring yearly, compared with an industry estimated average cost of $30,000 per case.

The American Hospital Association is working with state associations and collaborative groups to support hospitals in CRBSI reduction. Nancy Foster, the AHA's vice president for quality and patient safety, points to the On the CUSP: Stop BSI initiative led by the Health Research and Educational Trust. HRET recently announced the availability of $5.8 million to support CUSP participants. The funds are part of an Agency for Healthcare Research and Quality grant that HRET administers.

This article 1st appeared in the September 2010 issue of HHN Magazine.

Winchester Hospital’s Hand-Hygiene Competency

An estimated 85 percent of hospital-acquired infections are due to organisms carried on the hands of personnel. As a result, Winchester Hospital has launched a hospital-wide hand hygiene competency for all employees in an effort to save patients from avoidable harm.

The competency includes reciting three opportunities for hand hygiene, communicating three infection prevention strategies (staying home if you are ill, coughing or sneezing into your elbow or sleeve, and hand hygiene), and demonstrating proper hand hygiene technique with either soap and water or alcohol-based hand gel.

To kick off the competency assessment, the hospital's senior management team had their hand hygiene practices reviewed by Pam Linzer, infection prevention specialist at Winchester Hospital. Every employee's hand hygiene competency is being assessed in their department and evaluated by a champion of Winchester Hospital's Environment of Safety Committee, a Nursing Quality Council representative, or an infection prevention champion selected within their department.

Last year, Winchester Hospital's Medical/Infectious Diseases Unit Performance Improvement Team set a goal to reduce all hospital-acquired infections due to multidrug resistant organisms (MRSA, CDIFF, VRE, or ESBL) by 50 percent (eight or more cases). Whereas 21 percent of unit employees were observed complying with hand hygiene in December 2008, the unit reached 100 percent compliance by March 2009. The monthly statistics have not fallen below 85 percent since that time.

The team achieved this goal through employee feedback, which suggested adding more Purell dispensers, making the dispensers more visible, adding wipe holders to the unit, and posting flyers about the importance of hand hygiene.
The second phase of the process, which began in April 2009, focused on the isolate practices and compliance. That month, employees of the Medical/Infectious Diseases Unit were observed complying with the use of gowns and gloves when entering a marked isolation room 50 percent of the time. Four months later, compliance had soared to 80 percent. The program is being rolled out to other units in the hospital.

Thanks to the great efforts of this team, Winchester Hospital has become a safer place for our patients and employees.

Winchester Hospital: A Focus on Outcomes

Like all hospitals, Winchester Hospital has its share of preventable harm events and, like all hospitals, it is constantly striving to improve. In 2008, Winchester Hospital experienced 108 preventable harm events in five categories: serious medication errors; surgical site infections; ventilator-associated pneumonia; falls with serious injury; and central line-associated bloodstream infections. At the close of 2010, this number had dropped to four. The goal for 2011 is zero. Winchester's passion for improvement inspired leaders at the Institute for Healthcare Improvement (IHI) to invite hospital leaders and staff to share these results at an international webinar. A team of health care leaders from Denmark that participated in the webinar subsequently sent staff members to visit Winchester Hospital to learn first-hand from our performance improvement efforts.

This article details some of Winchester Hospital's remarkable achievements.

Winchester’s Hospital to Home Care for Joint Replacement Patients

Hospital to Home Care for Elective Joint Replacement Patients

Providing high-quality post-acute care to patients recovering from an illness or injury is a critical component of the healthcare delivery system. The Medicare fee-for-service payment method has historically limited the incentive to promote integrated post-acute care where providers work together to determine the most appropriate and cost-effective care setting and then collaborate to achieve a smooth care transition.

However, a partnership between the Winchester Hospital Joint Program, Excel Orthopedics, and Winchester Home Care via a private health information exchange is changing that. Winchester Home Care is taking on reform of the current system with an integrated post-acute care management model for patients who undergo elective joint replacements.

The program was launched in 2013 with the intent of:

Breaking down post-acute care silos, and replacing them with a collaborative approach around identifying which patients are appropriate for each post-acute care setting.
Reducing rehabilitation stays and increasing the rate of discharges to home after elective joint replacement surgery.
Creating a post-acute care system that is more patient centered and that reduces the need for emergent care and rehospitalization.

An initial team identified technology (including a mechanism to communicate patient information via a secure system) and education (of all parties, including the patient) as central to the project's success.

The project launch was aided by a grant of $75,000 from The Massachusetts eHealth Institute that supported efforts to improve communication and enhance the efficiency of workflow between the orthopedic practice, pre-admission testing, and home care. In the planning phase of the eHealth project implementation, the home care team worked to begin the shift towards enabling more patients to go directly home from their surgical inpatient stay. The Mass HIway was used beginning in May 2014 and provided a seamless approach to communicating information, eliminating the manual processes set up during the implementation phase.

Critical to the effort was the identification of patients who are appropriate for discharge directly home versus a transfer to a skilled nursing facility. One of the mechanisms used to determine this for some patients is RAPT (Risk Assessment and Prediction Tool), developed by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. This tool helps determine whether a patient is a suitable candidate for an integrated program, which enables the patient to be discharged from a hospital directly to their home.

In addition, the use of a secure electronic communication system triggers a process by which an increased number of patients are enrolled in Winchester Hospital pre-surgical education (Joint Class). By increasing the number of participants in this Joint Class, patients are better educated on their options for post-acute care, with an emphasis on the option of going directly home with services after their inpatient stay. The added feature of having this secure electronic communication is that upon discharge from home care, certain clinical documents can be sent to the orthopedic office, allowing the surgeon to review the patient's progress with recovery.

The team was able to shift significantly the percentage of patients who were discharged home from their surgical inpatient stay versus discharge to a skilled rehab facility. This shift began during the planning phase for the Mass HIway implementation project and, to date, reflects a 30% increase in these patients receiving their post-surgical care at home.

According to Karen Keaney, director of Winchester Home Care, "This program has resulted in a significant increase in patients' electing to receive their post-hospitalization services in the home care setting as compared to a rehabilitation facility. Our patients have benefited from the partnership between the orthopedic practice, hospital, and home care as evidenced by excellent clinical outcomes, and, most notably, a zero readmission rate for patients admitted directly to home care from inpatient surgical hospitalization."

The Conversation Project

The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care.
Too many people are dying in a way they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.

It’s time to transform our culture so we shift from not talking about dying to talking about it. It’s time to share the way we want to live at the end of our lives. And it’s time to communicate about the kind of care we want and don’t want for ourselves.

We believe that the place for this to begin is at the kitchen table—not in the intensive care unit—with the people we love, before it’s too late.

Together we can make these difficult conversations easier. We can make sure that our own wishes and those of our loved ones are expressed and respected.
Read more…

The Conversation Starter Kit

It’s not easy to talk about how you want the end of your life to be. But it’s one of the most important conversations you can have with your loved ones.

This Starter Kit will help you get your thoughts together and then have the conversation. This isn’t about filling out Advance Directives or other medical forms. It’s about talking to your loved ones about what you or they want for end-of-life care.

Whether you’re getting ready to tell someone what you want, or you want to help someone else get ready to talk, we hope the Starter Kit will be a useful guide. We want you to be the expert on your wishes and those of your loved ones. Not the doctors or nurses.

AHRQ’s Questions Are The Answer

Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction.

Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.

Click on the AHRQ banner above to visit the site.

Honoring Choices Massachusetts

Honoring-Choices-IMAGE--2

Who We Are Honoring Choices Massachusetts is a consumer focused, nonprofit organization which informs, empowers and helps adults make a health care plan and connect to quality care that honors their choices, all through their lives.

We provide access to comprehensive health care planning information, Massachusetts planning documents, and an easy to follow three step planning guide to help adults create their own personal health care plan.

We also help adults and families connect to Community Partners who provide hands-on help and resources to help adults start a health care planning discussion, create a personal plan and connect to person-centered care. Community Partners are community groups, care professionals, and health care organizations who work together to share resources and coordinate care for adults and families in their communities.

Our mission is to ensure that Massachusetts adults, including our most vulnerable citizens, have access to early and on-going health care planning that promotes wellness and lifelong person centered care that honors their values and choices.

Leveraging Data Reports Webinar Series – Recordings Now Available

The Center for Health Information and Analysis (CHIA), Massachusetts Health and Hospital Association, Massachusetts Coalition for the Prevention of Medical Errors, and New England QIN QIO have partnered up to offer a webinar series on leveraging data reports to drive quality Improvement.

CHIA’s and New England QIN-QIOs Readmission Reports Methodology is available here...

Our 1st Session focused on CHIA’s All-Payer Hospital Specific Report. We also highlighted how a Massachusetts hospital has utilized the QIO reports to drive their readmission improvement activities.

Download presentation slides here...
Watch the recorded webinar here...

Our 2nd Session focused on the NE QIN-QIO’s Medicare, Fee for Service Hospital Specific Report. We will also highlight how a Massachusetts hospital has utilized the QIO reports to drive their readmission improvement activities.

Download the presentation slides here...
Watch the recorded webinar here...