TOP HONORS | HONORABLE MENTION | KAISER PERMANENTE AWARD
Honored at the CAPH Annual Conference on December 2, 2010, this year's awarded programs address five critical focus areas:
- Clinical Quality Improvement
- Improvements in Patient Experience
- Coordinated Systems of Care
- Political Effectiveness and Community Support, and,
- Efficiency and Access.
TOP HONORS:
Alameda County Medical Center
Early Identification and Treatment of Community-Acquired Pneumonia
This project, which took place at the medical center’s Highland Hospital campus, was designed to identify and treat patients with community-acquired pneumonia at an earlier stage and improve their outcomes.
Using a multi-level approach that included the Board of Trustees, executive team, department heads, providers, technicians, and ancillary staff, the project included the following elements: (1) a new Emergency Department (ED) process that utilizes a modular patient flow design; (2) a screening triage tool to identify patients with pneumonia earlier; (3) training for nursing staff in the ED to collect critical time-sensitive test such as blood cultures; (4) cues built into the EMR to identify when tests have been performed, flagging them for review; and (5) the launch of an educational campaign to improve awareness of the core measure requirements. As a result, composite pneumonia measure compliance has improved steadily and certain specific measures have had marked improvement, including prevention measures such as vaccinations and time to antibiotics, appropriate antibiotic selection and interventions such as drawing blood cultures before antibiotic administration. The steady and consistent improvement in performance each quarter over the past 18 months suggests that these practice-changing measures are reliable and sustainable.
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San Mateo Medical Center
Community Health Network for the Underserved
San Mateo Medical Center, the San Mateo County Health System and the Health Plan of San Mateo have created the Community Health Network for the Underserved (CHNU) to address the need to expand coverage for uninsured adults and the financial challenges of sustaining a growing public health care delivery system. The County sought to redefine its areas of focus and responsibility and enlist greater participation from the private provider community in serving the Medi-Cal and uninsured population. The concept was to maximize the effectiveness of each delivery system partner and best direct the community’s local tax resources devoted to health care, and build on the strengths and capacities of each participating organization.
The CHNU established a regular forum for provider leaders and County leadership to discuss key challenges in addressing the health care needs of the underserved, as well as partnerships that have expanded the role of private sector delivery systems. As a result of efforts thus far, the County has seen expanded involvement in services to the indigent and Medi-Cal populations from 10 major private provider organizations serving the County, an estimated $12 million in estimated value of partnerships and/or new funding secured to support the CHNU, and improved geographic access for up to 600 low-income women who will be delivering babies in San Mateo County.
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University of California at Davis Health System
Collaborative Chemotherapy Efficiency Project
The initial goal of this project was to reduce the length of stay for inpatient chemotherapy patients by implementing new efficiencies. The project succeeded in this goal but also was successful in improving quality and patient safety, thanks to steps taken during the course of this effort.
The project was able to reduce the time between hospital admission and the start of chemotherapy, and eliminate unnecessary admissions, in part by treating patients like “pre-op” patients – i.e., ensuring that all lab work, x-rays, and other relevant procedures were completed prior to admission. While reviewing the checklist to accomplish this objective, the project leaders also identified a problem with the quality of written chemotherapy orders and were able to improve upon this practice.
As a result of these various improvements, length of stay was reduced by more than two days and has been maintained for more than 18 months; the length of time from admission to start of chemotherapy also has decreased; and the process for writing chemotherapy orders has been completely revised. Thanks to the new chemotherapy order procedure, patient safety has been improved; 13 “near-miss errors” have been caught. This project also has enhanced both patient and staff satisfaction. The effort has now been expanded to include outpatient chemotherapy as well.
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HONORABLE MENTION:
Contra Costa Regional Medical Center
Emergency DepartmentPatient Flow Redesign
Contra Costa Regional Medical Center began an improvement project in January 2008 to increase the Emergency Department’s patient flow and efficiency. The aim was to reduce cycle time of discharged patients by bringing emergency department services closer to the patient on the front-end and reducing the number of steps in the process from arrival to discharge home or bed placement.
“Lean” principles were applied to streamline the entire emergency department front-end process to remove barriers between the patient presenting to first contact with the physician. The changes included: removing Registration from the Front-End Process and implemented bedside registration, condensing the overall nursing triage process, moving fast track from the back of the department to the front end of the department, and creating a Lab Draw Station right inside the department next to the nurses’ station. Without adding staff or space, there was a 50% reduction in patients leaving without being seen, a 20% reduction in length of stay, and a 43% decrease in the amount of time from patient’s arrival to being seen by a physician.
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ValleyCare Olive View-UCLA Medical Center
Medical Walk-In Process Flow
With the ever increasing patient population seeking urgent and non-urgent medical care at Olive View-UCLA Medical Center and the overwhelming impact it has had on emergency department services, the need to improve and streamline the Medical Walk-In (MWI) processes and operations became critical. Quality and Performance Improvement projects and exercises were implemented throughout the continuum of patient care flow processes in MWI. By redesigning many of the patient care processes, documentation tools, and physician productivity expectation in this clinical area, overall productivity rates increased. The rates of patients who came to MWI seeking care but decided to leave before being seen by a qualified medical practitioner was reduced with the interventions implemented.
To clearly assess the issues, nursing staff conducted a thorough process and patient flow analysis for all patients directed to MWI post triage. Patient flow charts of the current system were drafted and analyzed to eliminate of waste and unnecessary decision points. Utilizing quality improvement models and tools to assess all systems and functions impacting patient flow, a thorough investigation began focusing on every step of the MWI cycle and turn-around-time. The nursing and ancillary service staffing models were analyzed for safety, efficiency, and fiscal effectiveness. Physician and resident staffing and throughput practices were analyzed in collaboration with the MWI medical director.
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San Francisco General Hospital and Trauma Center
Operating Room Efficiency Project
This project sought to improve Operating Room efficiencies in order to increase the capacity to serve patients and improve access to care. The medical center set out to improve its OR throughput, eliminate bottlenecks, reduce duplication, meet increasing demands for service, and address budget constraints. It was determined that there was unused surgery capacity that could be used to meet critical needs if certain efficiencies could be put in place.
Through a grant from the California Healthcare Foundation and with assistance from the USC Viterbi School of Engineering, the hospital was able to identify many areas for improvement. The project team developed flowcharts, gathered data on patient flow, conducted focus group discussions, reviewed roles and responsibilities, and developed new standard work practices. The team used “Lean” practices as part of its effort. As a result of these efforts, the OR turnover time has been reduced by approximately 15%, “first case in room on time” has improved from 25% to 80%, and there has been a 60% reduction in overtime costs. An OR Report Card developed to track performance has enabled the hospital to sustain and even improve upon the gains accomplished. Key data from the Report Card is reviewed monthly by the OR Committee and reported to the Quality Council.
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KAISER PERMANENTE CLINICAL SYSTEMS DEVELOPMENT AWARD:
Ventura County Medical Center
Behavioral Health Service Integration into Primary Care
This project focuses on the need to coordinate Behavioral Health Care and Primary Care in the patient’s primary care home, within the safety net population. The integration of behavioral health care and primary health care has been recognized as critical to improving the health outcomes of patients, and reducing costs.
This collaboration between the Ventura County Health Care Agency’s Behavioral Health Department and the Ambulatory Care Division uses a three-pronged approach to solve this problem, within the medical home model: Co-location of the Behavioral Health with Ambulatory Care Primary Care clinics; Medication Management/Outpatient Psychiatric Consult, where the primary care physician can receive direct consultation with a behavioral health psychiatrist; and the Collaboration Project, which utilizes the evidence-based IMPACT model of collaborative care to integrate behavioral health treatment for depression into the primary care setting.
These efforts have reduced barriers to access for patients and have enhanced communication between providers. As a result of these activities, patients can now receive behavioral health care at their medical home, removing the stigma of mental illness that they may have felt, and psychiatrists have seen the volume of referrals increase. Additionally, primary care physicians are learning from the treatment strategies of their psychiatry colleagues.
Click here to learn about the QLA Webinar Series featuring three QLA awardees.
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