Partnership for Patients
Safe Deliveries Roadmap
Safe Table
November 19, 2013
Presented at Washington State Hospital Association Safe Table 11/19/2013
CME Credits
• You will receive an email with a link to the evaluation
form.
• After you complete the evaluation, you will be
redirected to a CME credit claim form where you will
enter the number of credits you are claiming.
• Once you click “submit,” you will receive your CME
certificate automatically.
Nurses can claim Category 1 credit toward
their state relicensure.
Presented at Washington State Hospital Association Safe Table 11/19/2013
Safe Tables
•Confidential
•Safe
•All teach
•All learn
Presented at Washington State Hospital Association Safe Table 11/19/2013
Partnership for Patients
• 40 – Percent reduction in harm
• 20 – Percent reduction in readmissions
• 13 – by 2013
Presented at Washington State Hospital Association Safe Table 11/19/2013
10 Targeted Strategies
Infection Reduction:
1. Catheter-associated urinary tract infections (CAUTI)
2. Central line-associated blood stream infections (CLABSI)
3. Surgical site infections (SSI)
4. Ventilator-associated pneumonia (VAP)
Nursing Care:
5. Injuries from falls and immobility
6. Pressure ulcers
High Risk:
7. Adverse drug events
8. Obstetrical adverse events
9. Venous thromboembolism or blood clots (VTE)
Continuity of Care:
10. Prevention of readmissions
Presented at Washington State Hospital Association Safe Table 11/19/2013
OB Adverse Events
• Partnership for Patients: 2012 – 2013
• Early Elective Delivery Prior to 39 Weeks
• Episiotomy
• Safe Deliveries Roadmap
• Partnership for Patients: 2014
• Early Elective Delivery Prior to 39 Weeks
• Episiotomy
• Safe Deliveries Roadmap
• Pre-eclampsia
• Hemorrhage
Presented at Washington State Hospital Association Safe Table 11/19/2013
Harm and Readmissions Reduction Results
Below the Line is Better
21%
CLABSI VAP
CAUTI
SSI
OBPressure
Readmissions
Episiotomy
Falls Ulcers OB
VTE* ADE
Achieve
by
December
2013
Baseline
2010
21%
12%
18%
Goal 20%
32%
32%
Goal 40%
89%
46%
Submission rates
for most recent
quarter:
CLABSI: 93.8%
VAP: 93.9%
CAUTI: 93.8%
SSI: 94.4%
Falls: 57.8%
Pressure Ulcers:
90.3%
EED: 84.1%
VTE: 85.2%
Readmission:
100.0%
ADE: 31.2%
Leadership,
Patient and
Family: 79.6%
54%
90%
Based on submitted data through Q2 2013 for CLABSI-ICU, CAUTI-ICU, SSI, and VAP
Based on submitted data through Q1 2013 for Falls, OB, OB-Episiotomy, Pressure Ulcers, and VTE
Based on submitted data through Q3 2012 for Readmissions
Based on submitted data through July 2013 for ADE-Anticoagulants
*Current rate is equal to baseline rate
Green – Reached Goal
Yellow – Moving in Right Direction
Red – Work to be Done
11/9/2013
Presented at Washington State Hospital Association Safe Table 11/19/2013
Progress
To date, Washington State Hospital Association hospitals working
together have achieved:
• 90% reduction in early elective deliveries – resulting in over 1,900
babies allowed to mature and $5 million in savings
• 89% reduction in ventilator-associated pneumonia from baseline –
resulting in two fewer patients experiencing ventilator-associated
pneumonia a week, saving $3.5 million
• 43% reduction in stage II, III and IV (or unstageable) pressure
ulcers– resulting one fewer patient experiencing a pressure ulcer a
week, saving $2.2 million
• 32% reduction in ICU central-line associated bloodstream
infections from baseline – resulting in one fewer patient
experiencing a central-line associated bloodstream infection a week,
saving $1 million
Presented at Washington State Hospital Association Safe Table 11/19/2013
Progress (continued)
Washington State Hospital Association hospitals working
together have achieved:
• 21% reduction in surgical site infections from baseline –
resulting in two fewer patients experiencing a surgical
infection each week, saving $2.5 million
• 18% reduction in readmissions from baseline – resulting
in over 4,000 fewer patients being readmitted to the
hospitals a year, $6 million in savings
• 12% reduction in falls – resulting in one fewer patient
falls each week, saving $1 million
Presented at Washington State Hospital Association Safe Table 11/19/2013
NEW!
Clinicians and Hospitals
Leading the Way
U.S. NEWS
• Volume of deliveries (annual)
• Average volume of deliveries per
attending provider (annual)
• Availability of an on-site neonatal
intensive care unit
• Availability of certain types of
specialists, such as neonatologists
• Midwife availability
• Rate of elective deliveries prior to 39
weeks gestational age
• Risk-adjusted rates of adverse
outcomes (maternal and/or infant)
• Risk-adjusted primary Cesareansection rate
• Risk-adjusted VBAC rate
• Episiotomy rate
• Breastfeeding rate
• Appropriate use of antenatal steroids
• Average length of stay
• Average cost
Compelling Case
• By the age of 44, most U.S. women have given birth. Four million
have a baby every year—
. In Virginia, for example,
primary C-section rates vary from under 14% to above 40%. Rates of
episiotomies, regarded by many experts as an unnecessary
procedure to expand the birth canal, range from 2.5% to more than
50%.
• We would publish the Maternity Care Indicators on
www.usnews.com, the free news-and-information website
published by U.S. News & World Report. The U.S. News site receives
more than 20 million unique visitors per month (according to
Omniture analytics), and our annual publication of "Best Hospitals"
rankings in 16 adult and 10 pediatric specialties consistently produce
some of the site's highest-traffic days.
NEW!
Partners
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American Congress of Obstetricians and Gynecologists
Association of Women’s Health, Obstetric & Neonatal Nurses
March of Dimes
Northwest Organization of Nurse Executives
Obstetrics Clinical Outcomes Assessment Program
Rural Healthcare Quality Network
Washington State Department of Health
Washington State Health Care Authority
Washington State Hospital Association – Partnership for Patients
Washington State Medical Association
Washington Perinatal Collaborative
More to Come…..
Presented at Washington State Hospital Association Safe Table 11/19/2013
Project Structure and Process
•Monthly meetings
•Bulletin board
•Newsletters
•Data reports
Advisory
LEAPT
Participating
Hospitals
Leadership
Measures
Presented at Washington State Hospital Association Safe Table 11/19/2013
Participating Hospitals
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Cascade Valley Hospital and Clinics
Central Washington Hospital
Coulee Medical Center
EvergreenHealth
Group Health Cooperative
Harrison Medical Center
Highline Medical Center
Island Hospital
Jefferson Healthcare
Kittitas Valley Healthcare
Lake Chelan Community Hospital
Legacy Salmon Creek Medical Center
Mid Valley Hospital
MultiCare Auburn Medical Center
MultiCare Good Samaritan Hospital
MultiCare Tacoma General Hospital
Newport Hospital
Othello Community Hospital
Overlake Hospital
PeaceHealth Southwest Medical Center
PeaceHealth St. Joseph Medical Center
PeaceHealth Sacred Heart Medical Center, Oregon
PMH Medical Center
Providence Holy Family Hospital
Providence Mt. Carmel Hospital
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Providence Regional Medical Center Everett
Providence Sacred Heart Medical Center & Children’s Hospital
Providence St. Mary Medical Center
Providence St. Peter Hospital
Pullman Regional Hospital
Samaritan Healthcare
Skagit Valley Hospital
St. Elizabeth Hospital
St. Francis Hospital
St. Joseph Medical Center – Franciscan Health System
Sunnyside Community Hospital & Clinics
Swedish/Ballard
Swedish /First Hill
Swedish/Edmonds
Swedish /Issaquah
Three Rivers Hospital
UW/University of Washington Medical Center
UW/Northwest Hospital & Medical Center
UW/Valley Medical Center
Valley Hospital/Rockwood Health System
Walla Walla General Hospital
Whidbey General Hospital
Whitman Hospital and Medical Center
Yakima Valley Memorial Hospital
Presented at Washington State Hospital Association Safe Table 11/19/2013
Project Leaders
Tom Benedetti, MD
Eric Knox, MD
Dale Reisner, MD
Kathleen Simpson PhD, RNC, FAAN
Presented at Washington State Hospital Association Safe Table 11/19/2013
Advisory Group
• Amy Bertone RN, Providence Health &
Services
• Angela Chien MD, Evergreen Health
• Ann Darlington CNM, Retired from Group
Health
• Bat-Sheva Stein RN, Department of Health
• Bruce Myers MD, Omak
• Deborah Castille RN, PeaceHealth
• Deborah Saner MD, Legacy Salmon Creek
• Douglas Madsen MD, PeaceHealth
• Drew Robilio MD, Franciscan Health System
• Duncan Neilson MD, Legacy Health System
• Ellen Kauffman MD, Foundation For
Healthcare Quality
• Frank Andersen MD, Providence Health &
Services
• Helen Phillips RN, Legacy Health System
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James Wallace MD, Brewster
Jane Dimer MD, Group Health
Jane Uhlir MD, Swedish
Katy Drennan MD, MultiCare
Lynn Rhett RN, Franciscan Health
System
Molly Parker MD, Port Townsend
Patrick Moran MD, Yakima
Peter Nielsen MD, Madigan
Rita Hsu MD, Wenatchee
Shelora Mangan RN, Legacy Health
System
Suzan Bishop RN, MultiCare
Susan Walker RN, University of
Washington
Tracey Kasnic RN, Central
Washington
Presented at Washington State Hospital Association Safe Table 11/19/2013
Leading Edge Advanced Practice Topics
LEAPT
• Kittitas Valley Healthcare
• Legacy Salmon Creek
Medical Center
• Overlake Medical Center
• PeaceHealth St. Joseph
Medical Center
• Providence Holy Family
Hospital
• Providence Sacred Heart
Medical Center and
Children’s Hospital
• Providence St Peter Hospital
• Samaritan Healthcare
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Swedish/Ballard
Swedish/Edmonds
Swedish/First Hill
Swedish/Issaquah
Three Rivers Hospital
UW Medicine/Northwest
Hospital & Medical Center
• UW Medicine/Valley
Medical Center
• Whidbey General Hospital
• Yakima Valley Memorial
Hospital
Presented at Washington State Hospital Association Safe Table 11/19/2013
Roll-out
• On-boarding: (July – December)
• Education
• Readiness assessment
AND, THEY’RE OFF!
• Testing: (October – December)
• Implementation: (January – December 2014)
Presented at Washington State Hospital Association Safe Table 11/19/2013
What we are learning
Since we are charting new waters:
• Implementation is messy
• Developing as we go
• Changing time-lines
• Course corrections
• We need to get more comfortable not having the
answers
“If you are not uncomfortable, you are not
learning!”
• Safety nets are necessary
Presented at Washington State Hospital Association Safe Table 11/19/2013
Ralph Stacey Matrix
Presented at Washington State Hospital Association Safe Table 11/19/2013
What we are Learning
• Everyone has something to teach/contribute
• Need to be sensitive when determining what can
be standardized and what should be customized
Presented at Washington State Hospital Association Safe Table 11/19/2013
General attitudes towards standardization:
Lessons learned from an attitude survey
“Standardiz
ation
Polyannas”
“Ambivalent”
Courtesy of Dr. Keith Georgeson
Presented at Washington State Hospital Association Safe Table 11/19/2013
“Haters”
What we are Learning
• Goodwill keeps things moving when we hit a wall
UPDATES
Presented at Washington State Hospital Association Safe Table 11/19/2013
Measures
Presented at Washington State Hospital Association Safe Table 11/19/2013
Data Sources
California Maternal Data System
Obstetrics Clinical Outcomes Assessment Program (OB COAP)
Washington State Health Data System
• Criteria
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Safe Deliveries Roadmap measures within specified period of time.
Data burden on hospitals
No duplication of data abstraction
Protection from disclosure and discovery – CQIP
Ability to drill down to individual cases for quality improvement
Hospital and system level reports
Costs with
Capability for health systems that cross state boundaries to allow all of
their hospitals to participate.
• Decision - leverage strengths of all three systems
• California Maternal Data System – Safe Deliveries Roadmap outcomes
• OB COAP – LEAPT project (to be determined)
• WA state Health Data System – support infrastructure build for future
HIGHER LOGIC
Medicaid Quality Incentive
Presented at Washington State Hospital Association Safe Table 11/19/2013
Induction Appropriateness
Numerator: number of patients undergoing a medical or non-medical
induction with documentation of consent, Bishop score and indication
Denominator: Number of patients undergoing a medical or non-medical
induction
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Documentation sources for Bishop score and induction can be taken from the consent, medical record, or checklist
available if audited by the Healthcare Authority. Hospitals are encouraged to make a part of the medical record if
possible.
Consent:
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For written consent the following is required under RCW 7.70.060(1):
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Identification of patient
Name of hospital in which treatment is to be performed
Name of attending physician
Nature, anticipated results, alternatives to and risk of proposed treatment, including nontreatment
When the proposed treatment will be given
Date and time of signing the consent
Signature of patient or patient’s representative
Witness
If hospital does not use a standard consent for all induction patients, the hospital will conduct an audit of a minimum
of thirty records randomly selected to review if all elements of consent are present. Audit must be available for the
Health Care Authority to review.
For hospitals that use on each of their induction patients a standard hospital consent that includes all elements, no
audit is needed.
Meeting Schedule
2013
• Roadmap Monthly (webcast)
• Thursday, December 5th 7:00 – 8:00 a.m.
• LEAPT Roadmap – kickoff
• Thursday, December 5th 7:00 – 8:30 a.m.
2014
• Roadmap Monthly (webcast) 7:00 – 8:00 a.m.
January 9
February 21
March 26
April 23
May 20
June 12
July 23
August 19
September 18
October 21
November 26
December 18
• Safe Tables (in-person) 9:00 a.m. – 2:30 p.m.
• April 1
• July 24
• November 20
2014 LEAPT TBA at Kickoff
Presented at Washington State Hospital Association Safe Table 11/19/2013
Thank You!
Mara Zabari, Director of Integration
Partnership for Patients
206-216-2529
maraz@wsha.org
Safe Deliveries Roadmap Website
http://www.wsha.org/0513.cfm%20
Presented at Washington State Hospital Association Safe Table 11/19/2013