The presentation
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Physician Led Changes
in Patient Safety
Marilouise Venditti MD
Chief Medical Officer
Anthony Macchiavelli MD
Adult Hospitalist Program Director
AtlantiCare
AtlantiCare
Regional Medical
Center
AtlantiCare
Behavioral
Health
AtlantiCare
Health
Services
AtlantiCare
Health
Engagement
AtlantiCare
Foundation
The AtlantiCare Family
5100 Member Workforce
Medical Staff
700 Physicians (150 Employed)
5 Operating Boards
65 Sites
80 Volunteer Board Members
Validation of Quality Work
Patient Safety Committee
• Platform which integrates all departments and
services into the safety program
• Mission: Enhance and provide the highest
principles, practice, and culture of safety for the
benefit of all who are served by AtlantiCare
Reporting Structure - Patient Safety
Activities
Quality Management Steering Committee
of the Board
Medical Executive
Committee
Patient Safety
Committee
Physicians’ Role in
Patient Safety
PSC Members
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William Aarons MD, CIMO
Howard Axelrod MD, Chair Dept. Surgery,
CSO
Robyn Begley DNP, VP of Nursing
Margaret Belfield, COO
Joan Brennan DNP, VP of Performance
Excellence
Rene Bunting VP Marketing and PR
Ana Cilursu MD, Medical Residency Dir
Haitham Dib MD, Attending Cardiologist and
Division Director
Julia Drew MSW MPH, System Executive
Dir Behavioral Health
Kathy Dudick MD, Chair Critical Care
Sandra Garrett-Baggs, Corporate Dir
Pharmacy
Walter Greiner, VP of Finance
Lori Herndon, President and CEO
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Cathy Iocona, Asst CIO
Kathi Johnson, Risk Director
Dr Joby Kolsun MD, Director Medical Staff
Quality
Anthony Macchiavelli MD, Director Adult
Hospitalist Program
Kevin McDonnell, COO Health Services
Romeo Pericic MD, Chair Dept of
Anesthesia
Liz Readeau MSN, Asst VP of Nursing
Gary Rosman MD, Medical Staff
John Saia DO, Medical Staff
Katherine Schneider MD, VP of Health
Engagement
Alexander Sharnoff Esq. Assoc. Corporate
Counsel
Marilouise Venditti MD, CMO
Mary Beth Kelly, Director Patient Safety
Serious Occurrence Process
Type of Event
– Undesirable, Unexpected
– Serious Occurrence
(may include near miss)
– Sentinel Event
Response
– Investigate, counsel,
peer review, briefing
– Action plan, case conf,
PI team + above
– RCA, manage public
perception, consider
command center +
above
RCA Team
• Lead by an administrator and a medical staff officer
• Key stakeholders invited to participate
• Tools: brainstorming, VA cause analysis tool
• Results report to Patient Safety Committee
Priority Themes to Date
• Clear communication and accessible information
• On-site supervision of residents
• Critical care model
Hospitalist Service: Our Solution to the
Remote Care Challenge
• The Hospitalist Service provides 24 hour physician
coverage of acute care campuses
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Days:
City: 6 Hospitalists and 2 APN / Day
Mainland: 5 Hospitalists and 2.5 APN / Day
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Nights:
City: 1 Hospitalist / Night
Mainland: 1 Hospitalist and .5 APN / Night
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12 Hospitalists operational / 24hours = 26 FTEs
Hospitalist Service Mission
1. Provide the highest quality patient service in a caring
and efficient manner
2. Educate and train medical professionals in Hospital
Medicine.
3. Advance medical knowledge through clinical research
and process improvement.”
Supervision of Residents
Hospitalist Teaching Service
Teaching attending and resident round together
-City July 1
-Mainland October 1
Critical Care Model
• Intensivists
• Closed Units
• Redundancy
• Transitions of care
Memorial Regional Hospital
The American Hospital Association
McKesson Quest for Quality
Prize Award
Our Mission
Memorial Healthcare System provides safe, quality,
cost-effective, patient- and family-centered care,
regardless of one’s ability to pay, with the goal of
improving the health of the community it serves.
Our Vision
Memorial Healthcare System will improve the health
of the community by becoming a world-class model
of safety, quality, service and efficiency.
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The Memorial Experience
 Pillars of Excellence
 Safety
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Quality
Service
People
Finance
Growth
Community
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THE MEMORIAL EXPERIENCE
A Culture of Safety, Quality and Service
Safety
Patient Centered Care
• Crew Resource Management
• Patient First Awards (Safety Alerts)
• Elopement Alerts
• OB Critical Assessment Team
• Safety and Quality Steering Committee
• PI Initiatives Stemming from Multiple Sources
• Just Culture (Accountability)
• Patient- and Family-Centered Care
• Patient Friendly MAR (Daily Medication Schedule)
• Help Alerts
• Palliative Care
• Healing Environment
• Transparency through Storytelling, Memorial
Experience and Disclosure
• Patient and Family Initiated Support Network /
Groups
Effectiveness
Efficiency
• Evidence-Based Practices
• Bedside Change of Shift Report
• Outcome Reporting
• Unit-Based Clinical Pharmacists
• Employed Intensivists and Hospitalists
• EPIC Electronic Medical Record
Timeliness
Equity
• Dedicated Rapid Response Teams
• Hourly and Multidisciplinary Rounding
• PCI Task Force
• Community Programs and Partnerships
• Special Needs Coordinator
• MOD Squad (Memorial Outfitted for Diversity)
• Charity Policy for the District
• Cultural Competency Training
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MRH Cultural Drivers
Ongoing Monitoring and Reporting through:
 90-Day Action Plans
 Monthly Operations Review
 Monthly Balanced Scorecards for Leadership
 Board Quality and Peer Review
 Commitment to Culture
Committed to Leadership Development
 Board Retreats and Educational Presentations
 Ongoing Leadership Development Sessions
 Personalized Coaching and Employee Mentorship Programs
 Continuing Education Programs
 AHA National Safety Foundation
“Patient Safety Leadership Fellowship”
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Community Diversity
 Diversity in our Board
 Diversity in our Leadership Team
 Diversity in our Medical Staff
 Diversity in our Employment Practices
 Diversity in our Patient and Family Advisory
Council
 Supplier Diversity Programs
 Diversity in our approach to the Community
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Quality and Safety Reporting Flows
Through the System
Board Peer Review
Hospital Medical Executive Committee
Quality Care & Patient Safety Council
Multidisciplinary Peer
Review Committee
Performance Improvement/Risk
Management Committee
Medical Staff Departments
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Board Peer Review
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Credentialing Activities
• Appointments, Reappointments and Peer Review Actions
Quality of Care and Service Reviews
• Physician Satisfaction
• Quality Indicators
 Core Measures
 Mortality & Morbidity
 Readmissions
 Surgical Case Review
 Hospital-Acquired Conditions (HAC)
• Safety Indicators
 Mislabeled/Unlabeled Specimens
 Medication Errors
 Pressure Ulcers
 Code 15, Sentinel Events and Sentinel Event Alerts
Risk Management and Safety Function
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Sentinel Events
Root Cause Analyses
Closed Claim Reporting
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Performance Improvement Initiatives
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Crew Resource Management
Chemotherapy Administration
Remifentanil Ordering and Administration
Interventional Radiology and Sedation
Obstetrical Critical Assessment Team (OB “CAT”)
Rapid Transfusion Protocol
Elopement Alert
Difficult Airway
Magnetic Resonance Imaging (MRI) Safety
Pressure Ulcers
Board Mandated Reduction in Mortality
Central Line Associated Blood Stream Infection (CLABSI)
Ventilator Associated Pneumonia (VAP)
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MRH Mortality
MRH Annual Mortality Rate
(includes in-patient)
34.6% reduction
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2.5
1.5
1
0.5
Excludes ED, Hospice, Psych, Rehab, and stillborn
2010
2009
2008
2007
2006
2005
2004
2003
2002
0
2001
Rate
2
10
Central Line Associated Blood Stream Infection (CLABSI)
Memorial Regional Hospital
250
236
83.9% reduction
200
150
132
100
65
38
41
50
6.4
3.8
2
1.3
1.3
0
2006
2007
#CLABSI
2008
RATE
2009
2010
Linear (#CLABSI)
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Ventilator Associated Pneumonia
Memorial Regional Hospital
70
60
95.0% reduction
60
50
40
30
21
20
10
5.6
8
1.9
4
0.7
0.4
3 0.3
0
2006
2007
#VAP
2008
RATE
2009
2010
Linear (#VAP)
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Patient- and Family-Centered Care
Initiatives
 Patient- and Family-Centered Care Department
 Patient and Family Resource Centers
 Bedside Change of Shift Report
 Daily Medication Schedule (Patient-Friendly MAR)
 Family Faculty Presentation at New Employee Orientation
 Patient and Families are Involved in Multidisciplinary Rounds
 Patient and Family Advisors Participate in the following:
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PI and Risk Management
Quality Care Councils
District Quality and Safety
Satisfaction Teams
Architectural Designs
Product Line Focus Groups
Palliative Care Team
Ethics Committee
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Dietary Meetings
Fall Prevention Team
Way Finding
Website Design
Strategic Planning Sessions
e-Health
End of Life Team
Bereavement Team
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Improving Patient Satisfaction
Flow
Variability
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MRH HCAHPS
Hospital Overall Percentile Rank by Received Date
100
90
80
70
60
50
40
30
20
10
0
Nov '10
Dec '10
Jan '11
Feb '11
Rate
Mar '11
Recommend
Apr '11
Goal
May '11
Jun '11
Jul '11
Aug '11
Sept '11
Linear (Rate)
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Evidence Based Order Sets
Goals and Objectives
Optimize Quality
and
Patient Safety
Achieve
Meaningful Use
Improve Resource
Utilization
Develop ~250
Order Sets
Utilizing Zynx®
Content
Deliverables
Develop seamless transition to CPOE
Reduce medication errors and adverse events
Specialty based Order Set workgroups drive content,
filtering up to Med Exec governance structure
Reduce variations in practice between
physicians and facilities
Improve operational efficiencies: reduce turnaround
times for meds, labs, diagnostic tests
Reduce length of stay
and readmission rates
Ensure compliance with evidence
based guidelines (CMS, TJC)
Derive provider specific quality and
utilization metrics via electronic data mining
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Commitment to Community Health
COMMUNITY NEEDS
ASSESSMENT
• Quality of Life Studies
• Neighborhood Targeted
Programs
• State of Florida DOH
Charts Database
• State of Florida DOH
Charts Database
• Vital Statistics
• Healthy People 20xx
• Selected Benchmark
Report
• Other Community
Information Services
(United Way, 211, etc.)
COMMUNITY-BASED
HEALTHCARE
PRIMARY CARE
SERVICES
• HITS Initiative
• Adult, Pediatric &
OB/GYN services
• JDCH Children’s Mobile
Health
Center
• Four convenient
clinic locations
• MHS Adult Mobile
Health Center
• Pharmacy
• Back-to-School
Health Fairs
• Disease
Management
•Homeless Clinics
• Behavioral Health
• Specialists
HOSPITAL-BASED HEALTHCARE
POST
DISCHARGE
• Hospice Care
• Palliative Care
• Home Health
OUTPATIENT
SERVICES
• Laboratory
• Radiology
• PT-OT
• Pain Center
• Etc.
ED
INPATIENT
• Hospitalists
• Specialists
• Intensivists
• Social Services
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Overall Community Health Approach
Major Initiatives
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Primary Care Initiative – Since 1992
• Pediatric / Obstetrical and Adult Services
• Prevention / Wellness
• Disease Management
• ED Diversion (2011)
Community Services Initiative
• Leading Causes of Death by Age
• Unintentional Injury by Age
• Collaboration / Partnerships
Community Benefits Initiative
• Trust / Quality of Life / Health
Community Youth Services
• Adolescent Behavioral Health and Childhood Obesity
Health Intervention with Targeted Services (HITS) Program Initiative
• Phase I – Overall Health and Eligibility - Targeted Neighborhoods
• Phase II – Preventable Admissions
Health Employees Reaching Out (H.E.R.O.) Initiative –Employee
Volunteer Program
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Questions?