BHCS Health Care Improvement
and ABC Baylor Success
Examples of Baylor Health Care
System National Quality Awards
HEALTHTEXAS PROVIDER
NETWORK RECEIVES
PRESTIGIOUS NATIONAL HONOR
American Medical Group
Association (AMGA) presents: The
Preeminence Award to HealthTexas,
Recognizing Excellence in
Leadership and Patient Care
HealthTexas was honored, March
20th at the AMGA 2010 Annual
Conference in New Orleans, as this
year’s recipient of the Medical
Group Preeminence Award by the
Executive Committee of the
American Medical Group
2
Association (AMGA).
©2009 Baylor Health Care System
Baylor Health Care System Quality
Performance and Ranking
Note: the American Hospital Association decided to stop publishing the rankings due to complaints from members that did not rank favorably.
Source: Hines S, Joshi MS. Variation in Quality of Care Within Health Care Systems. Joint Commission Journal on
Quality and Patient Safety. 2008;34(6):326-332.
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©2009 Baylor Health Care System
BHCS Process Excellence:
Heart Failure Order Set
Standardized heart failure order set at Baylor Health Care
System has led to improved outcomes, reduced costs of care,
and increased adherence to evidence-based processes of care
•
Standardized heart failure order set use was associated with
significantly increased core measures compliance and
reduced in-patient mortality
•
Direct cost for initial admissions alone and in combination
with readmissions were significantly lower with order set use
•
$2 billion cost reduction and 2,000 lives mortality reduction
opportunity annually across U.S.
Ballard DJ, Ogola G, Fleming NS, Stauffer BD, Leonard BM, Khetan R, Yancy CW. Impact of a standardized heart failure order4
set on mortality, readmission, and quality and costs of care. Int J Qual Health Care. 2010 Dec;22(6):437-44
©2009 Baylor Health Care System
International Society for Quality in
Health Care
•
International Journal for Quality in Health
Care article 2nd place 2011 Peter
Reizenstein prize
•
Ballard DJ, Ogola G, Fleming NS, Stauffer
BD, Leonard BM, Khetan R, Yancy CW.
Impact of a standardized heart failure order
set on mortality, readmission, and quality
and costs of care. Int J Qual Health Care.
2010 Dec;22(6):437-44
5
©2009 Baylor Health Care System
Evaluating the Pneumonia Order
Set: Cost Effectiveness Results
•
Mean difference (standard error) in in-hospital mortality and
costs were estimated at 1.67(0.62)% and $383(207)
respectively, with both showing a benefit with order set use
•
From the estimates of mortality and cost differences, the
incremental cost-effectiveness ratio (ICER) =
-$22,882 per additional life saved
•
Potential life years saved, based on adjusted life
expectancy calculations for all patients in the study
population who died, discounted based on the 5 year
survival reported for pneumonia patients, was estimated at
12 years per patient
Fleming NS, Ogola G, Ballard DJ. Implementing a standardized order set for community acquired
pneumonia: impact on mortality and cost. Jt Comm J Qual Patient Saf 2009 Aug;35(8):414-21.
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©2009 Baylor Health Care System
Evaluating the Pneumonia Order
Set: Cost Effectiveness Results
• For every 60 patients who received the order
set, 1 additional life was saved (1/.0167)
• For every 60 patients who received the order
set, $23,000 were saved (60 x $383)
• For the approximate 2,000 patients receiving
the order set, 33 lives were saved and
$766,000 were saved
Fleming NS, Ogola G, Ballard DJ. Implementing a standardized order set for community acquired
pneumonia: impact on mortality and cost. Jt Comm J Qual Patient Saf 2009 Aug;35(8):414-21.
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©2009 Baylor Health Care System
PDCA Efforts to Improve Revenue:
Outpatient Recurring Accounts
• Aim: to reduce by 50% the final unbilled dollar
value of Baylor All Saints Infusion Center outpatient
recurring accounts that were > 90 days old through
the implementation of regular shared tracking, audit
and account maintenance processes
• The team’s goal was to see a reduction of
outstanding final unbilled balances from $1,191,554
to $595,777 by March 31, 2010
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©2009 Baylor Health Care System
PDCA Efforts to Improve Revenue:
Outpatient Recurring Accounts
Infusion Center Final Unbilled Recurring Accounts > 90 Days
$1,400,000.00
$1,200,000.00
$1,000,000.00
$800,000.00
$600,000.00
$400,000.00
$200,000.00
$0.00
9
©2009 Baylor Health Care System
ABC Baylor Expansion
Because of ABC-Baylor success, we are now
teaching it elsewhere in the US and abroad:
•
Texas small and rural hospitals
•
Hazleton and Meadville, Pennsylvania
•
Willis-Knighton Health Care
System (Shreveport, Louisiana)
•
Sentara (Norfolk, Virginia)
•
Mexico
•
Possibly Kunming City, China
10
©2009 Baylor Health Care System
Health Care Quality Domains

Safe – avoiding injury to patients from care that is intended to help them

Timely – reducing waits and harmful delays

Effective - providing services based on scientific knowledge to all who could
benefit and refraining from providing services to those not likely to benefit
(avoiding overuse and underuse)

Equitable - providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographical location, and
socioeconomic status

Efficient – avoiding waste

Patient Centered - providing care that is respectful of and responsive to
individual patient preferences, needs, and values
Source: Institute of Medicine. Crossing the Quality Chasm. Washington, D.C.: National Academies Press; 2001.
11
©2009 Baylor Health Care System
STEEEP Focus: Safe
Project Title:
Increasing Hand Hygiene Compliance
Background:
Hand washing is the number one most important part of preventing the spread
of infections. Hand Hygiene compliance at the facility was 83.57% over a seven
month period. This lack of compliance leads to preventable infections in hospitalized
patients.
AIM Statement:
By May 31, 2008, the facility will improve the hand hygiene compliance rate from
73.13% to 90% through the implementation of a strong educational and awareness
program, proper locations for foam dispensers and hand hygiene stations, and
pocket hand sanitizers provided to staff.
Results:
The “You Bugged Me” program was established to hold staff accountable for
proper hand hygiene practices. This program, along with the proper placement
of the foam dispensers and hand hygiene stations, increased hand hygiene
compliance rates to 91.69% over an eight month period which helped prevent
infections in hospitalized patients. The “You Bugged Me” program was adopted
a second facility, along with the visual management poster campaign “Got Foam.”
This second facility increased hand hygiene compliance from 69.7% to 98%.
Additionally, through the adoption of these standards, BHCS has increased hand
hygiene compliance rates from 85.31% in July 2008 to 97.41% in July 2011.
©2009 Baylor Health Care System
STEEEP Focus: Timely
Project Title:
Push to Full: Improving Admission to Exam Time in the Emergency
Department (ED)
Background:
In April 2007 it was taking 63 minutes for an ED patient to get
examined in the ED. The facility implemented methodology to get the
patient from door to exam in 48 minutes. Subsequently the ED Council
has tracked this and other measures to improve timely ED care.
AIM Statement: Over the next 10 weeks, staff will reduce door-to-exam time in the
Emergency Department by 20% by implementing the strategies of
direct-to-bed triage, expedited bedside registration and immediate
notification of physicians when patients are placed in a treatment
room.
Results:
Target of 48 minutes was exceeded with 36 minutes being the
average lowest monthly time from April 2007 to March 2008. From
March 2010 to August 2011 had only one month (February 2011)
where the average time from door-to-exam exceeded 30 minutes.
©2009 Baylor Health Care System
STEEEP Focus: Effective
Project Title:
Medication Reconciliation Improvement
Background:
Medication Reconciliation is a Joint Commission National Patient
Safety Goal requirement. In fiscal year 2010, the facility medication
reconciliation all-or-none bundle score was 69.4%.
AIM Statement: The facility will increase the medication reconciliation all-or-none
bundle score from a rate of 69.4% to 86% by January 31, 2011.
Results:
Through execution of a hospital wide daily auditing process of all
discharge/transfer patients standardized medication reconciliation
forms and standardized training materials, the facility increased the
medication reconciliation all-or-none bundle rate from 69.4% to
90%. For FY11, this was the highest improvement across the Baylor
Health Care System.
©2009 Baylor Health Care System
STEEEP Focus: Efficient
Project Title:
“Let Me Catch My Breath”
Background:
Patients at the facility currently receive therapeutic duplicates of
medications (DuoNeb and Spiriva) that treat COPD and asthma. The
continuation of this practice results in sub-optimal outcomes for the
patients, increased cost for pharmacy, increased out-patient
medication costs, and wasted effort by the respiratory therapy staff.
AIM Statement: By November 17, 2010, facility physicians, pharmacists, and
respiratory therapists will reduce the incidence of patients receiving
Spiriva and DuoNeb therapeutic duplications from 100% to 50%
throughout the hospital by using physician education, therapeutic
auto-interchange, and patient therapy monitoring.
Results:
Through integration of best practices, collaborative efforts, and
standardized education, the facility decreased the incidence of
patients receiving Spiriva and DuoNeb therapeutic duplications by
55%, exceeding their goal. Through the elimination of wasteful rework,
the project team saved $19,708.14.
©2009 Baylor Health Care System
STEEEP Focus: Equitable
Project Title:
Collect Every Patient’s Race, Ethnicity, and Primary Language
Designation
Background:
Identifying ethnic and minority groups for all patient visits helps
recognize gaps in the rates of preventive services received by
advantaged groups. The facility identifies this information 38.5% of the
time for all patients.
AIM Statement: By June 8, 2011, the facility will increase the percentage of electronic
health records with patient designated race, ethnicity, and primary
language identified from 38.5% to 50% for all patient visits.
Results:
Through easily accessible and standardized forms, the facility
increased the percentage of identified patients from 38.5% to 54.5%
(as of September 2011).The project team continues to improve the
process to reach Kaiser Permanente’s benchmark of 86%.These
ongoing improvements will help identify additional areas for
improvement to ensure we are providing the same care for all
patients.
©2009 Baylor Health Care System
STEEEP Focus:
Patient Centered
Project Title:
Family Centered Care in the NICU: Open Access and Bedside Reporting
Background:
There have been numerous complaints from families as a result of being asked to
leave the NICU for various reasons. This directly influences the Press Ganey score
of “NICU was Family Friendly” which is currently at 82.5% (<10 th percentile).
AIM Statement:
The facility Neonatal Intensive Care Unit (NICU) will increase its “NICU was
Family Friendly” Press Ganey mean score from 82.5% to 91.1% by June 30,
2011 by implementing 24 hour access for parents and beside change of shift
report with family inclusion.
Results:
Through the development of a standardized training program, display of visual
management informational posters, and weekly rounding with families to obtain the
voice of the customer, the facility increased the Press Ganey score of “NICU was
Family Friendly” from 82.5% to 100%. As a result of this project, the facility
Neonatal Intensive Care Unit was awarded with a grant from the NICU Helping
Hands Foundation for $300,000 to fund “Project NICU.” The interventions from
the project were adopted across the Baylor Health Care System as a best
practice and was shared at the National NICU Leadership Forum in Las Vegas.
©2009 Baylor Health Care System
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