Pursuing High Value

Healthcare

Optimizing Laboratory TestingWebinar #5May 7, 2015

1

Agenda

WelcomeTeam Status Reports

o Progress/Activities Since Learning Session

Data Team Updates Current data and reports Discussion

Phase 2 of Collaborative●Next Steps

Action Period Learning Session #4 DHMC- June 4, 2015

2

Our First Collaborative: Global Aim

We aim to reduce harm to patients and conserve system resources by optimizing the use of laboratory tests for patients cared for in our region’s hospitals.  We will use a collaborative approach considering the best medical evidence and quality improvement science.  It begins with an evaluation of current test ordering profiles and patterns followed by an organized plan to optimize testing and ends with a plan to sustain these practices.  By doing this we expect to reduce cost and improve satisfaction and quality of care for patients and the health system.  It is important to work on this now because as health care professionals we can play an important role in health care reform by designing more patient-centered, efficient and high value inpatient care.  

3

Quality Improvement Process

Assessment

Theme

Global Aim

Specific Aim

Change Ideas

Measure(s)

PDSA

SDSA

12

31

23

SuccessMeasure

Global Aim

Modified from Quality By Design, A Clinical Microsystems ApproachNelson, Batalden and Godfrey© Trustees of Dartmouth College

Step 1- Form Team

Step 2- Get Baseline Data

Step 3- Create Global Aim

Step 4- Create Specific Aim

Step 5 –Determine Cause and Effects

Step 6- Brainstorm Change Ideas

Step 7 –Determine Process Measures

Step 8- Test Your Changes

4

We are here!

We aim to reduce harm to patients and conserve system resources by optimizing the use of laboratory tests for patients cared for in our region’s hospitals. We will use a collaborative approach considering the best medical evidence and quality improvement science. It begins with an evaluation of current test ordering profiles and patterns followed by an organized plan to optimize testing and ends with a plan to sustain these practices. By doing this we expect to reduce cost and improve satisfaction and quality of care for patients and the health system. It is important to work on this now because as health care professionals we can play an important role in health care reform by designing more patient-centered, efficient and high value inpatient care.

NVRH Reduce the number of unnecessary labs; Target CBC/CBCD, BMP/CMP, Albumin, and Troponins (w and w/o reflex testing) Study Number of Tests, Number of Tests per Avg. Daily Census, and Number of Tests per Patient per day. Compare the total Number of Phlebotomies, Avg. Daily Census, Avg. LOS, and Annual Discharges for 18 yo+.

Porter Create a QI culture Decrease blood draws, patient discomfort, anemia

UVM Medical Center Decrease unnecessary venipunctures and blood loss Retrieved and reviewed All Service Medicine Admissions with standing daily lab orders

In Family Practice, Medicine, PCIM

Brattleboro Minimizing routine morning laboratories (CBC and BMP) for patients admitted within 24 hours (evening and night admissions) Optimizing CBC ordering for stable patients (every 48-72 hours)

CVH Decrease the number of laboratory draws / day Patients will not getting woken up at 6am with a needle Reduce the possibility of anemia Reducing patient pain and discomfort

Global Aim Organizational Aims Measures and

PDSA Cycles ?

Team Progress Reports

RRMCBrattleboroNVRHBenningtonPorterDHMCCVMCUVMMC

New Team Members?

Meeting Frequency?

Data Findings?

Identified Improvement Opportunities?

Test of Change/PDSA Cycles?

PDSA Outcomes?

4

Data Update

Data Definitions ResourceSample of current monthly data reportsDiscussionWhat’s Next?

Phase 2 of Collaborative

Work with current data baseDeeper dive based on organization specific findingsDeeper dive based on group findings??

9

Learning Session 1Oct. 22

8:30 to 3:30

LearningSession 4

Jun. 4 DHMC8:30 to 3:30

LearningSession 2

Feb. 12 UVM8:30 to 3:30

Kick-Off Week 1

Sept 11, 2PM

LearningSession 3Apr. 2 CVH

8:30 to 3:30

Pre-work5-6 weeks

Conference Call /

WebinarNov 6, 2PM

Conference Call /

WebinarDec 4, 2PM

Conference Call /

WebinarJan. 8, 2PM

Conference Call /

WebinarMar 5, 2PM

Conference Call /

WebinarMay 7, 2PM

Continuous Coaching/Faculty Support

Coll

ab

ora

tive

Tim

eli

ne

Next Steps

Action Period Continue to Review and submit data Determine change ideas Design tests of change Trial tests of change Evaluate Results

Support Set up a time for Faculty to join a Team Mtg.

Next Learning Session June 4, 8:00 to 3:30 DHMC

14