Quality and Patient · PDF fileAdministrator – Elaine Mead Quality and Patient Safety...
Transcript of Quality and Patient · PDF fileAdministrator – Elaine Mead Quality and Patient Safety...
Quality and Patient Safetyat
Cleveland Clinic
Shannon Connor Phillips, MD, MPHPatient Safety Officer
J Michael Henderson, MDChair, Quality and Patient Safety Institute
Cleveland Clinic: Quality and Patient Safety What are we doing?
• Quality and Patient Safety Institute – 2006
• Leadership is committed to Quality and Safety as a highpriority.
• Infrastructure development to fulfill Mission and Vision
• Focus Areas
Departments and Directors
Quality Accreditation Risk Management Data Environment Surveys&
OutcomesProcess
Improvement
JackieMatthews
EileenPomiecko
VickiBokar
EricHixson
StuartKline
BarbaraAckerman
Robert Frye
Chairman – J. Michael Henderson, MDAdministrator – Elaine Mead
Quality and Patient Safety Institute
Physician Leadership:Shannon Phillips Nick Smedira Chris Hebert George Topalsky
Tom Fraser Ajay Kumar Brian Parker
Quality and Patient Safety Institute
FUNCTIONS:
• Administrative Structure and Authority
• Coordination: All departments contribute to programs for Quality andPatient Safety.
• Develop a communication structure to clinical departments forinformation / education / planning / implementation for Quality andPatient Safety.
• Connect Quality and Patient Safety to leadership and clinical Institutes
Support Team in the Clinical Institutes
Each Clinical Institute has a Support Teamcomprised of experts in:
- Quality
- Safety
- Clinical Risk Management
- Accreditation
- Infection Control
Who “owns” Quality and Patient Safety?
We all do
Institutes QPSI
Balance of Responsibility
What Drives Quality and Patient Safety?
• Regulation: CMS / Joint Commission / ODH
• Required Reporting: CMS: Core Measures / POA / IPPS / OPPS /PQRI; ODH -2007 legislation for Quality Reports
• Patient Safety: NPSG / IHI / AHRQ – Patient Safety Indicators /Leapfrog
• Quality Metrics “standard setters”: National Quality Forum / IHI
• Scorecards: US News and World Report / Payors
Focus Area 1: Accreditation & Regulation
• Approach going forward: - Best Practices / Continuous Readiness
- It really is about the patient.
• QPSI / Institute Team
- Content experts: Communication / education
- Action experts: Institutes / the front line
- Incorporate the standards into daily practice.
Focus Area 2: Quality Data and Reporting
• Align Clinical Outcomes and Process Measures
• Cleveland Clinic Outcomes Books
• Quality Data capture as part of clinical practice (EMR)
Quality Outcomes Reporting:Aligning Clinical Outcomes and Process Measures
Clinical Outcomes: - Publications / Outcomes Books
- Mostly High Profile areas
- X percent of CC patients
- Excellent results
Process Measures:
- Publicly reported data
- Drawn from all CC patients
- Opportunity for improvement
Clinical Outcomes: National Quality Datasets• An Opportunity for the Institutes:• Recommend to all Institutes
• Quality Improvement and Reporting
• Source data for Outcomes Books
National Surgical QualityImprovement Program
ICU Database:Critical Outcomes
• What is your“Best” Database?
Quality Data capture in Clinical Practice
• Data Management in QPSI:- Oversight responsibility for quality data collection /abstraction- Combined forces with ITD and Medical Operations
• Electronic Data Capture:- Increase “Quality” data capture as we move to Inpatient Epic- Example: Surgical Episode (NSQIP)
• Data Reporting:- Keep it Simple (and actionable).- Scorecards with Medical Operations
Paper Electronic
Focus Area 3: Patient Safety
• Focus of attention - Cleveland Clinic 2007 factoids:
32 SentinelEvents in 2007
DVT / PE Rate
• 30 /1000 eligiblepts
• (Ohio rate – 9)
Decubitus Ulcer rate
• 20 / 1000 EligiblePts
• (Ohio rate -17)
Overall SurgicalSite Infectionrate was 7.6%
318 Staph Aureus
Blood streaminfections
Patient Safety: Clinical Risk Management
• SERS: Event reporting
• Focus on “Harm” events. Timely investigation & Action Plans
• Disclosure / apology / early intervention
SERS Incident ReportingYear 2007
Quarter 3
Facility Cleveland Clinic
Events Year 2007
Code Severity Description Total Quarter 3
A Category A: Circumstances or events that have the capacity to cause an error 140
B Category B: Event occurred, did not reach the patient/person 40 Events Initial Severity Code2
C Category C: Reached the patient/person, did not cause harm 162 Facility Involved No Harm Potential or Actual HarmGrand Total
D Category D: Reached patient/person, required monitoring/intervention to confirm no harm 104 CC 446 60 506
E Category E: Temporary harm to the patient/person and required intervention 52 EUC 46 16 62
F Category F: Temporary harm to the patient/person and required initial or prolonged hosp 4 FVW 163 32 195
G Category G: Permanent patient/person harm 1 HIL 157 29 186
I Category I: Death 3 HUR 67 13 80
Grand Total 506 LAK 69 14 83
LUT 37 9 46
MMT 140 11 151
SPT 77 14 91
Grand Total 1202 198 1400
No Harm: Severity Level A through D
Potential or Actual Harm: Severity Level E through I
Year 2007
Quarter 3
Facility Cleveland Clinic
Severity Desc Category E: Temporary harm to the patient/person and required intervention
Events
Event Type Total
Diagnostic Test 2
Equip / Device 3
Fall 13
Infection 1
Rx/IV Infiltration 8
Monitoring 1
Other 9
Skin Breakdown 11
Treatment/Proc 4
446
46
163 157
67 69
37
140
7760
1632 29
13 14 9 11 14
0
50
100
150
200
250
300
350
400
450
500
CC EUC FVW HIL HUR LAK LUT MMT SPT
Rep
ort
ed
Even
ts
No Harm Potential or Actual Harm
2
3
13
1
8
1
9
11
4
0
2
4
6
8
10
12
14
Diagnostic Test Equip / Device Fall Infection Rx/IV Infiltration Monitoring Other Skin Breakdown Treatment/Proc
Re
po
rte
d E
ve
nts
Focus Area 4: Metrics
• Scorecards for Quality & Safety
• Data drives improvement
• Work to national standards (NQF / IHI / AHRQ etc)
DATA: “If you can’t measure it, you can’t manage it” Edward Deming
Focus Area 5: External Reports
Reputation
Safety
2003 – 2005 HOSPITAL AND SURGEON OUTCOMES
New York StateDepartment of Health
Volumes / outcomes / cost / safety
Outcomes
Communication, Education, Training
and Awareness
Monitoring and Accountability
Performance Improvement Quality
And
Safety
QPSI
An Approach to “QUALITY” – Cleveland Clinic
• Leadership: A hospital commitment that Quality & PatientSafety are important.
• A structure to coordinate “quality” activities
• Build a “TEAM” to develop and support a plan for Quality andPatient Safety.
• Involve the physicians.
• Embed Quality into daily clinical practice.