Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are...

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Quality and Patient Safety at Cleveland Clinic Shannon Connor Phillips, MD, MPH Patient Safety Officer J Michael Henderson, MD Chair, Quality and Patient Safety Institute

Transcript of Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are...

Page 1: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Quality and Patient Safetyat

Cleveland Clinic

Shannon Connor Phillips, MD, MPHPatient Safety Officer

J Michael Henderson, MDChair, Quality and Patient Safety Institute

Page 2: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 3: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 4: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 5: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Support Team in the Clinical Institutes

Each Clinical Institute has a Support Teamcomprised of experts in:

- Quality

- Safety

- Clinical Risk Management

- Accreditation

- Infection Control

Page 6: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Who “owns” Quality and Patient Safety?

We all do

Institutes QPSI

Balance of Responsibility

Page 7: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 8: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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.

Page 9: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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)

Page 10: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 11: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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?

Page 12: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 13: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 14: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 15: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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

Page 16: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Focus Area 5: External Reports

Reputation

Safety

2003 – 2005 HOSPITAL AND SURGEON OUTCOMES

New York StateDepartment of Health

Volumes / outcomes / cost / safety

Outcomes

Page 17: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Communication, Education, Training

and Awareness

Monitoring and Accountability

Performance Improvement Quality

And

Safety

QPSI

Page 18: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

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.

Page 19: Quality and Patient Safety - Cleveland ClinicCleveland Clinic: Quality and Patient Safety What are we doing? •Quality and Patient Safety Institute – 2006 •Leadership is committed

Quality, Safety and Patient Experience Strategy

Quality, Safety and Patient Experience Strategy

Integrated Quality & Patient Safety Framework

Integrated Quality & Patient Safety Framework

Quarterly Patient Safety & Quality Report

Quarterly Patient Safety & Quality Report

Chapter 20 Quality Improvement & Patient Safety

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Patient Safety & Quality JA PaSQ 20112012.pdf · 2013-11-26 · •Patient safety and quality network sustainability WP1&7 •Patient Safety good clinical practices exchange mechanism

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Patient Safety Quality Resources

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National Healthcare Safety NetworkNational Healthcare Safety Network 2017 Patient Safety Data Quality Guidance and Toolkit for Reporting Facilities. The NHSN Patient Safety Data Quality

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