Transcript www.whaqualitycenter.org

HRET Improvement Leader Fellowship
WHA Guidance Call
Travis Dollak and Thomas Kaster
WHA Quality Coordinators
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Webinar Agenda
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Future Fellowship Events
How to Catch Up if you Missed Chicago
Overall WHA-ILF Guidance and Strategy
HRET and CMS Harm Across the Board
Description
• Harm Across the Board template demo and
rewards
• Upcoming deadlines and events
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Future HRET Fellowship Events
• San Diego – July 24 and 25
–As soon as we know
• Chicago, September 30 and October 1
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How to Catch Up if you Missed Chicago
• To be receive a funded slot for the San Diego
ILF we are asking you to complete the IHI
Open School Wave 1 Modules
– You will need to register on HRET’s / IHI site
• Click Here to Enroll
– http://app.ihi.org/lms/home.aspx?CatalogGUID=5b5c79b8-f019-442c-a199de2041cdfbf5
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Overall WHA-ILF Guidance and Strategy
• HRET-IHI Open School Valued at over $7000
• The more you give the more you get
– Not required to do anything
• WHA wants to capitalize on your achievements
– Webinars, Q&A’s and Storyboards
• HRET and WHA provide you a audience to share
your great work at a National and Federal level
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Harm Across the Board Template WIFM
• Giving you an essential resource for driving
improvement in your hospital
• Demonstrating throughout the country the
great work we do here in WI
• Building awareness at the federal level of how
essential and valuable this work is
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Harm Across the Board Template
Description
• Provides a framework that changes the discussion
from numbers and rates into how people are literally
harmed in facilities
• Brings the reality that people are harmed to the
forefront
• Helps people change the way they think about
common errors ---no harm is acceptable
• Template will be sent via email and on the WHA
Quality Center
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Title Slide
(1 of 15)
Improving Harm Across the Board
(2 of 15)
TEMPLATE GUIDE
• Treat harms as events that can be summed
• Focus on harms (outcomes) rather then
preventive measures (process)
• Special conditions can be considered a harm
(e.g., EED, Readmits, …)
• Produce an overall harm trend for the hospital
(**Delete this slide when content of
presentation is complete)
(3 of 15)
Harms/1,000 discharges
2012 Breakthrough in Reducing HARM:
250
to
50
harms/1,000
discharges
350
300
250
200
150
100
50
0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
2011
Timeframe
Quarter - Year
Q4
Q1
Q2
2012
WHA has created a template for all 4 graphs in this template
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(4 of 15)
Cut “harm across the board” in half:
60 patients per quarter to under 30
Total # of Harms
Total Harms by Quarter
100
80
60
40
20
0
55
56
64
66
78
52
58
57
30
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Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
2011
Timeframe
Quarter - Year
Q4
Q1
Q2
2012
WHA has created a template for all 4 graphs in this template
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(5 of 15)
2012 Breakthrough in Readmission:
From 20% of discharges to 10% of discharges
Readmission: % Discharges
25
20
15
10
5
0
Q1
Q2
2011
Q3
Q4
Q1
Q2
Q3
Q4
2012
WHA has created a template for all 4 graphs in this template
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(6 of 15)
2012 Breakthrough in Reducing Readmissions:
From 20 per quarter to 10 per quarter
Readmissions
25
20
15
10
5
0
Q1
Q2
Q3
2011
Q4
Q1
Q2
Q3
Q4
2012
WHA has created a template for all 4 graphs in this template
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(7 of 15)
Pearls
• Please list the drivers of safety that produced
these results.
• Include one about patient and family
engagement, if relevant
The Most Important Slide
(8 of 15)
Defining Moment(s) In Our Journey
• Name and date one or two defining moments.
• Moments that caused the organization to
commit to extraordinary safety.
• Moments that resulted in a big breakthrough
in the organization’s ability to deliver safety.
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(9 of 15)
Strategies to Drive Results
• What challenges did you encounter that you
were able to overcome to achieve the results
you are presenting here?
• What were the strategies you used to
overcome them?
(10 of 15)
Risk Profile by Areas of Risk
HACs
Estimated annual number of patients at risk in each area
ADE
# of inpatients:
CAUTI
# pts in IP units with catheter in place:
CLABSI
# pts in IP units with central lines:
Falls
# of discharges:
Ob AE
# of women with deliveries:
Pr Ulcer
# of discharges:
SSI
# of applicable surgical pts:
VAP
# of patients on a ventilator:
VTE
# of inpatients:
EED
# of women with elective deliveries
TOTAL
Risk opportunities for harm across the board
Readmit
# of inpatients at risk of readmit:
Number
EXAMPLE
HACs
Estimated annual number of patients at risk in each area
ADE
4587 of inpatients:
CAUTI
1268 pts in IP units with catheter in place:
CLABSI
668 pts in IP units with central lines:
Falls
4587 of discharges:
Ob AE
747 of women with deliveries:
Pr Ulcer
4587 of discharges:
SSI
5502 of applicable surgical pts:
VAP
183 of patients on a ventilator:
VTE
4587 of inpatients:
EED
283 of women with elective deliveries
Readmit
4587 of inpatients at risk of readmit:
TOTAL
31,586 Risk opportunities for harm across the board
(11 of 15)
Improving Harms by HAC
• Scale: number of hospital-acquired conditions
(HACs) at each level
– IDEAL: level represents what we see as best possible
– At Target: level represents meeting improvement
target
– Progress: level not yet at target
– Opportunity: level represents an improvement
opportunity
(**Delete this slide when content of presentation
is complete)
Improving HAC Rates
HACs
Baseline
[time period]
Target
40% Reduction OR
ADE
<7% Insulin, <5% INR, 100% Med Rec
CAUTI
.48 per 1000 catheter days
CLABSI
.48 per 1000 central line days
Falls
2.15 per 1000 days OR
.5 (with injury) per 1000 days
Ob AE
.1208 per 100 births
Pr Ulcer
3.21 per 1000 discharges
SSI
.504 per 100
VAP
.66 per 1000 ventilator days
VTE
.556 per 1000 discharges
EED
<2%
Readmit
(12 of 15)
Current
Improvement Status
[time period] (scale)
WHA can
help fill
this page if
you send
your draft
slides
20% reduction
Use the baseline data that is available to you
WHA can also help with Target Rates
EXAMPLE
HACs
Baseline
[time period]
Target
Current
[time period]
Improvement
Status (scale)
ADE
0.008 (2011)
40% ↓ 0.005
0.007 (Jan-Dec 2012)
Progress
CAUTI
0.0008 (2011)
40% ↓ 0.0005
0 (Jan-Nov 2012)
Ideal
CLABSI
0 (2011)
Sustain
0 (Jan-Dec 2012)
Ideal
Falls w
Injury
0 (Jan-Dec 2011)
Sustain
0 (Jan-Sep 2012)
Ideal
Ob AE
0.012 (Dec 2011)
40% ↓ 0.0072
0.0011 (Jan-Sep 2012)
Ideal
EED
0 (Dec 2011)
Sustain
0 (Jan-Nov 2012)
Ideal
Pr Ulcer
0 (Oct-Dec 2011)
Sustain
0.0002 (Jan-Sep 2012)
Ideal
SSI
0.003 (2011)
Sustain
0.003 (Jan-Sep 2012)
Ideal
VAP
0.0 (2011)
Sustain
0 (Jan-Sep 2012)
Ideal
VTE
0.0002 (2011)
40% ↓ 0.0011
0 (Jan-Dec 2012)
Ideal
Readmit
0.066 (2011)
Sustain
0.068 (Jan-Sep 2012)
Ideal
Our Hospital Risk
Profile & Result
Annual Volume (Discharges)
Total risk: annual harm opportunities
Risks per patients (Total Opportunities)/Discharges)
Number of PfP Harm Areas Applicable (0 – 11)
Number of PfP Harm Areas Applicable & Adopted
Number of PfP Areas at Improvement Target
Number of PfP Areas at IDEAL
(13 of 15)
EXAMPLE
Annual Volume (Discharges)
4587
Total risk: annual harm opportunities
31,586
Risks per patients (Total
Opportunities)/Discharges)
6.9
Number of PfP Harm Areas Applicable (0 – 11)
11
Number of PfP Harm Areas Applicable &
Adopted
11
Number of PfP Areas at Improvement Target
1
Number of PfP Areas at IDEAL
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(14 of 15)
Future Actions to Reduce Harm
• What other actions will you take to reduce
harm in the future?
(15 of 15)
Photo of Hospital CEO &
Safety Team
Future Details
• Draft Templates Due to WHA by April 29th
• Weekly HATB Development and Coaching Calls
• Please send to WHA
• Final Templates Due June 3rd
– Top 3 from Wisconsin to be on storyboards in
San Diego (93 total)
– Top 3 in San Diego to receive certificates and
discuss progress with Don Berwick
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