Transcript Reducing Readmission Coaching Call September 2012

K-HEN Progress and
Taking it to the Next Level
Donna R. Meador, K-HEN Project Director
Elizabeth G. Cobb, KHA VP Health Policy
What is a HEN?
• A CMS-funded Quality
Improvement Program- part
of the “Partnership for
Patients”
• 3700 hospitals nationwide
• 1600 hospitals in HRET HEN
• Over 90 Kentucky Hospitals
working with KHA
2
HEN Collaboratives
There are 10 “Focus
Areas”
Hospitals are asked to:
•Work intensely in at
least 2 areas and
•Submit data in ALL
areas in which you
provide services
40/20: Reduce harm in America’s hospitals by 40% and
preventable readmissions by 20% by end of 2013
3
K-HEN “Annual Report”
“Face-to-Face” educational meetings
 Kick-Off Conference in July – clinical topics +
patient safety, attended by 240 hospital
representatives;
 August 2012 HEN Week in Chicago – attended
by 9 hosp. reps;
 Prematurity Summit, in collaboration with
March of Dimes,
 attended by 150
 Governor’s press conference on state-wide initiative to
reduce EED;
4
K-HEN Annual Report cont’d.
 November HEN Week in Indianapolis – attended
by 31 hosp. reps;
 IP Conference “Boot Camp” in Decemberattended by 191
 Readmissions Workshop on “Transitions of Care”,
attended by 180 healthcare providers from all
settings
 Regional OB Meeting in Hopkinsville – attended
by 11 physicians, nurses and administrators
5
K-HEN Annual Report cont’d.
February 5-6 TeamSTEPPS Training
attended by 48 hospital reps
February 19 Neonatal Quality
Improvement Summit attended by
75 hospital reps
March 5-7 Quality Conference/HEN
Convening – OVER 140
REGISTERED!
6
K-HEN Annual Report cont’d.
 HSOPS Surveys – completed with 20 K-HEN hospitals and
more in progress
 Coaching Calls – August-January, hosted 50+ coaching calls/
webinars, with attendance by >390 hospital reps
 Technical Assistance – provided on-site, on-line, and telephone
assistance to many hospitals in quality improvement and data
collection efforts
 Reports – created and distributed Quarterly CEO Dashboard to
assist hospital leaders to monitor progress, participation, and
overall engagement
7
So how are we doing, KY?
Readmissions Within 30 Days
14%
12%
Readmission Rate
10%
8%
6%
Current rate 6% (-51%)
# Readm. Prevented = 636
Cost savings to date =
$6,105,600
4%
2%
0%
Baseline
12%
12%
12%
12%
MayMayJun-12 Jul-12 Aug-12Sep-12 Oct-12 Nov-12Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13Sep-13 Oct-13 Nov-13Dec-13
12
13
12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12% 12%
Hospital
11%
10%
12%
11%
11%
13%
11%
10%
12%
11%
10%
6%
Goal
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
Jan-12 Feb-12 Mar-12 Apr-12
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
10%
8
Excessive Anticoagulation with Warfarin
100.0
ADE Rate/1,000 Patient Days
90.0
80.0
70.0
60.0
50.0
40.0
30.0
Current rate 35.2 (-60.1%)
# ADE’s prev. to date = 84
Cost savings to date = $252,000
20.0
10.0
0.0
Baseline
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
88.2
Hospital
22.6
58.0
44.8
30.3
32.3
90.9
0.0
60.6
70.2
24.9
41.9
35.2
Goal
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
52.9
9
All Falls: With or Without Injury
4.5
Fall Rate/1,000 Patient Days
4.0
3.5
3.0
2.5
2.0
1.5
Current rate 3.4 (-3.1%)
#Falls prev. to date = 31
1.0
0.5
0.0
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
3.5
Baseline
3.5
3.5
3.5
3.5
Hospital
3.2
3.5
2.7
3.1
3.1
3.7
3.3
4.1
4.3
3.6
3.4
3.4
Goal
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
2.1
10
W
Falls with Injury
Fall Rate/1,000 Patient Days
1.2
1.0
0.8
0.6
0.4
Current rate 0.9 (-0.8%)
0.2
0.0
Baseline
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
Hospital
1.1
1.1
1.1
1.0
1.0
0.9
1.0
0.8
0.8
0.9
0.8
0.9
Goal
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
11
HAPU Stage II & Above
0.6%
0.5%
Current rate 0.3% (56.1%)
HAPU Rate
0.4%
0.3%
0.2%
0.1%
0.0%
Jan- Feb- Mar- Apr- May- JunAug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- JunAug- Sep- Oct- Nov- DecJul-12
Jul-13
12
12
12
12
12
12
12
12
12
12
12
13
13
13
13
13
13
13
13
13
13
13
Baseline 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Hospital
0%
1%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Goal
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
12
HAPU Stage III & IV
1%
1%
HAPU Rate
1%
1%
Current rate 1% (440.3%)
0%
0%
0%
0%
0%
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Baseline
0%
0%
0%
0%
Hospital
0%
0%
0%
0%
0%
0%
0%
1%
0%
0%
0%
1%
Goal
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
13
Catheter-Associated UTIs
1.8
CAUTI Rate/1,000 Catheter Days
1.6
1.4
1.2
1.0
0.8
0.6
Current rate 1.0 (-33.6%)
# CAUTI prev. to date = 53
Cost savings to date = $39,750
0.4
0.2
0.0
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
Baseline
1.5
1.5
1.5
1.5
Hospital
0.7
1.5
1.0
1.3
1.4
1.3
1.3
1.6
1.0
1.0
1.3
1.0
Goal
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
0.9
14
Central Line Blood Stream Infections
CLBSI Rate/1,000 Line Days
2.5
Current rate 0.7 (-42%)
2.0
1.5
1.0
0.5
0.0
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
1.2
Baseline
1.2
1.2
1.2
1.2
Hospital
2.0
1.1
2.0
1.5
1.4
0.9
1.4
1.5
1.8
1.1
1.8
0.7
Goal
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
15
Ventilator-Associated Pneumonias
VAP Rate/1,000 Ventilator Days
4.5
4.0
3.5
3.0
2.5
2.0
1.5
Current rate 1.1 (-69%)
# VAP prev. to date = 34
Cost savings to date =
$1,462,000
1.0
0.5
0.0
Baseline
3.6
3.6
3.6
3.6
May12
3.6
Hospital
3.0
3.8
4.2
1.7
Goal
2.2
2.2
2.2
2.2
Jan-12 Feb-12 Mar-12 Apr-12
3.6
3.6
3.6
3.6
May13
3.6
2.2
2.2
2.2
2.2
2.2
Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
3.6
3.6
3.6
3.6
3.6
3.6
3.6
3.8
2.7
0.9
1.4
3.2
2.6
1.6
1.1
2.2
2.2
2.2
2.2
2.2
2.2
2.2
2.2
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
3.6
3.6
3.6
3.6
3.6
3.6
3.6
2.2
2.2
2.2
2.2
2.2
2.2
2.2
16
Surgical Site Infections
6.0%
5.0%
Current rate 1.5% (-18.6%)
SSI Rate
4.0%
3.0%
2.0%
1.0%
0.0%
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
Baseline
2%
2%
2%
2%
Hospital
2%
3%
3%
3%
2%
2%
6%
3%
3%
3%
3%
1%
Goal
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
17
Early Elective Deliveries
25.0%
EED Rate
20.0%
15.0%
10.0%
Current rate 12.5% (-38.9%)
# EED’s prev. to date = 290
Cost savings unavailable
5.0%
0.0%
Baseline
20%
20%
20%
20%
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20%
Hospital
14%
18%
16%
16%
16%
14%
14%
11%
8%
8%
11%
13%
Goal
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
Jan-12 Feb-12 Mar-12 Apr-12
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
12%
18
Venous Thrombo-Embolisms
0.5%
0.4%
0.4%
VTE Rate
0.3%
Current rate 0.2% (53.8%)
0.3%
0.2%
0.2%
0.1%
0.1%
0.0%
Jan-12 Feb-12 Mar-12 Apr-12
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Baseline
0%
0%
0%
0%
Hospital
0%
0%
0%
0%
0%
0%
0%
0%
0%
Goal
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
19
Total Harm
50.0
Total Harm/1,000 Patient Days
45.0
40.0
Current rate 7.5 (-75.2%)
# Harms prev. to date = 3,254
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Baseline
30.2
30.2
30.2
30.2
MayMayJun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
12
13
30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2 30.2
Hospital
15.2
15.8
39.2
17.8
17.1
44.1
19.2
18.3
44.8
17.1
16.6
7.5
Goal
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
Jan-12 Feb-12 Mar-12 Apr-12
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
18.1
20
Next Steps
• Chicago HEN Week – March 18-22, includes special
Sr. Leaders sessions on Tuesday 3/19
– Collaborative Training
– Improvement Leader Fellows
– Senior Leader Training
• Additional Patient Safety TeamSTEPPS TrainingMay
• Ongoing Coaching Calls/Webinars – evaluate the
educational and support needs of our hospitals and
provide through coaching and networking
21
Next Steps
• HSOPS Surveys – USE HSOPS data to drive
unit-level improvement through skills-based
training
• Technical Assistance – evaluating individual
hospital improvement and provide technical
assistance
• Senior Leaders – provide training to gain
buy-in and support from senior leaders to
drive improvement work
22
Celebrate
Reached CMS January 31, 2013
Reporting Goal!
– 96% hospitals reporting on 6 or more
areas
Individual hospital goals!
More hospitals in Kentucky engaged
than in most every state!
23
Call To Action
Every hospital should be actively
working on:
– Readmissions – participation and data submission
– Adverse Drug Events – participation and data
submission
– EED- participation, 70% with hard stop p/p by 4/1
Every hospital to set an improvement
goal in 3 areas
Kentucky hospitals WILL reach 40/20
Goal by December 2013!
24
Thank you! Questions?
25