Reform Sharpens Focus on Quality Outcomes

Joe Cantlupe, for HealthLeaders Media , March 16, 2011
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One of the reasons that the C-suite embraced reexamining the readmission rate in heart condition patients was that Bronson believed its heart failure readmission rate was “not the best practice; and that wasn’t good enough.”

In heart failure situations involving readmissions, a multidisciplinary approach using specialized committees that focus on clinical inventories and a host of quality measures are considered, Mayer says.

A performance improvement team was created that focuses on heart failure and heart failure readmission rates, with physicians as co-chairs and hospital operation leaders, nursing, and pharmacists part of the team. The Bronson team examined literature in the field. “We built upon this to identify other prospective interventions we wanted to test,” Mayer says.

A review of medication was at the forefront of specific evaluations for readmission. Hospital officials determined that there were an average of 16 prescriptions for each heart patient and that patients were not conforming to prescriptions, had wrong medications, or outdated medications, according to the review.

The hospital also evaluated patients’ attitudes and sent nurse practitioners to patients’ homes to review drugs taken at home following discharge. Under the Bronson procedure, a nurse practitioner visits the home of every heart failure patient after the patient’s release from the hospital, regardless of whether the patient receives services from a home healthcare agency.

Reducing length of stay

Once a patient is in the hospital, another key effort toward better quality is reducing length of stay. Doing so increases capacity in the system (including beds and staff time), minimizes waiting times, and maximizes productivity and the patient experience. A shorter time in the hospital is often less disruptive for the patient and his or her family.

Several years ago, the University of North Carolina Health Care System had its capacity stretched to the limit, and it wasn’t in a position to have new construction projects. UNC leaders looked at other ways to reduce length of stay, focusing on more efficient and effective care.

The 803-licensed-bed UNC Health System began to embark on a Lean system to increase efficiency in LOS issues. Lean and Six Sigma are part of a business management strategy designed to improve quality by removing defects in a system. Each Six Sigma project carried out within an organization follows a defined sequence of steps and has qualified financial targets.

UNC worked with Boston Consulting Group to establish its program. BCG noted that a hospital with 800 beds that cuts average LOS by just 10% could free up nearly 80 beds per year, enabling the delivery of more than 4,000 additional procedures and boosting operating profit by almost $30 million, according to documentation by the Wharton School of the University of Pennsylvania.

Moving forward on LOS, the health system was particularly successful with its liver transplant team, among the most complex and complicated in care. With specific changes in place, the team reduced average LOS from 15 days to 8.6, says UNC surgeon Alexander H. Toledo, MD, who is assistant professor in the department of surgery, division of abdominal transplant surgery.

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