Rural WI Hospitals Improving Together

1. Rural WI Hospitals Improving Together Overview of the surgical care improvement and stroke collaboratives Dana Richardson, RN, MHA Vice President, Quality 608-274-1820 drichardson@wha.org

2. Collaborative Method • Multi-professional teams commit to improve services within a specific subject and to share how they made their improvement with others • Focused on a clinical or administrative subject • Gap between best and current practice • Learn from experts about the evidence for improvement, change concepts and practical changes • Use small changes in quick succession • Set measureable targets and collect data to track performance • Meet at least twice to share experiences • Participate in a continuous exchange of ideas via visits, e-mail or conference calls

3. Surgical Care Improvement Project (SCIP)

4. The SCIP project national goal is to “reduce preventable surgical morbidity and mortality by 25% by 2010” • National leadership provided by CMS and IHI • Evidence based guidelines • Consensus measures • Funding provided by WI Office of Rural Health, Flex Grant Program • Lead by Wisconsin Hospital Association

5. Why Surgical Care Improvement? • National and state interest • 30 million major operations per year in the U.S. • Known variation in perioperative care, despite major advances in surgical and anesthesia technique • Evidence based interventions are available to prevent complications • Surgical site infection (SSI) is one of the more common HAI • Patients with post-op complications have: • Increased length of stay • Increased mortality • Increased costs • CMS includes SSI in list of non-payment DRG’s

6. Hospital Profits Source: IHI Clinical Advisory Board interview & analysis

7. 4 Target Areas • Surgical infection prevention ** • Appropriate timing and use of antibiotics • Appropriate hair removal • Postoperative glucose control • Postoperative normothermia • Cardiovascular complication prevention ** • Beta blockers for patients on beta blockers prior to admission • Venous thromboembolism prevention ** • Venous prophylaxis ordered • Venous prophylaxis received • Respiratory complication prevention (ventilator pts.) • HOB elevated • Stress ulcer prophylaxis • Ventilator weaning protocol ** Target area included in Rural SCIP Project

8. Project Goals • Engage rural hospitals in: • a structured shared learning project • objective decision making • team development • Support process change implementation related to surgical care • Educate rural hospitals regarding the connection between nationally recognized quality indicators and process improvement within the hospital setting

9. Participating Hospitals • Amery Regional Medical Center, Amery • Baldwin Area Medical Center, Baldwin • Boscobel Area Health Care, Boscobel • Columbus Community Hospital, Columbus • Good Samaritan Health Center, Merrill • Grant Regional Health Center, Lancaster • Hayward Area Memorial Hospital, Hayward • Hudson Hospital, Hudson • Langlade Memorial Hospital, Antigo • Memorial Hospital of Lafayette Co., Darlington • Memorial Medical Center, Ashland • Memorial Medical Center, Neillsville • Reedsburg Area Medical Center, Reedsburg • Ripon Medical Center, Ripon • Sacred Heart-St. Mary’s Hospital, Rhinelander • Sauk Prairie Memorial Hospital, Prairie du Sac • Southwest Health Center, Platteville • Spooner Health System, Spooner • Tomah Memorial Hospital, Tomah • Waupun Memorial Hospital, Waupun • Westfields Hospital, New Richmond

10. Structure • Monthly data collection • Excel data collection tool • Monthly data aggregation by WHA • Planning conference call with participating hospitals • 3 full day learning sessions (February, April, June) • Conference calls • Provided research and best practices • Respond to questions

11. Results - Measures

12. Results - Measures

13. Stroke

14. National leadership through American Heart/Stroke Association • Evidence based guidelines • Data collection tool • Consensus measures • State leadership through WI Stroke Committee & the WI Heart Disease & Stroke Prevention Program • Approx. 25 TJC Certified Primary Stroke Centers in WI • Funding provided by WI Office of Rural Health, Flex Grant Program • Co-lead by American Heart Association & Wisconsin Hospital Association

16. Goals • Engage rural hospitals in: • a structured shared learning project • objective decision making • team development • Support process improvement change using evidence-based guidelines • Engage rural/critical access hospitals to use the quality data collected to monitor the progress of process improvement activities

17. Participating Hospitals • Agnesian HealthCare – Fond du Lac • Black River Memorial Hospital – Black River Falls • Bond Health Center – Oconto • Community Memorial Hospital Inc. – Oconto Falls • Divine Savior Healthcare – Portage • Fort HealthCare – Fort Atkinson • Good Samaritan Health Center – Merrill • Grant Regional Health Center – Lancaster • Langlade Memorial Hospital – Antigo • Memorial Hospital of Lafayette County – Darlington • Memorial Medical Center – Neillsville • Moundview Memorial Hospital & Clinic Inc. – Friendship • Riverview Hospital Association – Wisconsin Rapids • Sacred Heart-St. Mary’s Hospital – Rhinelander • Spooner Health System – Spooner • St. Joseph’s Hospital – Hillsboro • Stoughton Hospital – Stoughton • Waupon Hospital – Waupon • Westfields Hospital – New Richmond

18. Train on GWTG patient management tool • 1 year GWTG patient management tool fee paid by grant for participating hospitals • Two full day learning session (Jan., June) • Conference calls (Dec., Feb., May) • 7 additional Webinars during the project hosted by GWTG

19. Key Learning Areas • Overview of Brain Attack Coalition Recommendations • Overview of Stroke Systems of Care • Understanding of Stroke Consensus Measures • Understanding of ASA Guidelines • Understanding of NIH Stroke Scale • Focus on stroke education • Focus on transfer protocols • Focus on strategies to overcome barriers

24. Were the goals of the project met for your hospital?

25. Lessons Learned • Barriers to Improvement • Data collection • Infrastructure • Low volume • Reduced access to time or expertise in identifying evidence and tools available • One key “nay sayer” can be a huge stumbling block • Advantages with Improvement • Issues are similar to other rural (and urban) hospitals • Less structure so they can make changes quicker • A good champion can move mountains • Rural hospitals want and can provide “state of the science” care in their communities

26. Is there a role for practice based research in collaborative improvement projects?