Quality & Safety at Hadassah A Progress Report

1. Quality & Safety at Hadassah A Progress Report Mayer Brezis, MD MPH Professor of Medicine, Center of Quality & SafetyChairman, Quality & Safety Committee Yoel Donchin, MD, Nurit Porat, RN

2. Quality & Safety at Hadassah • Students Projects • Institution-wide Projects • Educational Activities • National Impact

3. Making Health Care Safer: A Critical Analysis of Patient Safety Practices Evidence Report Agency for Healthcare Research & Quality www.ahrq.gov/clinic/ptsafety

4. Venous Thromboembolism in Neurosurgery Dr. G. Rosenthal, S. Goldman RN, Prof. F. Umanski, Prof. D. Varone, Dr. Y Weiss Departments of Neurosurgery, Hematology, Central Management, Center for Quality & Safety Hadassah University Hospital Jerusalem, Israel

5. 58 year-old woman underwent resection of meningioma • On post-op day 2, sudden onset of respiratory distress • Chest CT demonstrates massive pulmonary embolism • Vena cava filter inserted & anticoagulation initiated • On post-op day 6 sudden onset of severe headache and vomiting

6. Follow-up CT Post-op CT

7. 10/239 4% 5/75 7% 0/94 0% • 5 months (2003) • 10 cases of thromboembolism • 7 vena cava filters inserted • Extended ICU & hospital stays Cases of thrombo-embolism Control

8. July 2003: Introduction of intermittent pneumatic compression devices 10/239 4% 5/75 7% 0/94 0% Cases of thrombo-embolism Control Intervention

9. 10/239 4% 5/75 7% 0/94 0% Cases of thrombo-embolism Control Intervention

10. 10/239 4% 5/757% 0/94 0% Cases of thrombo-embolism Control Intervention Control Control Intervention

11. Conclusion: Quality can reduce morbidity & save costs

12. Quality indicators for the management of myocardial infarction M. Cohen, Dr. A. Pollack, Prof. A. Weiss, Prof. C. Lotan Intensive Cardiac Units, Division of Cardiology & Department of Medicine, Mt. Scopus & Ein Kerem Hadassah University Hospital Jerusalem, Israel

13. Hadassah(%)899050836944’ 102’ Quality indicators for myocardial infarction, Hadassah vs. US data

14. Hadassah Peterson R, JAMA 2004;291:195

15. Quality in Health Care • Evidence-based • System-minded

16. How can we make sure the patient gets the result? Will the pathology result get lost? P. Topol, RN, Dr. A. Zlotogorski, Prof. A. Ingbar, Dr. A. Mali, T. Friedman, RN, M. Benhur, N. Porat, RN Departments of Dermatology, Pathology, Information Systems, Nursing and Quality & Safety Committee 0% 1% failed malignancy reports 4% Will the pathology result get lost? p<0.05 Percent of patients having received the result of their skin biopsy A clinic-based intervention (led by the head nurse, involving both physicians & patients) An institution-wide intervention: electronic alerts sent to physician’s computer whenever a pathology report is ready

17. This quality improvement project, awarded prize of best poster at the meeting of the Israeli Society for Quality in Medicine, is posted at the dermatology clinic as a reminder for both patients, nurses and physicians

18. Quality & Safety Committee Subcommittee for Medication Errors

20. Specific labels for lines to patients - to avoid mix up

21. Interactive software to learnprescribing for new physicians Screen from software asking: “Would you approve this prescription?”

22. Quality in Health Care • Evidence-based • System-minded • Patient-centered

25. Palliative Care in General Internal Medicine: A successful pilot intervention among elderly patients with life threatening illness and impaired cognition S. Gottsman, RN, MA et al. Head Nurse, Medicine B, Mt Scopus

26. Intervention Staff-initiated meetings with relatives, to communicate information on patient’s condition; to listen to their questions and to their preferences based on patient’s prior wishes – if any had been expressed; and finally to attempt shared goal setting and decision making Control ward – no intervention

27. Percent of relatives agreeing with negative statements Intervention Control

28. Emerging methods for quality evaluation Is the X-ray interpretation by the junior staff on duty correct? Dr. Y. Mintz, Dr. D. Kisselgoff, Y. Gronowitz, A. Shaham, R. Hefez, Dr. D. Shaham Departments of Surgery, Radiology, and Center for Quality & Safety

30. Hip fracture Frontal bone fracture

31. Validity of X-ray Interpretations in Trauma mean & 95% CI (confidence interval)

32. Reliability of X-ray Interpretation on Duty

33. A Senior Resident in Radiology Concluded: “We need to look at ourselves”

34. Summary & Conclusion • Students Projects • Institution-wide Projects • Educational Activities • National Impact Diverse projects attempt to make healthcare at Hadassah more patient-centered, more evidence-based and more system-minded. Increased accountability by department heads for quality and safety may be a key to further successes.

35. How would an open disclosure policy about mistakes affect hospital image in public’s eyes? MD student Zivan Beer ImproveImage Damage Image No Change

36. How would an open disclosure policy about mistakes affect hospital image in public’s eyes? N=115 N=570 p<0.001 MD student Zivan Beer ImproveImage Damage Image No Change

37. “Tell the truth and tell it fast” N. Augustine. Crisis Management Harvard Business Review (2000) Risk management: Extreme honesty may be the best policy(The V.A. Experience) Annals of Internal Medicine ‘99 New position statement by the Ethics Board of the Israeli Medical Association supports transparency (May 2004)

38. IMA Ethics Board Position Paper “The physician has an obligation to disclose to the patient that a mishap has happened”