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Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012

Georgia Hospital Engagement Network Patient and Family Centered Safe Care Putting Patients First 40/20 by ‘13. Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012. The GHAREF HEN Team. Objectives .

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Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012

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  1. Georgia Hospital Engagement NetworkPatient and Family Centered Safe CarePutting Patients First40/20 by ‘13 Celebrating Our Success Continuing Our Positive Net Forward Energy December 5, 2012

  2. The GHAREF HEN Team

  3. Objectives • Discuss Year One Results for the Georgia Hospital Engagement Network • Describe the anticipated Positive Net Forward Eliminating Preventable All Cause Harm Approach • Outline how your organization will implement an all cause harm approach to eliminating preventable patient harm.

  4. Outline • Welcome & Introduction • State of the HEN from the National View • Year 1 Results • State of the State HEN Report • Education Snapshot • Learning Collaboratives • EED • HAC • HAI • Readmission • Small Rural and Critical Access Hospital Learning Community • Positive Net Forward Energy 2013

  5. Introduction

  6. Where We Started

  7. Partnerships Essential to Success • HEN Partners • HEN Hospitals • Community Partners • State Agency Partners • Healthcare Partners • Professional Society Partners • National Affinity Groups • Quality Improvement Partners • Other HENs If we are not working together, we are not doing our job!

  8. State of the GA HEN

  9. Financial Impact: Baseline 2010 to July 2011 - June 2012

  10. Results Over $44 Million Saved! 1,465 Patients’ Harm Prevented!!

  11. Education -A Key Element to Promote Change • January 4 – November 19 GHA HEN education facts: • 60 Educational Activities • 4,414 individuals participated • 341.25 hours of education • Average evaluation score 4.56 on a scale of 1-5 • Topics included: • Evidence Based Leadership • CUSP • Reliable Process Design • Lean Six Sigma • Defects Analysis • Rounding • Transitions of Care Coordination

  12. EED - Overview • EED Action Group met in April 2012 to review 2009 data regarding EED • Key stakeholders: March of Dimes, Department of Public Health, OB/GYN Society of Georgia Atlanta Chapter, Georgia Nurses Association, and other were in attendance • Developed and agreed upon plan to reduce EED’s by 40% • Ultimate overall goal for Georgia: 0% • Timely goal for August 2012: 5% or less • Plan: Encourage use of “hard stops”, March of Dimes Toolkit or IHI bundles to empower nurses and schedulers

  13. EED - Results • There are 83 birthing hospitals in Georgia • 58 (70%) of those hospitals turned in data • 19 (31%) of the 58 hospitals were already at a 0% EED rate • Of the 39 hospitals needing improvement about ½ showed significant gains!! • 3 of those hospitals went from a 14% or higher EED rate to a 0% rate sustained for at least 3 months!!

  14. EED: The Results 6

  15. EED: Financial Impact • According to Managed Care Magazine it costs around $41,000 for a late preterm NICU visit • The incidents went from 147 incidents in March 2012 to just 32 in August 2012 • That’s a decrease of 117 incidents • If even a ¼ of the babies went to NICU, we saved Georgia Healthcare $1,178,750.00 OVER 1 MILLION Dollars!!

  16. HAC: Falls, Pressure Ulcers, VTEs • 39 hospitals participated in the HAC LC • Quarter 2 2012, 22 of the 39 hospitals had outcome rate above target for at least 1 of 3 conditions: • 11 hospitals above target for FALLS • 7 hospitals above target for DVT/PE • 4 hospitals above target for PRESSURE ULCERS • Medication Reconciliation 2013

  17. PSI3: Pressure Ulcer Rate Q2 - 2012

  18. PSI12: Postoperative PE/DVT Rate Q2 - 2012

  19. Falls and Trauma (CMS-HAC5) Histogram Q2 - 2012

  20. HAI: CLABSI, CAUTI, VAP, SSI • First Focus : CLABSI • We used what we learned from CUSP to spread to other hospitals and units • Created the NICU Affinity Group to address CLABSI in the NICU • CAUTI work began • Device Utilization Focus – get them out! • 2013: • All HAI Prevention • National SUSP Program • VAP to VAE

  21. Our CLABSI Outcomes

  22. CLABSI – Spread to Other Areas

  23. NICU Affinity Group CLABSI

  24. CAUTI Improving

  25. VAP – Prevention Is Occurring • 22 Hospitals with Zero VAP Q2 2012 • Move to VAE in NHSN February 2013

  26. Readmissions

  27. Small Rural & Critical Access Hospitals Getting Back To Basics Creating a Culture of Safety

  28. SMALL RURAL AND CRITICAL ACCESS • Nine Learning Community Education Sessions held • 60 Small Rural and Critical Access Hospitals participated • 15 Critical Access Hospitals worked on multiple topics • 18 Small Rural Hospitals worked on multiple topics • 1 Small Rural Hospital worked on all ten topics • New ideas defined and studied • Successful networking • Variety of quality improvement topics presented

  29. CHALLENGES • Communication regarding expectations • Knowledge surrounding submitting data • Feedback regarding hospital-specific data • Information related to participation • Time commitment related to participation • Physician and Staff Engagement

  30. IMPROVEMENTS • Data submission simplified • Meeting standardization • Evaluations appreciated, comments acted upon • All Teach, All Learn • Executive Leadership Survey • Development of Executive Quality Action Council • Refocus on the Voice of the Patient: Patient and Family Centered Safe Care Advisory Action Group • Feedback from recognition program reviewed and triggered change

  31. Positive Net Forward Energy • 24 Hospitals highlighted in GHA Weekly Mail • Georgia Getting National Recognition • HEN Virtual Meeting, May 2012, Dr. William Bornstein, Emory Healthcare • National Rural Health Association Meeting, Rural Affinity Working Group Presentation, July 2012, Norma Jean Morgan, Effingham Health System • Strong Start Webinar November – EED, Lynne Hall, Vi Naylor • QNET, December 2012 Presentations • Sue Bowen, Shepherd Center • Heidi Nelson, University Hospital • Vi Naylor, Georgia HEN

  32. Moving to Eliminate “All Cause Harm” • Patient and Family Centered Safe Care Culture • Emphasis on Hospital Visits and Coaching • Enhancing Education opportunities • Process Measure Data Submission Continues All Teach, All Learn Member Input Essential

  33. Upcoming Educational Opportunities • GHA Patient Safety Summit January 9 – 10 • GHA Trustees Conference January 11 -13 • February 2013 HEN Kickoff

  34. Thank You for All You Do to Keep Patients Safe We Look Forward to Working With You in 2013!

  35. Contact Information • Phone: 770-249-4500 • Vi Naylor: vnaylor@gha.org • Kathy McGowan: kmcgowan@gha.org • Joyce Reid: jreid@gha.org • Denise Flook: dflook@gha.org • Faizah Muheb: fmuheb@gha.org • Martha Harrell: mharrell@gha.org • Lynne Hall: lhall@gha.org • Lorna Martin: lmartin@gha.org

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