Process and Methods

1. Trans-Atlantic alliance to compare patient safety performance between the UK and US organizationsThe business case for preventing inpatient falls Dr. MahmoodAdil – National Health Service, England Diane Huntley - Kaiser Permanente, CAPascal Briot - Intermountain Healthcare, UTpascal.briot@imail.org Hospital Engagement Network Falls Affinity Group Call – March 7, 2013

2. Align on definition of fall severity between organizations* Develop methods to track incremental cost of harm that could be standardized and easily used by other global systems Generate effective partnerships between clinical, finance, and analytic experts in three organizations Demonstrate that international collaboration is an effective sharing and learning tool to make a difference in reducing patient harm around the globe Process and Methods * See Appendix I

3. Execution Nov-Dec 2010 Outcomes Jan-May 2011 Cost of Falls Calculator 2012 Idea Sept 2010 Will May 2010 Journey of our collaboration Refining Falls project Starting ADE project 2013 Sept. 2010: Initial Meeting with NHS, Kaiser Permanente, and Intermountain IHI Forum 2011: Poster Presentation International Forum & ISQua 2012: Oral Presentation Upcoming NPS Congress 2013: Oral Presentation

4. 1. How to identify rate and severity of falls Impact of information measurement system and professional cultures 2. How to identify savings associated with reduction in rate of falls Matched cohort comparison of length of stay, labs, imaging and Rx utilization 3. How to track intervention “cost” Identification of intervention & accounting methodologies 4. How to “put it all together” Cost of falls calculator B-C=D Benefits(costs of poor quality or service) Costs (costs of improvement intervention) Dividends (Case for Change) Challenges for All

5. 1. Fall prevalence rate per 1000 patient days 2010 data * IH sample size for major injury not statistically significant

6. 2. Mean extended length of stay 2010 data * IH sample size for major injury not statistically significant

7. 3. Tracking of interventionsIntermountain example 2010 - 2011 Board Goal (2010) Designated Fall Champions Post Falls Assessment Implementation Mini-RCA for Falls (Falls Assessment Huddle) Patient Safety Index Skill Pass Off for bed types New Bed (with integrated bed alarm) Nurse Call System Integration 2005 - 2007 Creation Safe Patient Handling team (earned Magnet status, gait belts & lift system, awareness signs) Standardize Fall definition Added electronic risk scoring/protocol to event system Developed web reports for front line Inclusion of falls on nurse manager dashboard 1998 Creation of Patient Safety Team Meeting Prep and Follow-up Nursing Falls Education Develop protocol

8. 3. Tracking of Intervention

9. 4. Fall risk calculator

10. Accurate identification of falls Robust event system to identify falls and severity. Culture of safety and no-blame 2. Calculating associated cost due to a fall Incremental length of stay by using cohort matching methodology Convert incremental resource use into actual cost 3. Track & cost your intervention to reduce fall Identify intervention in terms of leadership, process improvement, infrastructure, information system and reporting Estimate the cost of intervention (allocated equipment cost over time) 4. Putting it all together using the calculator Pre-requisite to use the calculator

11. Accurate and consistent identification of falls Agreed on use of standard definition of severity of falls and methodology to measure falls rate. The WHO should include new codes for hospital associated falls in its next version of ICD classification system. 2. Track and cost your intervention to reduce fall Quality Improvement culture to track intervention: clinical and finance teams need to find ways to share data and work together for creating the ‘business case for safety’ and achieving sustainable outcomes. Need a good activity based cost accounting system. If it is not possible to separate out the effect of an intervention and the cost of it because interventions are cumulative, it may be best to look at impact over time. 3. Degree of similarity of interventions across institutions ‘Extended Length of Stay’ is a good indicator to quantify harm-related incremental cost and resource utilization. Lessons learned due to our collaboration

12. Multidisciplinary Team Program Office Quality Dept Project Management Wrightington, Wigan and Leigh Hospital Institute for Health Care Delivery Research Northern California Region Sponsors Clinical Program Leadership Patient Harm Reduction Program NCAL Quality NCAL Finance Finance Analytics Finance Quality Northern California Risk and Safety HEROES Initiative California Analytics Patient Safety Clinical Quality Analytic ROI Tactical Team

13. Intermountain ROI tactical initiatives • Led by our Asst. VP for quality and patient safety and reported to our CNO / VP for clinical operation • Mission: • To build a partnership between clinical and financial experts to use the best available data and expertise • To provide careful ROI analysis of quality and patient safety initiatives in order to give leadership insight into strategic opportunities • To build a standardized approached to calculating ROI that can be “exported” to other initiatives on a system, regional or facility level • To quantify existing quality improvement projects that may assist in meeting Intermountain’s goal of maintaining a low rate of cost increases to CPI+1% • Areas of concentrations: • Falls • Adverse Drug Events (ADE) • Central Line Associated Blood Stream Infection (CLABSI)

14. Intermountain fall with injury rate

15. Methodology for ROI calculation Savings: • Decrease payment on legal claims • Decrease variable cost due to • reduction in complication associated with fall reduction • reduction in LOS Potential impact on revenue stream? Expenses: • Costs of implementation of falls prevention initiatives • Personnel (new staff, education, training, …) • IT / information / measurements (Risk event system, data tracking and reporting, …) • Infrastructure (equipment, supply, …) How to allocate capital expenditure?

16. Decreased Payment on Legal Claims

17. Reduced Patient Costs • Savings

18. Approximation of Financial Outcome

19. Next Steps • Refine Patient Cost Reduction Calculations • Verify whether charges related to falls are billable • Determine appropriate comparison • No Falls : Falls • No Falls : Falls with Injury • Investigate employee injury claims • Refine allocation of capital costs • Beds, remodeling • Across applicable risk events (pressure ulcer,…) • Create methodology for budgeting utilization changes at dept. level • Apply ROI methodology to other risk events

20. Clear and simple objective to be agreed from the outset Staged approach to build the momentum and measurable goals for each stage An effective coordinator able to leverage the use of web technology Establish common ground for data sharing and incorporating each others standards in a practical manner Act like one team with commitment and flexibility to achieve common results across the organizations Lessons learned for a successful international collaboration

21. Thank you! Questions

22. Appendix I -Severity of Falls Definitions

23. Appendix II - SchmidPlus ABCS

24. Appendix III - Collaboration Team