Working Together to Champion Patient Safety Carol Wagner Vice President Patient Safety

1. Working Together to Champion Patient Safety Carol Wagner Vice President Patient Safety Washington State Hospital Association Randy Benson Executive Director Rural Healthcare Quality Network

2. Overview: • Understand how economic turmoil and healthcare reform is making patient safety even more important • Understand how the WSHA Patient Safety Program & RHQN support rural Washington Hospitals

3. Interactive Session • This will be an interactive session • Please feel free to ask questions • Use of voting

4. Question: • At Chelan, my favorite event is the: • Sessions and meetings • Ice cream social • Barbeque • Sitting out on our patio watching the lake

5. Question: • I have been to this conference ___ times: • Once, this is the first time • 2-5 times • 6-10 times • 11 or more times

6. Question: • Your role at your hospital is: • Community board member • CEO or administrator • Physician or nursing leadership • Other hospital leadership

7. Question • Is payment for care in your hospital likely to: • Increase over the next few years • Stay the same over the next few years • Go down over the next few years • I don’t know

8. Question: • Pressure to increase quality and safety of care is coming in our region the most strongly from: • Media and community • Payors • Regulators • Hospital staff • Board members

9. Question: • Hospitals should be paid for: • Providing a service (regardless of safety and quality) • Providing a service safely (did not harm the patient) • Providing a service, safely with quality (evidence based, timely care with no harm to patient) • Don’t know

10. Question: • Critical Access Hospitals are currently paid for: • Providing a service (regardless of safety and quality) • Providing a service safely (did not harm the patient) • Providing a service, safely with quality (evidence based, timely care with no harm to patient) • Don’t know

11. Question: • Urban or PPS Hospitals are starting to be paid for: • Providing a service (regardless of safety and quality) • Providing a service safely (did not harm the patient) • Providing a service, safely with quality (evidence based, timely care with no harm to patient) • Don’t know

12. Healthcare Reform Philosophies • Payment for quality*, safe care • Don’t pay for harm • Readmissions for 30 days • Hospital acquired infections • Adverse events • Hospital compare *care follows the medical evidence Initially impact PPS/urban hospitals

13. “Rehospitalizations among Patients in the Medicare Fee-for Service Program”New England Journal of Medicine, April 2, 2009 19% of Medicare patients were rehospitalized within 30 days 50% of the 30-day readmissions, there was no physician bill between the discharge and readmission 70% of readmitted surgical patients is for a medical reason Costing Medicare $17.4 billion a year

14. *Data Source: DOH Preliminary Revisit File for Q3 2008 discharges with UB04 reporting. Learning from each other – Sharing best practices

15. Washington Rehospitalizations Support of Commonwealth Fund and IHI Looking for approximately 10 hospitals to participate Testing Specific Strategies to Reduce Readmissions

16. Hospital Acquired Infections 100,000 people die from hospital acquired infections each year.

19. Media response to MRSA and hospital acquired infections has been intense.

20. Question What is the most effective way that staff can prevent transmission of infection in your hospital? • Hand hygiene • Test all patients for MRSA • Sterilize more equipment • Keep visitors out so they don’t spread infections

21. Eliminating Hospital Acquired Infections Hand Hygiene Central Lines Ventilator Associated Pneumonia MRSA – Multidrug Resistant Organisms Surgical Site Urinary Catheter Staff Immunizations

22. CEO and Trustee Challenge Washing hands can reduce hospital acquired infections by 25%

23. Soap and Sanitizer Usage 2008 traveled over 1,500 miles conducting “secret shopper” visits and listening to nurses!

30. Lessons Learned: Nurses liked the focus on hand hygiene- - important to keeping their families safe Soap containers just inside and outside the door were viewed very positively by nurses Staff were positive about seeing their results. Many staff had stories about how they had carried home organisms to their families. It is personal!

31. Hand Hygiene on Entry to Hospitals

32. Sanitizer by Staff and Family Lounges

33. Sanitizer at Nursing Stations

34. Hand Hygiene Congratulations As of June 3, 2009

35. Winners to be announced at the WSHA Annual Meeting! BEST HANDS ON CARE AWARD

36. Kick-off Meeting • July 15, 2009 • Dr. Peter Pronovost • Sam Watson Meeting designed specifically to build upon the work Washington hospitals have already done…challenge us to higher levels! • Eliminate infections and enhance skills to identify and eliminate defects.

37. The number of central line-associated blood stream infections varies among Washington hospitals.

38. Standardization • Emergency Code Calls • Isolation Precaution Signage • Wristbands – if using • World Health Organization Surgical Checklist WSHA Board Approved Implementation Goal October 1, 2009

39. Healthcare Reform Philosophies • Payment for quality*, safe care • Don’t pay for harm • Readmissions for 30 days • Hospital acquired infections • Adverse events • Hospital compare *care follows the medical evidence Initially impact PPS/urban hospitals

40. Question: • Adverse events reported to the DOH are considered public information and can be disclosed to the press. • True • False

41. Question: • An adverse event must be reported to the DOH within what timeframe? • 48 hrs. of their occurrence • 21 days of their occurrence • 48 hours of you knowledge of the event • 21 days of your knowledge of the event

42. Question: • For every adverse event reported to the state, a Root Cause Analysis (RCA) must be completed. • True • False

43. Question: • Reporting adverse events is optional; a hospital can decide if it is really needed. • True • False

44. Question: • What percent of Washington hospitals have reported an adverse event since 2006? • 0-20% • 21-40% • 41-60% • 61-80% • 81-100%

45. Adverse Events Support • Provide education concerning recognition of adverse events • External peer review to promote ‘best practice’ and avoid adverse events • Train staff on how to properly conduct a root cause analysis (RCA) • On-site support when RCA occurs

46. "External peer review, provided by the Rural Healthcare Quality Network, is invaluable to us in maintaining and enhancing quality patient care, preventing adverse events and delivering 'best practice' medicine”. Jon Smiley, CEO Sunnyside Community Hospital

47. RHQN providing on-site support for quality and survey readiness. • Classes for administrators • Training for staff • Problem resolution Using Lean and Six Sigma 101 – Supporting CAH

48. Activities Related to Hospital Compare • Facility Education Concerning Smoking Cessation Counseling • Provision of training through the Washington State Tobacco Quit Line • Provision of brochures and other supplies for patient education • Facility Education Concerning Discharge Planning Documentation