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Start Measuring. Start Improving. Webinar SeriesMeasuring and CommunicatingResuscitation Quality ImprovementWednesday April 26, 201712:00pm – 1:00pm CTPresenter: Ronald R. Galfione, MD
Measuring and Communicating Resuscitation Quality ImprovementRonald R. Galfione, MDInternal MedicineAssociate Quality OfficerHouston Methodist HospitalLearn more at heart.org/resuscitation4/26/2017 2015, American Heart Association2
Measuring and Communicating Resuscitation QualityImprovement for Get with the Guidelines ResuscitationHouston Methodist HospitalRonald R. Galfione, MDApril 26th, 2017
Speaker IntroductionRonald R. Galfione, MDInternal MedicineAssociate Quality OfficerHouston Methodist Hospital
Disclosure Neither I nor any member of my immediate familyhas a financial relationship or interest with anyproprietary entity producing health care goods,commercial products or services related to thecontent of this presentation I do not intend to discuss anunapproved/investigative use of commercialproducts/devices
Learning Objectives Discuss data collection and disseminationprocess Review how opportunities for improvementdrive process and performance initiatives Explain benefits of effective andstandardized communication processes Describe future initiatives and sustainabilityof performance outcomes
OverviewAbout Houston Methodist HospitalAbout Code Blue/CERT SubcommitteeComparative measure outcomes data (2013-2015)Current initiatives– Drill downs on opportunities for improvement– Closed loop communication– Technology innovation– Policy review Future initiatives– EMR system Code Navigator/Narrator enhancements– Policy updates Summary
Houston Methodist Hospital
Houston Methodist System:Leading Medicine 7 hospitalsA research instituteA comprehensive residency program2,043 operating beds814,309 outpatient visits101,508 admissions20,000 employeesMore than 4,500 physiciansPhysician organization with 572physiciansAffiliated with the Weill Cornell Medicine,New York Presbyterian Hospital, TexasA&M University and Texas AnnualConference of the United Methodist
Houston Methodist Hospital (HMH)Houston, TX (Texas Medical Center)830 operating beds78 operating rooms1,479 affiliated physicians7,395 employees36,720 admissions326,534 outpatient visits72,399 emergency room visits1,026 birthsMore than 12,406 internationalencounters from 84 countries 36 ACGME-accredited (plus 7 nonACGME) residency programs with 262ACGME residents and 6 non-ACGMEresidents
Code Blue/CERT - Subcommittee
StructureQuality and Patient Safety SteeringCommitteeCritical Care CMPI*Code Blue/CERT*Subcommittee*Note: CMPI: Care Management Performance Improvement; CERT: Clinical Emergency Rapid Response Team
Membership Associate Quality Officer (AQO) Vice President Sponsorship Code Blue Responders– Resident Physicians– Nurse Practitioners– Respiratory Therapy– Anesthesia Pharmacy Supply Chain Nursing Leadership Quality Specialists
Subcommittee Activities Monthly meetings Facilitated by AQO Coordinated by Performance ImprovementSpecialist Utilization of PDCA (Plan-Do-Check-Act) Process–––––Disseminate and review of relevant dataReview & drill down opportunities for improvementBrainstorm and identify action plans/initiativesImplement & track outcomes of action plans/initiativesContinue PDCA cycle
Data-Driven Performance Improvement
Change in Practice/StructureDesignated quality specialists for Resuscitation RegistryBefore 2013 Abstractor notunder Quality Had other jobfunctions2013 Designatedabstractorunder Quality2014 - Present Abstractor PerformanceImprovement(PI) Specialist
Change in ProcessUtilized PDCA cycle to guide continuous performanceimprovement Review data,practice, process,policies Identify & discuss:trends, issues/OFIs*barriers, solutions,action plan Implement orcontinue effectivepractice &/orprocess change Repeat cycle*OFIs: Opportunities for improvementPLANDOACTCHECK Implement orexecute action plan Reinforce bestpractice Educate Escalate Review & analyzedata Identifyeffectiveness ofaction plan
Advantages Quality department leadership oversight Dedicated abstractor Reviewed medical records & submitted registry data Educated staff when OFIs occur Dedicated Performance Improvement (PI) Specialist Liaison between abstractor & clinicalstaff/leadership/code blue subcommittee Performance Improvement (PI) Specialist or Abstractor Clarified & verified accuracy & completeness ofdocumentation (phone, email, face-to-face) Provided more timely feedback & education to unitstaff/leadership/Code Blue team
Problem/OFIWhat did 2013 data say?Recognition Measures Performance CY 201310085Percent80Opportunity forImprovement (OFI)60402002013% Pulseless Cardiac Events Monitored or WitnessedTime to First Chest Compression 1 minDevice Confirmation of Correct ET Tube PlacementTime to 1st Shock 2 min for VF/Pulseless VTGoal19
Data AnalysisIs this an old or new OFI*?Time to 1st Shock 2 Min for VF/Pulseless 02011Time to First Shock 2 Minutes for VF/Pulseless VTGoalLinear (Time to First Shock 2 Minutes for VF/Pulseless VT)*OFI: opportunity for improvement20122013
Barriers Mean turn around time (TAT) of code record to Quality 3days from date of code eventCode BlueannouncedCPR InitiatedStaff completescode recordData abstracted& entered indatabaseCopy of coderecord should besent to Quality(w/in 3 days ofcode)Verified &signed-off byunit manager No opportunity to address documentation issues timely Lack of buy-in and engagement from front-line staff Lack of knowledge regarding resuscitation best practices andregistry measures
Initiatives Tracked code sheet turnaround time Presented data regularly to Code Blue/CERTSubcommittee– Holds people more accountable– Underpins transparency Drilled-down, discussed, and learned from OFI Communization loop process Presented to Nursing Leadership Council, UnitNursing Leadership and Chief Nursing Officer
Initiatives (con’t):Communication Feedback LoopCode Bluedocumentationreceived byabstractorIdentify OFIswith outcomemeasuresCommunicationwith unitleadership –electronic andin person;escalation toupperleadership ifneeded accountability*OFI: opportunity for improvement; **PDCA: Plan-Do-Check-ActEnact actionplans ringsuccess ofaction plans –sustainabilityandhardwiring
Data TrendWhat changed in 2014 & 2015?Time to 1st Shock 2 Min for VF/Pulseless 020112012201320142015Time to First Shock 2 Minutes for VF/Pulseless VTGoalLinear (Time to First Shock 2 Minutes for VF/Pulseless VT)Before 2013 Abstractor not underQuality Had other job functions20132014 - Present Designated abstractorunder Quality Abstractor PerformanceImprovement (PI)Specialist Initiatives implemented
Measure of SuccessHow did the data look when changes were implemented?Recognition Measures Performance: 2013 - 6% Pulseless Cardiac Events Monitored or WitnessedTime to First Chest Compression 1 minDevice Confirmation of Correct ET Tube PlacementTime to 1st Shock 2 min for VF/Pulseless VTGoal25
Sustainability – Current Initiatives Hardwire communication feedback loop–––––Timeliness of communicationAccountabilityCollaboration with unit leadership & staffTimely identification of OFIsCode Blue Debriefing ‘Hot’ and ‘Cold’ processes– Development & implementation of process improvementinitiatives at point of care Process ownership of frontline staff
Sustainability (cont.) Innovation – Integration of Technology– EMR* system Narrator/Navigator Project (capability toprovide real time feedback)– Collaboration with end users, upper leadership,education, quality and code responders– Mock codes/training before implementation– Stepwise Rollout:Phase I: Emergency DepartmentPhase II: Intensive Care UnitsDelineate rolesPhase III: Acute Care UnitsImplementSimulation Labtraining videoTrainingImprove toolSuper User TrainingImplementComputer-basedtraining module for allRN staff*EMR: Electronic Medical Record
Sustainability (cont.) Code Blue Debriefing– Collaborative discussions regarding successes and barriers aftercode blue event– ‘Hot’ and ‘Cold’ processes Frequent policy review– Addressed geographical barriers Possible delay in code team arrival poor outcomes‒ Align with practice‒ Integration with electronic medical record system
Sustainability - Future Clinical decision support in EMR system CodeNarrator/Navigator– Standardize & hardwire EMR system solutions– Complete & accurate documentation in real time– Comply with quality and outcome measure requirements Investigate new technology in driving efficiency andeffectiveness of care
Recognize & CelebrateAmerican HeartAssociation QualityAchievement AwardsHouse of Blues NewOrleansNovember 14th, 2016
SummaryAssign dedicated quality specialists to registryStandardize processesProvide timely feedbackBe transparent with dataUtilize PDCA Process for continuous process improvementEngage leadership & cliniciansLearn from opportunities for improvementAlign best practices with policies, practice, EMR* systemLeverage technology to improve process, practice, &outcomes Recognize & celebrate successes
Contact InformationContact InformationDr. Ronald Galfione, Associate Quality Officerrgalfione@houstonmethodist.orgAshley Eugene, Senior Quality Outcomes Specialistaleugene@houstonmethodist.orgNora Dumlao, Clinical Outcomes SpecialistNTDumlao@houstonmethodist.org
Thank You for Joining!We welcome your questions on Get With The Guidelines-ResuscitationTanya Lane Truitt, RN MS, Senior ManagerQSI Programs & Operations: Resuscitation & HF, Get With The Guidelines tanya.truitt@heart.orgLiz Olson, CVA, Program ManagerGet With The Guidelines Resuscitation & HFliz.olson@heart.orgLearn more at heart.org/resuscitation4/26/2017 2013, American Heart Association34
Start Measuring. Start Improving. Webinar Series. Measuring and Communicating Resuscitation Quality Improvement. Wednesday April 26, 2017. 12:00pm - 1:00pm CT
