When on Jan. 18 in Washington, D.C., executives and leaders of the Charlotte, N.C.-based Premier health alliance held a live-plus-telephonic press briefing to announce three years of results from the organization’s ongoing QUEST High-Performing Hospitals Collaborative program, one of the member hospital executives participating was from the McLeod Regional Medical Center in Florence, S.C., the flagship of the 771-bed McLeod Health, whose five hospitals see patients from across a broad service center that encompasses parts of northeastern South Carolina and southeastern North Carolina.
Donna Isgett, R.N., M.S.N., senior vice president, corporate quality and safety, at McLeod Health, spoke of her health system’s enthusiastic participation in the QUEST program, whose broad results had encompassed remarkable gains in patient safety and care quality, the use of evidence-based care protocols, and cost-effectiveness, over three years of performance improvement work. McLeod was one of 157 hospitals that had been charter participants in the QUEST program and that had been able to document strong results across the board.
Among the results documented at McLeod Regional Medical Center over the past three years have been the following:
< A 28-percent reduction in the hospital’s mortality rate from a 2.37-percent rate to a 1.91-percent rate, with an estimated 276 lives saved over three years
< A 22-percent reduction in per-case cost, from a baseline case mix-adjusted cost per discharge of $6,925 to a cost per discharge of $5,377 (with a $1,546 relative reduction in cost) over three years
< A 7.1-percent increase in the use of evidence-based care delivery over three years
Recently, Isgett and Coy Irvin, M.D., chief medical officer and vice president medical affairs, at McLeod Health, spoke with HCI Editor-in-Chief Mark Hagland, regarding their organization’s participation in the QUEST program, and what the lessons learned so far from that participation. Below are excerpts from that interview.
With regard to the 28-percent reduction in expected mortality rate over three years, how does that translate into actual lives saved? What's more, you've also achieved very meaningful cost savings within the same time span.
Donna Isgett, R.N., M.S.N.: Our flagship hospital has a census of 416 patients today [the day of this interview]. We probably have about 60-65 deaths a month here, and we’re saving about 15 patient lives a month at this facility. Meanwhile, on the cost side, we were able to save about $1,500 in cost per case over three years.
Donna Isgett, R.N., M.S.N.
What made you decide to participate in QUEST?
I was here at the time of the founding of the program; and in fact, I sat in on the design team for QUEST. As you know, Premier is a group of not-for-profit hospitals, and we’re one of the owners. And they said, we have to get healthcare as close to perfect as it can be. They used an accelerated design process, and they flew me and others in from across the country in order to participate in the discussions, and it involved not just providers but also payers, as well as representatives of such groups as the National Quality Forum and the Leapfrog Group and agencies and organizations such as AHRQ [the federal Agency for Healthcare Research and Quality] and the Joint Commission.
And over a couple of days, we designed this idea of a totally transparent group, where we’d all share data, and where we’d reduce costs, reduce mortality, avoid harm, improve the use of evidence-based care, and improve the patient experience, in that context.
Now, we’ve always been a hospital very dedicated to quality. We had won the Quest for Quality from McKesson and the AHA in 2010, and we were one of seven organizations involved in the grant with the Robert Wood Johnson Foundation called Pursuing Perfection, which was managed by the Institute for Healthcare Improvement ran that grant for RWJF. So quality has always been top-of-mind for us, and so we naturally participated.
What have been the biggest challenges in your participation over the past three years?
Coy Irvin, M.D.: The biggest challenge has been to try to use the infrastructures we had in place in order to get the doctors involved, so we could really get down to the correct way to do it, because there’s so much variability in process; getting the docs involved in figuring that out for us was huge.
Coy Irvin, M.D.
Isgett: And we had taken on mortality reduction within a diagnosis, but had never taken on global reduction of mortality as a whole. So, mortality reduction within AMI [acute myocardial infarction] or sepsis—taking that on and then broadening it out to a whole—we weren’t sure how we would be able to connect mortality across diagnoses. But the physicians and nurses jumped in and participated.
Irvin: It was led by our cardiologists, and then the nurses and others in various areas, such as pharmacy, the emergency room and surgery, became involved; we had physicians, nurses, and pharmacists all involved, depending on the specialty.