At the 606-bed Maine Medical Center in Portland, clinician and executive leaders have been developing a broad range of improvement initiatives using data analytics tools (like the folks at Brigham and Women's Hospital, the Maine Medical Center is using tools from Cary, N.C.-based SAS). “We use the business intelligence tool as an analytic tool, but also as the mechanism by which we try to keep the physicians and staff abreast of our priorities and our progress on achieving those priorities,” explains Doug Salvador, M.D., patient safety officer and associate chief medical officer at the hospital. “So we've worked with more and more physicians in groups on new key process indicators, and then found forums within those groups to regularly review those sets of data.” Among the many initiatives at Maine Medical Center has been one around the use of blood transfusion in cardiac surgeries. Following up on national clinical studies that found blood transfusion was done too often in cardiac surgeries, Salvador and his colleagues have reduced blood transfusion rates for those surgeries from 60 to under 20 percent, while saving at least $300,000 in the past two years on the cost of acquiring blood products.

At Gaston Memorial Hospital in Gastonia, a suburb of Charlotte, N.C., clinicians have developed an innovative program that is providing them with real-time alerts for handling cases of MRSA (Methicillin-resistant Staphylococcus aureus) and Clostridium difficile bacterial infections. Using the Safety Surveillor product from Charlotte, N.C.-based Premier Inc., as well as the Soarian products from Malvern, Pa.-based Siemens Medical Systems, clinicians at Gaston Memorial have been making significant progress in managing and minimizing bacterial infections in inpatients, reports Jan Mathews, R.N., director of clinical performance improvement at the 435-bed regional community hospital.

At the nine-hospital, Omaha-based Alegent Health, vice president and chief quality officer Mark Kestner, M.D., and his colleagues have been initiating a series of care quality improvement projects, using data derived from the organization's clinical information systems, under an umbrella process called Quality Accelerator. “We're using the diffusion theory with regard to designing new processes, testing them in a controlled environment, undergoing rapid-cycle change, and then diffusing completed, vetted processes across the organization,” says Kestner. Among the numerous projects initiated so far are a reengineered, automated medication-reconciliation process that has increased the percentage of time nurses spend on patient care each day; and the development of a program that has automated nurses' verbal reports to each other at the time of shift handoff.

At the 500-bed VA North Texas Health Care System in Dallas, William Yarbrough, M.D., a staff physician, and his colleagues have used continuously fed clinical IS data to dramatically reduce catheter-related bloodstream infections in the hospital's medical and surgical ICUs. Automation of the infection monitoring process has been essential to its success, Yarbrough emphasizes. A previous paper-based version of the program failed for a variety of physical and process reasons, he says.