Now in its 10th year, the St. Luke’s University Health Network Quality Improvement Awards Program recognizes internal innovations in care and efficiency. This year the winner of the top prize went to a group for development of a post-acute skilled nursing care network designed to better coordinate care after patients are discharged from the hospital.
Based in Bethlehem, Pa., St. Luke’s created the competition to allow teams of doctors, nurses and other caregivers and administrative staff come up with and test their own ideas about how to raise standards, expedite workflow or otherwise improve care and service. Then the projects are judged on their quantitative results.
In a recent interview, Diana Tarone, performance improvement project manager for St. Luke’s, said the ideas for projects could come from the bottom up or the top down. “It could be someone in our sterilization department who realizes there is a more efficient way to do something,” she said. “We look at where our opportunities lie. Is there something we want to do better? Is there a new measure coming from CMS that is going to be publicly reported? Is there something with a higher mortality rate, such as sepsis, that we want to impact? Are there opportunities to eliminate waste and to lower cost?”
While some of the projects require financial investment or other resources, many of them are put into place without any additional resources, she said.
Tarone said the enthusiasm for the program was evident at the awards program held on Oct. 18. “People were excited about what happened. We did a 10-year look-back and saw teams that were successful 10 years ago and they are still successful today and continuing to improve.”
The number of projects varies from year to year, but since 2011 it has been increasing, Tarone said. “This year we had 46 submissions, throughout the network of seven hospitals and our physicians group. We have five first-place winners and five second-place winners, and from the five first-place winners we pick one Presidential Award winner.”
When the awards are given out, the ideas have already been put into practice at St. Luke’s. “They may have been spread across the network,” she said, “or shared at a national level with Premier or at another national conference.”
Work on the project to create a preferred skilled nursing facility (SNF) network began in 2013, said Laura Kohler, bundled payments for care improvement program director. “In order to select the providers, we had to figure out where our referrals were coming from and who we were sending patients to — who where our highest-volume drivers,” she explained. Her team started taking a look at what their claims data was showing about length of stay, overall cost, and readmission rates.
“We approached the SNFs to see if they would collaborate with us on decreasing their length of stay and readmissions. In order to do that, we had to embed some of our practitioners in the SNFs. We had to develop clinical pathways that address the patient needs from admission to the SNF through discharge,” she said. They also developed physician-to-physician handoffs and worked with SNFs to develop transition-of-care documents. “We also educated SNF nurses on best practices for clinical diagnoses of conditions such as COPD, pneumonia or sepsis. There was a lot of collaboration based on process, operational metrics and clinical outcomes.”
One challenge, she said, is that the SNFs and hospitals do not have the best health information exchange. They do have EHRs, but the hospital EHR and SNF EHR don’t communicate across an HIE platform, Kohler said. “There are technologies we are looking at to help us in getting admission and discharge dates and basic demographic information so we are able to manage populations of people in volume in skilled nursing facilities over time in a care management platform.”
Besides the SNF network project, here are the other First-Place teams this year:
• Reducing the Incidence of Acute Kidney Injury and Hypotension in Total Hip and Total Knee Population. By standardizing pre- and post-surgical procedures, a team at St. Luke’s University Hospital in Fountain Hill was able to significantly reduce the number of patients recovering from hip and knee replacements who developed kidney injuries and hypotension (low blood pressure).
• Improving Emergency Department Throughput. The quality improvement (QI) team implemented actions to decrease turn-around times in the Emergency Department at St. Luke’s Warren Campus. The initiative resulted in patients being seen sooner and an improvement in patient satisfaction.
• Optimizing Medicare Wellness Visits Within Primary Care. Under the Affordable Care Act, most health plans must provide preventive services. This QI team from St. Luke’s Physician Group increased and improved the ability of its providers to be sure their patients received personalized preventive care plans that included appropriate screenings and wellness visits.
• Patient SafetyNet: Improving Patient Safety Throughout Early Recognition. This QI team at the Bethlehem Campus was able to not only better identify patients at risk for respiratory depression (hypoventilation) and prevent potential patient harm, but also reduce costs by decreasing the number of patients requiring transfer to critical care.