2016 quality summit - enloe medical center us... · 2016 – 2017 quality initiatives 26 2016...

A Focus on Communication

Quality Summit ANNUAL REPORT

2016

Cover: © 2016 Photo by Chico Enterprise-Record, Emily Bertolino, reprinted with permission

The Healing Arts Gallery at the Enloe Regional Cancer Center uses the power of art to inspire healing and wellness and features work of local artists touched by cancer.Candy Matthews – “Finch on Peony” (watercolor)

2016 Quality Summit ■ 1

CONTENTS

Patient-centered Care 2

Recognition for Exceptional Care 5

2015 – 2016 Quality Initiatives 6

Quality Improvement Posters 8

Quality Summit Award 25

2016 – 2017 Quality Initiatives 26

2016 Perspective 28

2 ■ 2016 Quality Summit

DISTINCTION

Enloe Medical Center’s annual Quality Summit underscores a culture of quality and patient-centered care that makes the Enloe experience special.

Enloe’s mission is “to improve the quality of your life through patient- centered care,” which is rooted in our now 10-year Planetree affiliation. We integrate Planetree’s 10 patient-centered components in order to achieve this mission: ■ Human interaction■ Friends, family and social support■ Access to information■ Healing environments■ Food and nutrition ■ Arts and entertainment■ Spirituality ■ Human touch■ Complementary therapies■ Healthy communities

PATIENT-CENTERED CARE


By designing processes and spaces with patients’ needs in mind, caregivers engage with them to improve both the experience and outcomes. This engagement is built on trust and anchored in strong communication.

Communication is the foundation of excellent patient care. With it, care is efficient, effective and patient-centered. Without it, continuity of care may be lost, work duplicated and patient care negatively impacted. The Institute for Healthcare Improvement put it this way: “Research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to communicate with the patient, family and health care team, he or she may be of no help.”

This year’s Quality Summit celebrates exceptional communication that makes a difference in patients’ lives. With projects representing a single unit to those with regional impact, Enloe caregivers demonstrate how strong teams communicating well achieve great patient outcomes.

Ambulating is beneficial for critical care patients. Our ICU/CCU staff communicates and collaborates with a multidisciplinary team of health care providers to support the healing process.


Unit-Based Communication: Enloe Behavioral Health

Enloe Behavioral Health provides the north state with patient-centered psychiatric care at its inpatient facility. To more fully integrate the Planetree components and improve the patient experience, staff came together to enhance the healing environment.

The entrance now includes a calming path to healing. Policies and signage are welcoming. The redesigned patient lounge offers a relaxing space with diversions and snacks. Staff and patients alike enjoy the Saturday Family Desserts. In recognition of the new spirit that infuses this unit, Enloe Behavioral Health was honored with Enloe’s Spirit of Planetree Program Award in 2016.

Interdepartmental Communication: Emergency Department, Cardiac Cath Lab, Surgery, Critical Care and FlightCare

In an emergency, the importance of communication and collaboration is most critical. A patient presented to the Emergency Department in a cardiac crisis. Despite successful open heart surgery, his condition required transfer to a tertiary care center. Physicians and staff from the surgical and critical care units stayed at his side, orchestrating a complex move to the awaiting Enloe FlightCare medical transport helicopter. The entire care team celebrated when they learned that their critically ill patient was on the road to recovery.

Regional Communication: Enloe Regional Transfer Center

As the only American College of Surgeons Verified Level II Trauma Center between the Sacramento area and Oregon, Enloe provides high-level care to patients throughout the north state. With the creation of the Enloe Regional Transfer Center, “one call does it all” for coordinating transfers of acutely ill patients. By facilitating communication between hospitals and physicians, the Enloe Regional Transfer Center supports timely patient care and safety. In its first month, nearly 400 transfers were handled.


Enloe is proud to be recognized for its quality and patient-centered care. In the past year, new and renewed recognitions have included:■ Enloe’s patient-centered achievements, particularly those arising from

the design of the Magnolia Tower, were recognized by the American Society of Healthcare Engineers at their 2016 national conference.

■ As of spring 2016, Enloe achieved the highest possible Hospital Safety Score in four out of the last five reporting periods, and is one of only 59 hospitals in California to earn an “A” rating out of 390 measured hospitals.

■ Enloe received a Gold Medal from Donor Network West through its Workplace Partnership for Life program, which connects organizations with hospitals to create engaging donation activities.

■ Enloe continues to hold its Planetree Bronze Recognition, acknowledging the patient-centered care provided consistently throughout the organization.

■ Enloe’s Patient-Family Advisory Council was selected to participate in a multi-year study that will create best practice guidelines for other hospitals to integrate patient and family recommendations into practice.

■ The Bariatric Surgery Program maintains its Blue Distinction Plus designation and again earned the Center of Excellence designation for this important therapeutic intervention.

■ Enloe is designated as a Blue Distinction Plus program for spine surgery.

Enloe is accredited for adhering to high patient safety standards by The Joint Commission and by the Commission on Accreditation of Medical Transport Systems for its exceptional FlightCare medical transport service. Enloe is a Designated STEMI Receiving Center, providing advanced care for severe heart attacks. Additionally, Enloe maintains The Joint Commission Gold Seal of Approval as an Advanced Primary Stroke Center for compliance with national best practice standards for stroke care.

ACHIEVEMENTSRECOGNITION FOR EXCEPTIONAL CARE


The 2015-16 initiatives reveal the many ways that quality care is expressed. One of these projects demonstrates that sustainability is quality. Several others show the value of process improvement to individuals, and another impacts large groups of patients and achieves measureable outcome improvements. While each initiative is different, together they underscore the importance and interrelated-ness of all these efforts to create an exceptional patient-centered experience at Enloe.

Sustainability

Teams built on the success of a 2014-2015 initiative to care for our environment as we care for our patients. Since 2014, over 3 tons of waste was diverted from landfills due to successful recycling. Regulated medi-cal waste disposal decreased by 20,000 pounds in the first three months of 2016. Over 2 million gallons of water were saved between July 2015 and March 2016 through engineering and landscape improvements. And through 2015, approximately 6,500 pieces of equipment were reprocessed, saving over $50,000.


INITIATIVES2015 – 2016 QUALITY INITIATIVES

continuation of the healthier hospital initiativebariatric patients transfer safe medication management transition of care


Transitional Care Coordination

By mobilizing a nurse and social worker, we screened patients for risk of early readmission when they discharged after hospitalization for pneumonia or chronic obstructive pulmonary disease (COPD). Through targeted interventions, pneumonia readmissions were reduced by 28% and COPD readmissions by 48% since 2014.

Care of the Medical Bariatric Patient

Specialized strategies are often required in order to provide medically complex bariatric patients with care designed for their specific needs. New equipment and training helps staff to give safe and sensitive care to the medical bariatric patient.

Partnering for Safe Medication Use

Plans continue for expanded pharmacy services in a new location that will provide improved access to outpatients, particularly those leaving the Emergency Department. Patient education about medication safety will also be available.






This year, 83 posters celebrate the spirit of quality that permeates Enloe. These posters, created by staff throughout the organization, highlight the many ways we provide quality care. From implementing new clinical care bundles to enhancing financial stewardship, this grassroots effort show-cases the many faces of quality at Enloe.

In 2015, we began displaying the posters prominently in the Magnolia Tower, enabling Enloe visitors to share in the Quality Summit experience throughout the year.

Using the Right Antibiotic for the Job

The Antibiotic Stewardship Committee promotes the use of local organism sensitivity data to aid in the selection of the appropriate antibiotic, and this has been associated with decreasing antibiotic use over two years. The new Antibiogram App gets the data directly to the health care providers.

Bariatric Surgery Program Demonstrates Excellence

Through implementation of the Center of Excellence standards of care, bariatric surgery patients have lower readmission rates (1.47% locally compared with 4.95% nationally) and robust follow up to ensure success.

QUALITY IMPROVEMENT POSTERS

IMPROVEMENTS

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Quality Summit Poster Presentations

2016 Quality Summit Posters

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Patients’ Hand Hygiene Awareness

Behavioral Health’s Occupational Therapy staff worked with staff and patients to raise awareness of the importance of good infection prevention through hand hygiene.

Improving Access to Diagnostic Information

By increasing use of the Trace-Master-Vue program across the organization, 97% of ECGs (up from 85% to 90%) are loaded to one electronic location for better access by the clinical team.

Fifth Floor Staff Engagement

Fifth Floor staff created many ways to improve engagement from the 59th percentile in 2014 to the 71st percentile in 2015, having fun along the way.

Enloe FlightCare Leads the Way in Safety

Enloe’s own helicopter medical transport service has incorporated many safety features often years before they are required by the FAA.

Improved Block Time Utilization

Surgery scheduling efficiency improved over three years as the main OR block utilization improved by 70% and the outpatient surgery center’s block utilization improved by 125%.

IMPROVEMENTS

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Quality Summit Poster Presentations

Utilization of Existing Surgery Block Time

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Main OROutpatient Surgery


Transition Care Keeps Patients Healthier

A team of one nurse and one social worker provided support to patients after discharge and reduced pneumonia readmissions by 28% and COPD readmissions by 48% since 2014.

Preventing Central IV Line-Associated Infections

Consistent implementation of best practice recommendations around central IV line insertion and management, implemented in 2015, delivers improved patient outcomes.

ECMO Helps Save a Life

For the first time at Enloe, teams of caregivers utilized Extracorporeal Membrane Oxygenation (ECMO) in March to support a critically ill heart patient while at Enloe and during a FlightCare transfer, ultimately leading to his good outcome.

Fire Safety is Patient Safety

As fire can be a risk even in the OR, a fire safety assessment is incorporated into the surgical safety time out.


Refinancing Saves Millions

Finance and Business Analysis were able to refinance the Century Project mortgage in six weeks and will realize savings of $22.5 million through 2038.

Creating the Most Accurate Description

Clinical Documentation Initiative specialist nurses work with physicians to help them fully and accurately describe patients’ diagnoses so that coding best reflects the level of care provided.

Case Management’s Central Role

Case Management has begun meeting weekly to help coordinate care for the most complex patients, reducing their average length of stay and costs.

Partners for Support

The Supportive and Palliative Care team partners with patients, families and their clinical team to provide support in the face of complex, serious medical illnesses.

Supplying the Hospital

Each month, caregivers in Central Supply and the Distribution Warehouse process hundreds of thousands of items that are needed for patient care.

Client Services Growing

Enloe Client Services provides great customer service as it works with local employers to meet the health and safety needs of their employees.


Caring for the Caregiver

Staff on the Oncology, Medical/Surgical & Pediatrics units created supportive discussion groups in July 2015, enabling staff to be more resilient as they care for very ill patients.

Better Tests, Better Bottom Line

Laboratory Services and the Nettleton Mother & Baby Care Center collaborated to introduce tests and order sets that result in better care and better financial stewardship.

Reducing Unintended Bundling

With new tracking processes in place since Nov. 2015, the number of items accidently left bundled in patient linens decreased 83%, which improves safety and reduces lost patient items.

Bedside Rounding

CNAs on the Surgical Care Unit implemented bedside rounding in 2016, which improved teamwork and reduced patient falls.

Community Paramedic Pilot Program

Working under a state grant, paramedics follow up with heart failure and heart attack patients after hospital

discharge and have been able to reduce acute heart attack patients’ 30-day readmission rate from 17.4% to 3.1% since it launched in July 2015.

Patient Safety Improvements

By aligning quality and coding efforts, overall documented patient safety metrics rose by 46.9% between 2013 and 2015, with improvements in some metrics by over 75%.

®


Top: Community paramedics follow up with recently discharged heart patients. Below Left: Enloe’s emergency response teams impact north state lives.Below Right: CT Scan imaging quality for trauma patients is improved through the use of metal-free backboards.

2016 Quality Summit ■ 1 4


The Face of Quality is YOU

Quality is a team effort, and the Clinical Resource Assessment nurses provide information to other clinicians to support quality improvement throughout the organization.

Improving ED Patient Flow

Moving patients directly into an ED (Emergency Department) bed contributed to reducing the “Left Without Being Seen” rate from 3.4% in 2014 to 1.4% in 2015 and improved the timeliness of patients’ being seen for the initial evaluation to less than national averages.

Better Imaging for Trauma Patients

New metal-free backboards for trauma patients resulted in improved quality and timeliness of imaging as patients no longer must be transferred off the old metal-containing boards that interfered with image quality. Old backboards are donated to Project SAVE for use in other parts of the world where the need is great.

ICU Best Practice Care Bundles

Using a daily worksheet and multidisciplinary rounds, the ICU Bundle tracks adherence to evidence-based best practices in the critical care units.


DCU Staff Engagement

DCU caregivers targeted staff development, education and recognition to improve teamwork and engagement on their unit.

ED Continuity of Care

ED Clinical Resource Nurses ensure patients receive appropriate follow up for studies ordered in the ED and help coordinate follow up for patients at Enloe clinics.

Serving More Patients

Since 2010 the number of patients seen in the ED increased 35%, and with process improvements in 2015, more of those patients are seen in a timely manner.

Improving Pain Control

Implementing new care pathways reduced the time for patients with long bone fractures to receive pain medication from more than 73 minutes to an average of 51.8 minutes throughout the past year, which is better than national averages.

ED Pit Crew

The ED models its performance during mock and real cardiac emergencies on a NASCAR pit crew, with clear roles and defined tasks in order to improve adherence to best practice guidelines.

Employee Wellness Program

With participation increasing from less than 100 in 2013 to more than 600 in 2015, the Wellness Program’s activities and health coaching have been able to improve the health of Enloe’s caregivers.



Enloe Regional Transfer Center

The Enloe Regional Transfer Center, introduced this year, offers a one-call service for care providers who need to send their patients to Enloe or whose patients need specialty inpatient care not provided at Enloe. The Transfer Center improves communication and timely care coordination for patients.

Preoperative Testing Outreach

The Enloe Surgical and Procedural Assessment Area (ESPAA) reaches out to referring physicians’ offices to improve the pre-operative experience for patients and providers.

Enloe Therapies Improving Communication

Always looking for ways to improve communication, the physical, occupational and speech therapists improved the referral process for clinical units, and they are participating in multidisciplinary care teams.

Coordinating Cancer Care

Interdisciplinary teams, patient care coordinators, supportive care and specialty cancer clinics help patients navigate their cancer care journey.

Infertility Support Group

This monthly meeting, launched in January, provides needed support to those in the community who are struggling with infertility.

Innovation Supports Safe Medication Use

Technology such as electronic order entry, secure texting and automatic prescribing alerts add to the culture of safe medication prescribing.

Good Documentation Describes Good Care

Staff in Quality Management reviews charts to ensure documentation matches the level of service provided.


ICD-10 Implementation

The Health Information Management team helped lead Enloe’s successful, smooth transition in October

2015 to a new way to describe medical care: ICD-10 codes.

Fecal Microbiota Transplantation

Through this innovative use of “good bacteria,” in a procedure introduced at Enloe in April 2015, 79% of patients with chronic C. difficile diarrhea were cured of this significant infection.

Partnering with Infection Prevention

With additional staff, the Infection Prevention staff collaborate with caregivers throughout the organization to provide resources and create solutions to reduce the impact of preventable infections.

Information Security

Enloe’s information services security team provides ongoing surveillance and education about the importance of keeping health information secure and protected.

Innovation in Pain Control

Peripheral continuous nerve blocks are available as an additional tool to manage pain on selected post-operative patients, which often reduces the need for opioid pain medications.

Improving CT Safety

Implementing national best practices from Image Wisely and Image Gently this year the CT Department has reduced exposure to radiation from CT scans with a particular focus on pediatric CT scans.

Onboarding Specialty Clinics

Multidisciplinary teams assure that as each clinic is added to the Enloe team, it meets uniformly high standards for patient-centered care.


Improving Patient Function at Enloe Rehabilitation Center

Over the past year, Enloe Rehabilitation Center patients show steady improvement in documented functional levels, with scores often above national benchmarks.

Safe and Sensitive Care for Medical Bariatric Patients

Staff received training on patient-centered care for bariatric patients and meet regularly to ensure that staff and patients have the appropriate resources to address specialized care needs.

Best Practice for OR Turnover

Sterile processing was recognized by a national trade magazine for the “NASCAR Pit Crew Style” room turnovers that increase OR efficiency and reduce the average turnover time by 7 minutes.

Nurse Liaisons Provide Important Support

Liaison Nurses work with the Total Joint Replacement, Neurosurgical & Spine and General & Colorectal Surgery programs to provide important coordination and continuity of care for patients and families.

Pre-and Post-Surgical Visitation

With the input of patients and families, new patient-directed visitation guidelines were created to welcome visitors before and after surgery.

New Cataract Service

Cataract surgery is now offered at same day surgery with specialized staff to provide the best patient experience.

We are Prompt Care

Enloe’s Prompt Care clinics see over 35,000 patients per year with improved timeliness of care to patients who often have no primary care doctor.


Pet Partners

Enloe’s Pets Assisting with Service (PAWS) program brings trained dogs with their human partners to multiple Enloe locations where they improve the physical and emotional health of patients.

Safe Pediatrics Discharge

Children in some types of casts require specialized car seats and vests to be safe in vehicles. Now Enloe can provide spica cast car seats and vests to improve safety for young patients at discharge.

Speech Recognition Transforms Work

Medical transcriptionists now are Healthcare Documentation Specialists who ensure the accuracy of documents created with speech recognition software.

Procedural Care Unit

The PCU provides specialized, timely and compassionate care to a variety of patients who have undergone an increasing variety of outpatient procedures.

Sustainability is Quality

Appropriate use of finite resources is important work. Through collaboration with surgical services, regulated medical waste was reduced by up to 31%, and recycling reduced waste going to landfills. Enloe also led water conservation by reducing water usage by 42%.

Improving Diagnosis in the Cardiac Cath Lab

Use of Fractional Flow Reserve testing helps determine whether an arterial blockage is significant and guides the most appropriate therapy for patients.


Pulmonary Rehabilitation Transitions

The Pulmonary Rehabilitation Program reduces the number of hospital days for participants. Now patients completing the initial 8-week program may continue in a 6-month transition program to build on their achieved gains.

Wound Ostomy Glove Use

The Wound Ostomy Clinic staff compared nitrile and vinyl gloves and adopted use recommendations that satisfy staff while demonstrating good financial stewardship.

Patient-Centered Care at Behavioral Health

The experience at Behavioral Health was re-created to be more welcoming to patients and families through incorporating Planetree elements into every aspect of care, including new visiting policies and Family Dessert Hour on Saturdays.

Emergency Preparation Promotes Patient Safety

Through use of the SimCenter, Radiology staff maintain their emergency management skills to be ready for any patient safety need in their area.

Improving Verbal Order Safety

The verbal order process was made over 66% more accurate by creating and implementing new processes.

Quiet is Best So Patients Can Rest

Staff participated in creating a new focus and slogan to promote a quiet, healing hospital environment.


Top: Behavioral Health received Enloe’s Spirit of Planetree Program Award. Below Left: Caregivers worked to reduce preventable hospital noise. Below Right: Emergency Services has advanced several quality initiatives this year.

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340B Program Saves Millions

Enloe’s participation in the federal government’s 340B drug discount program realized approximately $5.4 million savings in 2015.

Partnering with Clinic Staff

Staff at the newly integrated Enloe clinics receive the benefits of in-depth education on topics including injection skills and aseptic technique.

Multidisciplinary Reviews for Safety

Five disciplines review each medication error to identify needed changes in education, process improvement, systems and policy.

Print Services Improves Efficiency

With a new streamlined process, print service requests are completed in one to two days rather than the five to seven days with the previous process.

Pet Therapy at the Rehabilitation Center

The center’s facility dog helps patients with their therapy and creates a tail-wagging positive experience for all.

Education for Medication Safety

The Medication Error Reduction Plan Committee identified six important focus areas for medication use and coordinated education over the past year to improve safety.

Patient-Centered Rehabilitation Care

The Enloe Rehabilitation Center team provides comprehensive, collaborative care, preparing patients for successful transitions and earning high patient satisfaction.


Appropriate Waste Management

Enloe prioritizes good stewardship of all resources, so all staff were trained to properly handle different types of waste and recycle appropriately.

Enloe Partners

The Enloe Foundation partners with local business members to create meaningful support of the programs and facilities at the medical center.

Safer Medication Documentation

By focusing on safe medication use, licensed staff significantly improved proper documentation of pain patch disposal.

Cardiac Telemetry Care

New processes and education around remote heart monitoring (telemetry) enhance the care provided to Enloe’s patients.

Sexual Assault Response Team

This team provides timely, compassionate assessments to help survivors of sexual assault. Enloe’s SART program is the only team with pediatric SART specialists north of Sacramento and works with a Rapid DNA service that is able to provide DNA evaluation within 20 days.


Primary Stroke Program Designation

Demonstrating excellent performance in stroke care, Enloe’s multidisciplinary team again achieved the prestigious designation as a Primary Stroke Center.

Pre-diabetes Classes

With 55% of California adults having pre-diabetes or diabetes, these classes provide education on healthy eating and lifestyle changes that may help participants avoid progressing from pre-diabetes to diabetes.

Wash-Rinse-Repeat

To improve outcomes, Enloe’s total joint replacement patients receive education and materials to properly prepare for their upcoming surgeries by washing with chlorhexidine.

Heart & Sole

This annual fun run, with over 300 participants in 2016, inspires community members to improve their heart health and support cardiovascular care at Enloe.


For the first time, two projects were selected to receive the Quality Summit Award.

Sustainability: Since 2014, the processes created by this broad-based team have become an integral part of how things are done at Enloe. Recycling, reprocessing, reducing waste and demonstrating stewardship of scarce resources positively impacts quality.

Transitional Care Coordination: This project built a framework that can be used to help patients transition successfully from an acute hospitalization. The team learned how to navigate the complexities of care faced by many patients with pulmonary diseases and connected them with the resources needed to be successful in the first 30 days after discharge.

QUALITY SUMMIT AWARD

AWARD

Below Left: Sustainability team Below Right: Transitional Care Coordination team


Five initiatives are the focus of the 2016-17 quality improvement cycle.

Radiation Safety

Patient evaluation in the Emergency Department often requires multiple diagnostic tests, including CT scans. Incorporating the latest evidence, a multidisciplinary team will create guidelines for the safe use of this important imaging technology.

Efficient Diagnosis: Improve Timely and Specific Diagnosis of Infections

Employing enhanced laboratory science tests improves the diagnosis of central nervous system and gastrointestinal infections. By doing so, treatment of these serious infections can be more specific and timely.

Care Team Communication: Enhance Communication of Fluid Balance

Monitoring and communicating a patient’s fluid balance guides daily clinical decisions. The work of this team will enhance existing processes to communicate this important measure of patient care.


2016 – 2017 QUALITY INITIATIVES

INITIATIVES

2016 Quality Summit ■ 2 72016 Quality Summit ■ 27

INITIATIVES

Fracture Reduction: Enloe Osteoporosis Clinic

Osteoporosis significantly impacts the lives of many in the north state. As a root cause of many fractures, osteoporosis is important to identify and treat in order to preserve the quality of life for patients. The forthcoming Enloe Osteoporosis Clinic will create a multidisciplinary approach to improve bone health and reduce the risk of a second fracture.

Patient Safety: Decrease Delirium in Vulnerable Patients

Delirium is commonly seen in patients with medical illnesses and may complicate a patient’s hospitalization and recovery. This initiative will create tools to identify those at risk for delirium and strategies to treat this condition.


In October 2015, the Institute of Medicine (IOM) released a new consensus study, “Improving Diagnosis in Health Care.” This document links patient safety to the accuracy of making diagnoses. Far from putting the responsibility for this on one group of individuals, the report clearly shows that communication among members of the care team as well as between the care team, patients and families plays an important role in making accurate diagnoses. Similarly, The Joint Commission elevates effective communication to the level of making it one of the 2016 National Patient Safety Goals.

Throughout this 2016-17 quality improvement cycle, caregivers at Enloe will focus on communication to create stronger teams, deliver even better care and partner in new, meaningful ways with patients and families. Through this work, we continue to strive to improve the quality of your life through patient-centered care.

– Stephen Covey, author of “The 7 Habits of Highly Effective People”

“ Listen with the intent to understand not the intent to reply.”

COMMITMENT2016 PERSPECTIVE

For more information about quality initiatives at Enloe Medical Center, contact Marcia Nelson, MD, MMM, CPE, FAAFP, FACPEVice President, Medical Affairs(530) 332-5414 or email: [email protected]

This local woman was successfully treated for an acute heart condition and is able to enjoy her healthy lifestyle again.

BACK COVER

enloe.org 1531 Esplanade, Chico, CA 95926 © 2016 Enloe Medical Center

Our Mission To improve the quality of your life through patient-centered care.

2016 quality summit - enloe medical center us... · 2016 – 2017 quality initiatives 26 2016...

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