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Session #9:Texas Children’s Hospital: Applying a Three-

Systems Approach to Improving Surgical Outcomes

Kathy Carberry, RN

Pre-Session Poll Question

How long does it take to do an appendectomy (the operation itself) at your organization? a) 1 to 2 hours b) 2 to 3 hoursc) 4 to 5 hours d) Unsure or not applicable

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Poll Question #2

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How long does it take for a patient who arrives in the emergency center with appendicitis to get to the OR in your organization?

a) 2 to 4 hours

b) 4 to 6 hours

c) 6 to 8 hours

d) 8 to 10 hours

e) Unsure or not applicable

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About the organization

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Using technology to provide higher quality, lower cost care

Non-for-profit children’s healthcare

Improve and streamline appendectomy care

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Industry Background

Research has shown that the mean length of stay (LOS) for appendectomy procedures can vary significantly based on a number of factors, including severity of appendicitis, operating room availability, surgeon preferences, nursing policies, and hospital systems.

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Pain Points

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Lack of data and lack of a prospective system for

measurement

Lack of teamwork and consistency in

treatment of appendectomy

cases

Current methods

involve after the fact data collection in

postoperative cases

No specific guidelines to apply to each

appendectomy case

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Our Approach and Results

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Goals

• Improve quality of care while reducing costs

• Create a streamlined approach to each specific appendectomy case to ensure continuity of care

• Demonstrate how order sets and variation can change culture

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The Tools

EDW

A late-binding data warehouse

platform

Population Analytics Advanced

Application – Appendectomy

Module

Permanent, integrated workgroup

teams

Evidence-based best practices

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Applying a Three Systems Approach…

Improves measurement and analytics (an analytics system)

Creates permanent cross-functional workgroup teams focused on identifying, deploying, and monitoring the effectiveness of quality improvements (a deployment system)

Deploys a data-driven approach to implementing evidence-based best practices (a content system)

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Monitoring Appendectomy

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Wound Classification

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Appendectomy Dashboard

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Results

• Developed appendectomy population health analytics platform

• Improved patient outcomes and reduced costs through cultural transformation

• End-to-end workflow optimization

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Measureable Results

36%Reduced postoperative length of stay

19% 36%

53% 19%

Reduced average variable direct costs

Increased order set adoption rates

Increased the percentage of patients receiving recommended antibiotic as first antibiotic

Decreased the time from diagnosis to surgery

Increased the accuracy of surgical wound classifications

30%

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Future Plans

Surgical hospitalist pilot in EC

EC triage protocol based on PAS

Same-day discharge from PACU

Shared savings program pilot

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© Used with permission. Texas Children’s Hospital.

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Lessons Learned

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• Cultural transformation takes time • It is critically important to build relationships • Multidisciplinary teams are critical to success • A physician champion is essential • Data is essential to know the truth

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Analytic Insights

AQuestions &

Answers

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Choose one thing…

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Write down one thing will you do differently after hearing this presentation

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Thank You

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Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?

1) Not at all satisfied

2) Somewhat satisfied

3) Moderately satisfied

4) Very satisfied

5) Extremely satisfied

2. What feedback or suggestions do you have?

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Upcoming SessionsBreakout Sessions – Wave 2 (2:30 PM – 3:15 PM)

10) Is Big Data a Big Deal…or Not?Dale Sanders, Senior Vice President, Health CatalystRichard Proctor, General Manager, Global Healthcare & Life Sciences, Hortonworks

11) Partners Healthcare Analytic Strategy for bundled Payments and Risk ManagementSreekanth Chaguturu, MD, Vice President for Population Health Management, Partners HealthCareHelen Chan, Senior Manager, Business Planning, Partners HealthCare

12) Sneak Peek: Improving Patient Engagement and Outcomes with Predictive AnalyticsGregory A. Spencer, MD, CMO & CMIO, Crystal Run HealthcareLouis G. Cervone, Jr., Director of Business Intelligence, Crystal Run Healthcare

13) How a Pioneer ACO is Using Analytics to Change Heart FailureSpencer H. Kubo, MD, CMO of BioControl Medical, United Heart &Vascular Clinic, Allina Integrated Medical Network

14) Entering Shared Risk for Community Hospitals Through Physician EngagementGreg Stock, CEO, Thibodaux Regional Medical CenterMark F. Hebert, MD, FACS, Surgical Specialist, Thibodaux Regional Medical Center

15) Panel – Children’s Hospitals: “Tike-mares”…Are the Monsters Under the Bed For Real?

Location

Grand Salon

Grand Ballroom A

Grand Ballroom D

Savoy

Murano

Venezia