Rady Demonstrates Improved Patient Outcomes, Culture Shift and Financial Savings with Winning Project
May 15, 2011
Posted by chcablogadmin in : Cost Reduction, Innovation, Quality
Your dedicated staff and their participation in RACE for Results are great examples of how we drive each other to excellence every day. We’d like to congratulate not only the top awardees listed here, but the 10 finalists and all 30 hospitals who submitted entries in the RACE for Results program this year. They are truly “the best children’s hospitals with the brightest ideas.” We’ll profile several of these proven improvements for you in upcoming blog issues. One of these improvement programs might be just what your hospital is looking for. — JR
CHCA’s RACE for Results award recognizes exceptional clinical and business improvements in children’s hospitals. This year, Owner Hospitals submitted 30 entries in important areas such as bloodstream infections, waste reduction, electronic medical records, throughput and rapid response teams. Selected by hospital peers and international health care experts, the winners will be featured in educational webcasts and publications for all Owner Hospitals to access for their own improvement work. CHCA honors the winning hospitals May 19 in St. Petersburg, FL.
Rady Children’s Reduces Surgical Site Infections
Rady Children’s Hospital (San Diego, CA) is the 2011 RACE for Results award winner. After launching an aggressive evidence-based response to prevent surgical site infections (SSIs), the Rady team achieved an 80 percent decrease in costly orthopedic spine SSIs in just one year while maintaining surgical volume. They identified 10 patient safety interventions that are now part of surgical procedures at the hospital.
High Cost of Treating SSIs
National statistics estimate surgical site infections affect 50,000 patients each year, leading to additional procedures and longer hospital stays. In October 2008, CMS stopped reimbursing hospitals for the extra care required to treat all surgical site infections. Estimates of increased costs of SSIs are $153,871 in charges per affected patient with an average length of stay of 16.1 days, which calculates to about $10,000 in charges per day. Applying that amount to the12 orthopedic spine program patients identified in 2008 and 2009 at Rady Children’s shows estimated charges of $1,538,710 for 10 SSIs in 2008 and $307,742 for the two in 2009.
The 12 SSI patients required a total of 30 additional surgical procedures, 15 additional readmissions, and numerous office visits. The cost of an orthopedic spine SSI not only poses a great risk to the patient’s outcome and length of stay, but also increases hospital expenses.
Reducing SSIs at Rady
Impressively, in 2010, the volume of spine surgeries increased without additional infections. The 2010 monthly volume rose 33% (January-October) to an average of 17.7 surgeries a month from the 2009 average of 13.3 surgeries a month.
Engaged, informed multidisciplinary health care providers used evidence-based knowledge to promote crucial change. These interventions not only became part of policy at Rady Children’s, but led to an increased culture of safety within surgical services.
2011 Winner:
Rady Children’s Hospital (San Diego, CA)
“An Evidence-Based Response to a Cluster of Surgical Site Infections Involving Pediatric Orthopedic Spine Patients”
Honorable Mention – Clinical Care Projects Category:
Cook Children’s Health Care System (Fort Worth, TX)
“Bundled Interventions and Pareto Principle Result in a Culture Change and Reduce Healthcare Associated Infection in the NICU”
Honorable Mention – Clinical Care Projects Category:
Phoenix Children’s Hospital (Phoenix, AZ)
“Children’s Asthma Care Collaborative”
Honorable Mention – Waste Reduction Category:
Nationwide Children’s Hospital (Columbus, Ohio)
“Neonatal Care Collaborative to Decrease Length of Stay”
add a commentJAMA Publishes Research Emphasizing Acuity in Children’s Hospitals
March 10, 2011
Posted by chcablogadmin in : Academic Medicine, Cost Reduction, Quality
“Hospital Utilization and Characteristics of Patients Experiencing Recurrent Readmissions Within Children’s Hospitals,” by lead author Jay G. Berry, M.D., MPH, an attending physician in the Complex Care Service at Children’s Hospital Boston; John Neff, M.D., from Seattle Children’s Hospital, and colleagues from six other CHCA Owner Hospitals, along with Matt Hall, Ph.D., and Jacqueline Kueser from CHCA, examined recurrent hospitalizations within a 365-day interval at 37 CHCA hospitals utilizing PHIS data.
One important finding was nearly 20 percent of admissions and one-quarter of inpatient expenditures ($3.4 billion) were accounted for by a small group (2.9 percent) of patients who were re-hospitalized at the same hospital four or more times within a one-year period. Many of the patients are children with chronic health conditions that require multiple, unavoidable and necessary re-hospitalizations. However, the re-hospitalizations associated with ambulatory care sensitive conditions and those associated with repeated hospitalizations for the same problem may be potentially avoidable. This growing acuity for children’s hospitals creates a necessity for more in-depth analysis of these complex cases and potential strategies to meet the patients’ health care needs, optimally manage their acute illnesses, and minimize their chronic illness exacerbations.
Jay Berry, M.D., MPH
It may be important for each CHCA hospital and their quality and leadership teams to examine children who are re-hospitalized repeatedly back to their hospital, particularly those children with complex, chronic health conditions who require substantial resources and staffing. — Jay Berry, M.D., MPH
Note: For more information about research and clinical innovation at Boston Children’s visit: Vector Blog or Dr. Berry’s blog entry on this paper.
add a commentSt. Louis Children’s Hospital: Low-Tech Solutions to Improve Labor Productivity
March 6, 2011
Posted by chcablogadmin in : Cost Reduction, Manpower & Workforce
Leaders at St. Louis Children’s Hospital have developed some innovative, simple and cost-effective ways to improve communication and alignment between their finance and clinical staff members regarding labor productivity. Through a blend of training, improvement techniques and user-friendly tracking tools, front line managers are better equipped to understand and flex staffing to meet budget demands. By building employee capabilities in this area, the hospital achieved cost savings of more than $3 million while simultaneously enhancing patient satisfaction and employee engagement. Learn about the executive strategies that made it all possible.
Lee Fetter
Several critical success factors were common across all of our labor productivity projects: (1) Establish stakeholder buy-in, (2) Acknowledge and work to remove workflow barriers from the staff perspective, and (3) Provide easy-to-use staffing decision tracking tools. — Lee Fetter, President and Senior Executive Officer, St. Louis Children’s Hospital
Increased Revenue, Efficiencies and Patient Satisfaction are Results of Revitalizing Bedside Care Collaborative
February 13, 2011
Posted by chcablogadmin in : Cost Reduction, Manpower & Workforce, Quality
Mounting evidence indicates increased time spent with patients by nursing directly correlates with a decrease in problematic care and adverse events. Amid data reports showing that nurses only spend approximately 30 percent of their time engaged in direct patient care, CHCA launched the Revitalizing Bedside Care Collaborative. The 10 participating Owner Hospitals implemented recommendations from a multi-disciplinary advisory panel, creating pediatric-specific opportunities to re-establish the valuable care that nurses provide to patients.
Motivated to increase innovation and remove barriers, the Collaborative designed pediatric-specific methods for transforming nursing based on national adult centered projects, such as Robert Wood Johnson Foundation’s “Transforming Care at the Bedside,” and The Institute of Medicine’s “blueprint” for transforming nursing roles.
Encouraging teams to focus their efforts on three areas − creating efficient clinical processes, improving staff teamwork and creating a patient centered experience − participating Owner Hospitals saw a 9 percent increase in nursing time in direct patient care, a 12 percent increase in patient/parent inpatient satisfaction scores, and a 30 percent decrease in nursing steps per hour.
Nancy Korom, RN, MSN
At Children’s Hospital of Wisconsin we were able to collaborate virtually with children’s hospitals across the country to share ideas and best practices in order to gain efficiencies and cost savings on the patient care units. This was a valuable experience for the staff and leaders involved to understand that we are not alone in our efforts to improve systems and processes. The collegiality and resources have endured beyond the collaborative work. — Nancy Korom, RN, MSN, NEA-BC, Vice President, Patient Care Services, Sophie Schroeder Endowed Chair for Nursing, Children’s Hospital of Wisconsin
All project documentation and session recordings including the new resource package are available on the Revitalizing Bedside Care Collaborative website.
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