The Obama administration is apparently impressed with a health care collaborative in Michigan that has had great success in improving patient outcomes and reducing hospital costs. Now other states might be "forced" to follow in the same successful steps of this initiative.
The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety and quality was created in March of 2003 as a 501 (c)(3) division of the MHA Health Foundation. MHA Keystone brings together hospitals, national experts and best practice evidence to improve patient safety by addressing the quality of health care delivery at the bedside.
Shoreline Medical joined the Keystone collaboration about two years ago, and has since developed a variety of order sets, protocols, bundles, and other initiatives that have worked wonders in assuring that patients are diagnosed swiftly, treated with the best practices that are scientifically based to improve outcomes for a particular diagnosis, and reduce costs to the hospital.
Here at shoreline we have a monthly Keystone meeting of a doctor from each department, nurses from each department, a pharmacist, x-ray tech, respiratory therapist, a member of the administration, and members of the billings and quality assurance team who are in charge of making sure the hospital is doing everything necessary to obtain the goals of the MHA keystone collaborative.
For Shoreline Medical, these meetings have resulted in a rapid response team, a sepsis protocol, an extubation protocol, a ventilator bundle, a sepsis bundle, a pneumonia bundle, an MI bundle, a heart failure bundle, a surgical bundle, among other successes that have reduced the number of patients being transported to the critical care, and obtaining nosocomial infections. This also includes a reduction in cases ventilator acquired pneumonia (VAP, other nosocomial pneumonia, and sepsis, and has likewise reduced readmission rates.
This committee also has created order sets that work to make sure the hospital meets all the core measures for each particular diagnosis that the Centers for Medicare/ Medicaid Services (CMS) require of them.
Core Measures are things the medical staff must do when a patient is admitted under a specific core measure set: acute mycardial infarction, heart failure, pneumonia, and surgical care. Within these four sets there are 27 core measures that are based on scientifically-researched standards of care that have been shown to result in improved clinical outcomes for patients.
The following are the core measures:
1. Acute Mycardial Infarction:
Interventions of the project include:
For example,while it's not the RTs role to insert foley catheters, central lines and pulmonary artery catheters, it's the role of every person at the bedside to make sure nurses and doctors are in compliance with infection control techniques to "reduce or eliminate catheter related blood stream infections in ICUs," as noted on the MHA website.
Since we RTs are often at the bedside, we need to be aware of proper technique, and remind doctors and nurses when they veer off course. The reverse also holds true when it comes to proper technique with ABG technique.
On a monthly basis
these core measures are then analyzed by the hospital Keystone Committee. As you can see by this chart, most of the core measures for this particular hospital have been met 90% of the time, as marked as green squares.
The red squares are areas where the core measure was not met 90% of the time, and may be an area that needs to be addressed by the hospital.
When I look at similar charts for Shoreline, I see a lot of red for the year 2007, and mostly green for 2010. This essentially shows how our hospital has improved. Another way to show improvement is a reduction in nosocomial infections, reduction in sepsis, reduction in VAP, and reduction in readmission rates. Another measure I should mention is a reduction in hospital costs.
These statistics are then organized by the Centers for Medicare/Medicaid Services (CMS) where anyone can go to see how each hospital is doing.
It must be noted, however, that these measures must not be used as a report card to compare hospitals, rather as a tool to for hospital improvement. What I mean by this is that if you consider 80-90% a B grade, and 90% or greater an A, you might actually be mislead.
If you have a small hospital that has only admitted 10 patients with an MI over a span of a month, and a larger hospital has admitted over 100 such patients, and both hospitals forget to
properly chart two patients for whatever reason, the small hospital's stats will show 80% (a B grade) and the larger hospital will show 98% (an A grade). Yet both hospitals made the same amount of errors.
So, again, these core measures and the percentages that go with them should not be used as a report card to compare hospitals, but as data to assist improvement.
The Michigan Keystone initiative, therefore, uses this data in a "collaborative" effort to improve patient outcomes and reduce costs. And obviously we've been doing a pretty good job, considering the Obama administration has so noticed the success.
Just for Shoreline alone, the Keystone Project has reduced the number of patients requiring intensive care services (the rapid response team helps with this), reduced VAP to zero cases over the past two years (the ventilator, pneumonia and sepsis bundles help with this), and significantly reduced morbidity and mortality due to sepsis.
Based on the success of the Michigan Keystone Collaborative, the Detroit Free Press, "Hospitals' aim: Cut infection deaths," by Patricia Anstett, "The Obama administration is disbursing $50 million to states to promote lessons learned here and will institute penalties by 2015 if hospitals have high infection rates."
In other words, the Obama administration's experts are going to force other states to incorporate Michigan's success. Likewise, the 10th Amendment states that "anything not covered in this here Constitution is left to the states." Therefore, I believe it's Un-Constitutional for the Fed to force states to comply to Federal Health care regulations.
The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety and quality was created in March of 2003 as a 501 (c)(3) division of the MHA Health Foundation. MHA Keystone brings together hospitals, national experts and best practice evidence to improve patient safety by addressing the quality of health care delivery at the bedside.
Shoreline Medical joined the Keystone collaboration about two years ago, and has since developed a variety of order sets, protocols, bundles, and other initiatives that have worked wonders in assuring that patients are diagnosed swiftly, treated with the best practices that are scientifically based to improve outcomes for a particular diagnosis, and reduce costs to the hospital.
Here at shoreline we have a monthly Keystone meeting of a doctor from each department, nurses from each department, a pharmacist, x-ray tech, respiratory therapist, a member of the administration, and members of the billings and quality assurance team who are in charge of making sure the hospital is doing everything necessary to obtain the goals of the MHA keystone collaborative.
For Shoreline Medical, these meetings have resulted in a rapid response team, a sepsis protocol, an extubation protocol, a ventilator bundle, a sepsis bundle, a pneumonia bundle, an MI bundle, a heart failure bundle, a surgical bundle, among other successes that have reduced the number of patients being transported to the critical care, and obtaining nosocomial infections. This also includes a reduction in cases ventilator acquired pneumonia (VAP, other nosocomial pneumonia, and sepsis, and has likewise reduced readmission rates.
This committee also has created order sets that work to make sure the hospital meets all the core measures for each particular diagnosis that the Centers for Medicare/ Medicaid Services (CMS) require of them.
Core Measures are things the medical staff must do when a patient is admitted under a specific core measure set: acute mycardial infarction, heart failure, pneumonia, and surgical care. Within these four sets there are 27 core measures that are based on scientifically-researched standards of care that have been shown to result in improved clinical outcomes for patients.
The following are the core measures:
1. Acute Mycardial Infarction:
- Aspirin at arrival
- Aspirin prescribed at discharge
- Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD)
- Smoking cessation advice/counseling
- Beta blocker prescribed at discharge
- Time to percutaneous transluminal coronary angioplasty (PTCA)
- Inpatient mortality
- Aspirin at arrival
- Aspirin prescribed at discharge
- Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD)
- Smoking cessation advice/counseling
- Beta blocker prescribed at discharge
- Time to percutaneous transluminal coronary angioplasty (PTCA)
- Inpatient mortality
- Oxygen assessment within 24 hours of arrival
- Pneumococcal and influenza screening and/or vaccination
- Blood cultures prior to first antibiotic dose
- Smoking cessation advice/counseling
- Arrival time to first antibiotic
- Providing a prophylactic antibiotic within 1 hour prior to surgical incision
- Providing a prophylactic antibiotic selection for surgical patients consistent with each type of surgical procedure
- Discontinuing the prophylactic antibiotic within 24 hours after the end of surgery because prolonged use of antibiotics increases the risk of Clostridium difficile infection -- a bacterium that causes diarrhea and more serious intestinal conditions such as colitis -- and the development of pathogens -microorganisms such as bacteria, viruses or parasites that can cause disease -- resistant to antibiotics
- Controlling postoperative serum glucose in cardiac surgery patients because high blood sugar weakens the immune system and increases the risk of infection
- Clipping the hair of surgery patients rather than shaving because skin abrasions increase the risk of infection
- Maintaining immediate postoperative normothermia (normal temperature) in colorectal surgery patients because increased temperatures pose a greater risk of infection, prolonged healing of wounds and longer hospital stays.
Interventions of the project include:
- Implement a unit based safety program
- Eliminate central line associated blood stream infections
- Eliminate Ventilator associated pneumonia (VAP
- Implement daily goal sheets
- Implement sepsis bundles to reduce ICU mortality from severe sepsis and septic shock
For example,while it's not the RTs role to insert foley catheters, central lines and pulmonary artery catheters, it's the role of every person at the bedside to make sure nurses and doctors are in compliance with infection control techniques to "reduce or eliminate catheter related blood stream infections in ICUs," as noted on the MHA website.
Since we RTs are often at the bedside, we need to be aware of proper technique, and remind doctors and nurses when they veer off course. The reverse also holds true when it comes to proper technique with ABG technique.
On a monthly basis
these core measures are then analyzed by the hospital Keystone Committee. As you can see by this chart, most of the core measures for this particular hospital have been met 90% of the time, as marked as green squares.The red squares are areas where the core measure was not met 90% of the time, and may be an area that needs to be addressed by the hospital.
When I look at similar charts for Shoreline, I see a lot of red for the year 2007, and mostly green for 2010. This essentially shows how our hospital has improved. Another way to show improvement is a reduction in nosocomial infections, reduction in sepsis, reduction in VAP, and reduction in readmission rates. Another measure I should mention is a reduction in hospital costs.
These statistics are then organized by the Centers for Medicare/Medicaid Services (CMS) where anyone can go to see how each hospital is doing.
It must be noted, however, that these measures must not be used as a report card to compare hospitals, rather as a tool to for hospital improvement. What I mean by this is that if you consider 80-90% a B grade, and 90% or greater an A, you might actually be mislead.
If you have a small hospital that has only admitted 10 patients with an MI over a span of a month, and a larger hospital has admitted over 100 such patients, and both hospitals forget to
properly chart two patients for whatever reason, the small hospital's stats will show 80% (a B grade) and the larger hospital will show 98% (an A grade). Yet both hospitals made the same amount of errors.
So, again, these core measures and the percentages that go with them should not be used as a report card to compare hospitals, but as data to assist improvement.
The Michigan Keystone initiative, therefore, uses this data in a "collaborative" effort to improve patient outcomes and reduce costs. And obviously we've been doing a pretty good job, considering the Obama administration has so noticed the success.
Just for Shoreline alone, the Keystone Project has reduced the number of patients requiring intensive care services (the rapid response team helps with this), reduced VAP to zero cases over the past two years (the ventilator, pneumonia and sepsis bundles help with this), and significantly reduced morbidity and mortality due to sepsis.
Based on the success of the Michigan Keystone Collaborative, the Detroit Free Press, "Hospitals' aim: Cut infection deaths," by Patricia Anstett, "The Obama administration is disbursing $50 million to states to promote lessons learned here and will institute penalties by 2015 if hospitals have high infection rates."
In other words, the Obama administration's experts are going to force other states to incorporate Michigan's success. Likewise, the 10th Amendment states that "anything not covered in this here Constitution is left to the states." Therefore, I believe it's Un-Constitutional for the Fed to force states to comply to Federal Health care regulations.
You can decide for yourself if this is a good thing or not, yet I'm always leery of when the government gets involved in medicine.
Regardless, the Keystone Process has had great success in reducing hospital infection rates and costs, and is a good model for other states to look at in developing their own programs.
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