PANAMA CITY, FLORIDA – Overall mortality rates from the end of 2007 to the beginning of 2010, at Bay Medical Center in Panama City, Florida have dropped from 3.4 to 2.1. A 1.3-point drop represents a huge reduction for any hospital and translates into lives saved. To date, Bay Medical Center’s rate for heart attack is down from 15.7% to 15.1%, for heart failure from 9% to 7.4% and pneumonia is holding at 8.5%. Those numbers are well below the risk-adjusted, national hospital mortality averages for heart attack (16.1%), heart failure (11.1% and pneumonia (11. 4%). The drop began with the onset of a quality improvement project facilitated by a Wisconsin-based process improvement firm, Compirion Healthcare Solutions, in 2008.
Compirion was engaged to help improve ED Throughput, Finance and Core Measures compliance. Early in the project, Compirion consultants along with the Director of Quality and Safety, Robert Campbell, PharmD, completed an observational study in the Emergency Department. Among many inconsistencies, they found that only 25% of the staff regularly washed their hands between visits with patients. In a presumably aseptic environment such as a hospital, diligence of staff washing their hands when moving from patient to patient can be easily taken for granted. Yet, according to The Joint Commission, hand-washing failures contribute to healthcare-associated infections that kill nearly 100,000 Americans each year and cost U.S. hospitals $4 billion to $29 billion annually to combat. Hand washing originally fell under the auspices of Infection Control. Instead, Compirion’s initial hand-washing observations were brought before the Steering Team.
“Out of concern for patient safety, the Steering Team took ownership of hand-washing protocols to a very personal level,” said Compirion Consultant Lynette Svingen acting as Interim Chief Nursing Officer. “CEO acknowledgment of the issue certainly got the ball rolling.”
According to Robert Campbell, Director of Performance Improvement, Patient Safety and Regulatory Compliance and Chair of the Core Measures team, “When the CEO is looking at you and points out that you didn’t wash your hands … you wash your hands.”
In the first four months, hand-washing compliance increased by 293%. The target was 80%, but scores have remained in the 88-93% compliant range. Accountability is ensured by submitting names of the non-compliant to their immediate managers. Other Core Measures compliance improvements included Blood Cultures prior to Antibiotic from 83% to 96%, Pneumonia Vaccine from 84% to 100% and Flu Vaccine from 58% to 91%. Currently the mortality rate for pneumonia at Bay Medical Center is 8.5, well below the risk-adjusted national average of 11.4.
Other issues with protocol non-compliance that affected patient safety were found in the inpatient and ICU Nursing units. In the Emergency Department, observation found that ICU-bound patients were being held too long. According to research, when ICU-bound patients are held in the Emergency Department for longer than 6 hours their mortality rate increases by 27%. Moving patients into the ICU or up to the floors became a priority for the Inpatient Bed Placement team driven by Compirion.
Another observation revealed that 30-50% of the 24-hour chart checks were missed. That contributed to a number of other issues including a long Length of Stay. The same percentage of transcribed physician orders was missing which had a domino effect that led to numerous variances in care. Quality programs were piloted, adjusted and then hard-wired.
According to Pam Spires, VP of Medical Staff and Performance Manager, “I think that the rapid transport of chest pain patients to the cath lab was also a contributing factor, but it’s hard to quantify exactly which measure created the biggest improvement. It was really everything working together.”
The importance and necessity of frequent rounding by all levels of hospital personnel quickly became evident. Lynette Svingen, Interim CNO implemented hourly rounding by bedside nurses, daily rounding during all shifts by the CNO and nurse leaders, and rounding several times a week for hospital administration. That increased awareness by the staff that leaders were interested in the level of patient care they were providing, not only to the extent of what was inspected by them but what was expected of them.
“Rounding serves as a proactive approach to patient, staff and physician satisfaction. If they see you and you are asking questions, they will voice what is going well and what needs to be improved,” stated Svingen. “Additionally, it creates an environment of accountability for everyone to do the right thing for the patient.”
Svingen added, “I acknowledge the true heroes of the project the Bay Medical Center employees, nurse directors, managers, and supervisors, Robert Campbell Director of Performance Improvement/Patient Safety/Regulatory Compliance, Dan Morgan COO, Pam Spires VP of Medical Staff Services and Performance Manager, Rick Smith VP of Professional and Ancillary Services of Medical Staff and Performance Manager. They were all instrumental in implementing process changes and completing rounding consistently throughout the project. Melanie Henning, Christina Schonz and Jennifer Cain were among those who were relentless in their efforts to collect and track data throughout this initiative. It was a successful team effort that can be implemented in any organization through inspection, improved communication, accountability, collaboration and teamwork.”
Spires concluded, “Working with Compirion was very enlightening. It was nice to have someone come in and help us ‘see the forest for the trees.’ It was eye-opening! You really need to have someone outside come in and ‘see.’ Their implementation of hourly rounding was a huge help. We really needed the Compirion ‘push’ to make it happen.
“It was a very positive experience. Their people were very helpful. Their resource management of staff was excellent. They are unlike other consultants who hand you a plan and then leave. The collaboration, teamwork and implementation were wonderful to rely on. They stood with us and by us and helped us to get it done.”
Bay Medical Center is listed as one of America’s top 50 hospitals and is a recipient of several awards for quality.
Compirion Healthcare Solutions, LLC is based in Elm Grove, Wisconsin. Compirion is a leader in healthcare consulting firms, focusing on hospital process improvement. Compirion works onsite, using a team approach, and offers a money-back guarantee that all goals are met. Client hospitals show sustainable performance improvements in Billable Volume, Patient Satisfaction, Core Measures, Length of Stay, Bed Control, Case Management, Patient Throughput and Staff Retention. Its experience includes Emergency Room, Surgical Utilization, Laboratory, Diagnostic Imaging, Materials Management, Inpatient, Outpatient and Nursing Care improvement projects. Compirion contracts only for measurable outcomes to help achieve patient satisfaction, staff loyalty and a better bottom line.