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Quality Initiatives at Bay Medical Center Result in Dramatic Drop in Healthcare Mortality Rate

March 17, 2010

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.

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New Blog Addresses the Impact of Improving Quality of Care on Hospital Finances

February 22, 2010

ELM GROVE, WISCONSIN – A new blog based on the long-standing axiom quality first, finances follow has just debuted at http://hospital-leader.com. The blog is being written by hospital leader Mark Brodeur, FACHE, a former CEO for community hospitals in Illinois, Missouri and Oklahoma. In light of the new Pay for Performance Mandates, known more commonly as P4P, the new blog should prove to be extremely relevant to those CEOs who might be struggling with the costs associated with improving quality of care. Brodeur will explain in his blog why alternative efforts such as cost cutting and maximizing revenue are minimally helpful in improving finances and are also short-lived.

In upcoming blogs, Brodeur will cite specific ways an institution can improve the quality of its services and will give specific performance targets that CEOs should be setting for their hospitals. Blogs include: The Key Role of Your Hospital’s Emergency Department, Processes of a Highly Functioning Emergency Department, Improving Staff Productivity in Your Emergency Department, Building New Business in Your Emergency Department, The Art of Making Sustainable Change and Improving Patient Throughput in Your Emergency Department.

ABOUT MARK BRODEUR
As a CEO, Brodeur has compiled a track record of significant improvements to his hospitals by strengthening their financial performance, growing services and redeveloping a mission-driven culture. Putting to use his background and knowledge base, he is able to address the real-world issues faced by hospitals trying to improve operational performance.

Mark Brodeur is a Fellow in the American College of Healthcare Executives. He also maintains associations with the American Hospital Association, Integrated Healthcare Association, MHA and The Governance Institute. Throughout his career, Brodeur’s hospitals have been recognized for their superior performance by industry groups such as HealthGrades (National Quality Healthcare Award), Foster McGaw (Foster McGaw Award) and Custom Learning Systems (Founders Award). Mark is currently Vice President – Consultant at Compirion Healthcare Solutions.

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No One Leaves Without Treatment at United Hospital Center

January 27, 2010

The week of Christmas left no one turned away from the Emergency Department at United Hospital Center in Clarksburg, West Virginia. For the first time in years, a zero LWOT (Left Without Treatment) metric appeared on the hospital dashboard. Compirion Healthcare Solutions, a healthcare process improvement firm from Elm Grove Wisconsin, worked side-by-side with the Triage/Registration Core Team to make that happen.

Compirion was hired to facilitate the Patients First project, a hospital-wide initiative to improve patient satisfaction and wait times. Goals included reducing the number of patients who Left Without Treatment to fewer than 2% and raising Patient Satisfaction rankings to the 75th percentile. At the start of the 28-week project, the LWOT percentage was 2.8. On Week 20 into the project, the percentage had reached zero. United Hospital Center normally sees about 109 patients per day.

According to Compirion consultant Roxanne Tackett, the reduction in the number of walkouts can be attributed to a dramatic reduction in overall Patient Throughput time, especially Door-to-Bed time; the Charge Nurses rounding on a regular basis; and significantly improved communication among the staff.
“Role descriptions are more defined and consistent throughout the organization. Also, work processes, including admissions and discharges, are better. All ancillary departments are on the same page in improving ‘Patients First’ and enhancing quality of expeditious patient care,” said Clinical Supervisor, RN Renee Hamrick.

Nurse Manager, RN Pam Mayle added, “My staff can see the big picture. They see the hospital as a whole and patient as a whole. Staff can put things together, no longer just doing tasks – as they now see the bigger picture – like making rounds and being a better manager. Patients and visitors have nice things to say for once! It’s like day and night, so much different. I feel like I am making a difference now!”

Along with the elimination of LWOT, Press Ganey InPatient Satisfaction rankings have soared to the 97th percentile. Hospital President and CEO Bruce Carter remarked, “I haven’t seen scores like this in 23 years.”

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Free Webinar Shows the Effect of Improved Quality on Hospital Finances

January 27, 2010

Compirion Healthcare Solutions is hosting a webinar that clearly demonstrates how hospitals that concentrate on quality across all areas, particularly the Emergency Department, financially outperform the competition. By providing a high level of service, as measured by quality and customer service indicators, an Emergency Department will be more cost-effective and business will grow. How to Operate a Highly Functioning ED premieres January 27 at 1:15 am CST. Additional dates and times, along with registration information, can be found at the website http://www.compirion.com. This free 45-minute webinar specifically speaks to issues hospital CEOs, CFOs, COOs, CNOs and Emergency Department Directors wrestle with everyday.

The Emergency Department accounts for roughly one-third of hospital admissions. Opinions formed in the Emergency Department make lasting impressions about the quality and convenience of all hospital services. This webinar looks at developing specific action steps hospitals can take to improve Emergency Department Patient Throughput, increase Staff Productivity and build New Business. How to Operate a Highly Functioning ED presents a comprehensive and coordinated approach that gradually changes hospital culture and results in a highly functioning Emergency Department that is sustainable.

The webinar, How to Operate a Highly Functioning ED, is being presented by Mark Brodeur, Senior Vice President at Compirion Healthcare Solutions. His extensive experience with operations improvement, management development and teambuilding, physician relations/recruitment and financial resource management have made him an invaluable member of Compirion’s consulting and senior leadership training team.

Before joining Compirion Healthcare Solutions, Brodeur held the prestigious positions of Chief Executive Officer at Jefferson Regional Medical Center in Crystal City, Missouri, and Interim Hospital Administrator at Valley View Regional Hospital in Ada Oklahoma.

How to Operate a Highly Functioning ED is the tenth in a series of free webinars being offered to help educate hospital executives, managers and clinicians in strategies for optimizing processes and procedures. Compirion’s presenters are drawn from its pool of healthcare consultants, which includes registered nurses, former C-level executives, physicians, business managers and clinicians. The webinars average about 45 minutes each, with a question-and-answer session at the end.

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Compirion to present Webinar, Preparing Your Hospital for Healthcare Reform

October 26, 2009

ELM GROVE, WISCONSIN – A free 40-minute webinar, Preparing Your Hospital for the Impact of Healthcare Reform, is being sponsored by Compirion Healthcare Solutions. The webinar is premiering Wednesday, November 18th at 1:15 pm, CST. Registration information, can be found at http://www.compirion.com/webinars/seminar_healthcare_reform.cfm. This important webinar will help CEOs, CFOs and COOs gain historical perspective on how hospitals successfully coped with changes in healthcare reimbursement. It will also explore which proven techniques will apply in the current healthcare environment and specific areas where operational improvement can have a big impact. By the conclusion of the webinar, attendees will be able to develop an action plan applicable to the specific needs of their hospital for maintaining or increasing reimbursements, improving operational efficiencies, growing business and improving patient outcomes.

Preparing Your Hospital for the Impact of Healthcare Reform is being presented by Mark Brodeur, Senior Vice President at Compirion Healthcare Solutions. Prior to joining Compirion, Brodeur enjoyed over 17 years as CEO for community hospitals in Illinois, Missouri and Oklahoma. He is renowned for strengthening financial performance, growing services and redeveloping mission–driven culture. Mark brings a total of 30 years of experience in hospital senior management to his new role at Compirion. His background and knowledge base enable Mark to address real-world issues faced by client-hospitals trying to improve operational performance.

Brodeur holds a Master’s degree in Healthcare Administration from St. Louis University and is a Fellow at the American College of Healthcare Executives. He also maintains associations with the American Hospital Association, Illinois Hospital Association, Missouri Hospital Association and The Governance Institute. Throughout his career, Brodeur’s hospitals have received special recognition for superior performance. Awards include National Quality Healthcare Award, Foster McGaw Award and the Founders Award from Custom Learning Systems, plus recognition from Healthgrades.

Preparing Your Hospital for the Impact of Healthcare Reform is the eighth in a series of free webinars being offered to help educate hospital executives, managers and clinicians in strategies for optimizing processes and procedures. Compirion’s presenters are drawn from its pool of healthcare consultants, which includes registered nurses, former C-level executives, physicians, business managers and clinicians. The webinars average about 40 minutes each, with a question-and-answer session at the end.

According to Compirion management, “We are presenting this series of free webinars because we truly believe that efficiency in the hospital, especially the ED, not only saves time and money, it saves lives. The faster you can get a patient to treatment, the better the outcomes you can expect. It is the premise on which Compirion was founded.”

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 Services, 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.

For more information on Compirion’s sustainable healthcare solutions, call 1-866-661-4677 or visit http://www.compirion.com/webinars.

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ED initiative adds $20M in revenues

October 8, 2009

Reprinted from June 1, 2009 issue of Emergency Department Management published by AHC Media.

Lower LWBS Rate, Volume Bring Benefits

A process improvement project addressing the entire emergency service line at The Medical Center of Central Georgia in Macon is expected to increase hospital revenues by $20 million — $24 million this year, according to DeLanor Doyle, MD, FACEP, the medical director of the emergency center.
Currently, revenues are $2 million to the positive side per month. This amount represents a 40-to-1 return on the fees paid to Compirion Healthcare Solutions of Elm Grove, WI, the firm that worked with the ED to design and implement the project, which was paid fees of about $500,000.

The accomplishments of the project, initiated in June 2008, include:

  • The hospital has consistently grown its billable patient volume through the ED by 15% in month-to-month comparisons with last year.
  • The percentage of ED patients leaving before treatment has been slashed from 14% to 2.72%.
  • By the end of Compirion’s engagement in January 2009, the elapsed time from patient registration to inpatient units had dropped by 50%.
  • The goal for door-to-treatment time for outpatients had been set at 4.5 hours; in January, the hours dropped from 6.65 to about four hours, well below the hospital’s target.

As a result of improved throughput, billable patient volume grew from 132 to 155-165 patients per day.
One of the most significant changes was to change the triage area in the front of the department into a “triage and treatment” area, says Barb Stickel, MSN, RN, senior vice president and chief nursing officer. “We utilized unused areas as treatment areas,” she explains.

Doyle adds, “We had a little quick care area next to triage that we started using, and triage rooms themselves were used as treatment areas, and we just triaged in a smaller area.”

In addition, nurse practitioners and physician assistants were brought to the front and, when needed, doctors, says Doyle. “So, instead of them just being triaged and waiting up to 15 hours, we can see them and have them out much more quickly,” he says.

To handle the increased volume in the ED, more beds on the floors needed to be available during peak hours. To address that issue, another new process that was implemented has been named “Code Census.” “When we realize we’re getting backed up, we will call an alert to the staff on a housewide page,” explains Stickel. “If we do not see the nurses are refocused on getting discharges moving within a reasonable period of time, we send another message: We play a few bars of the ‘William Tell Overture.’”

This unorthodox approach has proved to be quite effective, she says. “It’s amazing, but within 30-45 minutes, the beds have freed up,” Stickel shares.

Another recommendation involved moving the chest pain center, which originally was located on another floor, into the fast track area closer to the ED. Fast-track patients are now being seen via the new triage and treatment process. This way, the chest pain specialists, who are also emergency physicians, can assist in the ED.

“Overnight, the two physicians cover the chest pain center as well as the ED,” notes Doyle. “The physicians in the ED now see more patients per hour than ever before.”

Team meetings spur quick results Generating projected revenue increases of $20 million to $24 million is impressive enough, but accomplishing the task in less than a year is really remarkable. How did The Medical Center of Central Georgia in Macon do it? By laying a solid foundation with the help of Elm Grove, WI-based Compirion Healthcare Solutions. “Starting in June 2008, we sat down with them and our nursing group, our medical director, and our administration, and at the very beginning we developed what metrics we wanted to improve and determined our baselines,” recalls Barb Stickel, MSN, RN, senior vice president and chief nursing officer. “We wanted to increase volume, improve quality of care within our core measures, and look at patient satisfaction — because any time you make changes, you do not want to adversely impact patient satisfaction.” The implementation phase was completed in December 2008, and it clearly has succeeded. In addition to boosting revenue and reducing the percentage of patients who leave before treatment, Stickel reports that core measures “are just about running at 100%.” These include giving aspirin and beta-blockers to heart attack patients within 90 minutes, and blood cultures and antibiotics for pneumonia patients within four hours. As wait times dropped, patient satisfaction scores climbed from the ninth percentile to higher than a 90th percentile ranking. “Our task force selected five questions for every patient to be asked,” says Stickel, noting they included topics such as wait time, overall experience, and confidence and trust in their doctor. The staff is able to keep track of their performance thanks to a dashboard developed with Compirion. “We have a weekly dashboard of our metrics, which shows us what the baselines were and what our targets are,” Stickel explains. “We still look at them. We don’t want to get complacent.” Sources For more information on strategies to increase revenues, contact:

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Compirion and Anderson Surgery Center Reduce OR Inefficiencies and Improve Finances

August 19, 2009

MARYVILLE, ILLINOIS – In the midst of bad economic times, Anderson Hospital’s Surgery Center is thriving, thanks to the devoted efforts of hospital staff and the assistance of a healthcare consulting firm out of Elm Grove, Wisconsin, Compirion Healthcare Solutions. While competing hospitals in the area are seeing a drop in utilization of their operating rooms, Anderson Hospital’s Surgery Center has seen Volume Hours increase 8.5% over the last six months.

At the end of last year, hospital administration noticed a slide in market share and began receiving negative feedback from local surgeons. In response, hospital leadership wanted to ensure they were doing everything possible to make the Surgery Center attractive to area surgeons. They also wanted to streamline processes and procedures in the department to handle more volume and to increase profitability.

According to Kim Perry, Director of Perioperative Services, “The Surgical Department had reached status quo. We tried but we weren’t moving along with Quality Indicators or Patient Satisfaction. I wasn’t satisfied with Anderson being a good (surgery center.) We needed to be the best.”

To assist in the improvement project, hospital President and CEO Keith Page suggested engaging Compirion Healthcare Solutions, a healthcare consulting firm focusing on hospital process improvement. Compirion had recently helped Anderson Hospital with a Patient Throughput improvement project in its Emergency Department that reduced door-to-admit time from 5.6 hours to 2.95 hours while increasing Billable Patient Volume 11%. Based on the success of that project, hospital leadership again chose to place their trust in Compirion.
Compirion sent a team of consultants to work onsite with management, staff and physicians from Surgical, Pre-Admission Testing (PAT) and Inpatient areas, and with management involvement from Diagnostic, Support, Registration and Case Management to define issues and determine goals. Hospital Core Teams were named and set up. Goals included:

  • • Determine metric baselines
    • Improve Core Measures scores
    • Improve OR utilization
    • Improve first-case on-time starts from 35% to 75%
    • Reduce PACU discharge delays from 75% to less than 25%
    • Increase block utilization to greater than 60%
    • Improve ambulatory Patient Satisfaction from 65th percentile to 90th percentile PRC ranking
    • Improve Physician and Staff Satisfaction
    • Reduce staff overtime by 50%
    • Reorganize surgical team leader roles to help improve staff development
    and competency

CNO Lisa Klaustermeyer said, “Katy Ward, the Clinical Coordinator, was a shining star during the project. She really saw the need to make things better. She got the Admitting Department on-board and turned it around quickly. She was able to engage and motivate her staff and get the physicians on-board with the trials. She even worked with the anesthesia staff. She was able to carve out a Liaison Nurse position from the existing staff. Compirion provided the diligence and kept everyone on task. They helped keep the focus on the project.”

The first few weeks were spent in observation of the processes and procedures in the OR, and baselines were set. About mid-project, as part of an outreach process, one-on-one interviews with area physicians were held. The interviews allowed the Core Teams team to determine the overall impression of the Anderson Surgery Center and monitor improvements in satisfaction throughout the project. About a dozen outside physicians met with hospital and Compirion personnel three times each during the project to gauge change in image and measure any increase in Physician Satisfaction scores.

At the beginning of the project, SCIP Core Measures compliance was inconsistent from measure to measure. Specifically, Antibiotic Discontinuation Within 24 Hours was at 81% while Appropriate Antibiotic was at 99%. The Core Measures team developed and instituted a PAT/Pre-Op checklist for improved interdepartmental quality and efficiency. Compirion staff educated the hospital staff in better documentation of antibiotic use. The compliance for Antibiotic Discontinuation Within 24 Hours rose to 100 percent.

Kim Perry said, “There were some things Compirion did that were minute but very significant. They added shelves to a cabinet that helped get calls organized. They helped get all paperwork organized ahead of time, which improved workflow. A simple solution of placing a sticker with a patient’s name on it had the effect of increasing staff satisfaction.”

Thirty-five percent of physicians were showing up 20 minutes late on average. Late physicians, combined with patient cancellations, was reducing the number of on-time surgery starts to 37%. That was costing the hospital thousands of dollars per cancellation and reducing the number of cases that could have been scheduled. Several initiatives in the Pre-Anesthesia Testing Department were piloted and later hard-wired into the process, along with new policies that made it easier and more convenient for the patient. An existing staff member was reassigned to a new position as Surgical Nurse Liaison to improve communication between the Surgery Center and the physician’s office. Her duties included calls to the physician to remind him of case times, and to ensure patient and chart readiness by obtaining all workups, test results and medical clearances ahead of time. Physicians who continued to be chronically late had their blocks canceled. By the 13th week from the project launch date, on-time starts (within a 5-minute grace period) had risen to 75%, and cancellations had dropped by 13%. The Anderson Surgery Center was recovering about $25,000 per month in lost revenue.

A new scheduling policy was instituted that allowed physicians to schedule smaller blocks, increasing the availability of room time. “Flipping” cases between rooms was encouraged, a privilege previously allowed only to in-house physicians. Now surgeons from outside the hospital could improve their productivity and billable hours. Block utilization started to climb.

The increase in efficiency created a domino effect of other issues that needed to be surmounted. Case clustering became the first issue to surface. The surgeons were taking advantage of the improved productivity and scheduling more cases of a similar type within their blocks. The second issue was the rise in demand for certain types of instrument trays. This triggered heavy flash loads and a higher risk of infection. In response, the Sterile Processing Team, driven by Perioperative Services Director Kim Perry, began working with physicians to improve case mix. At the same time, Anderson hospital administration invested more than $50,000 in the purchase of new equipment for gynecology, orthopedic and general surgery, plus in multiple miscellaneous specialty instruments. An instrument Quality Assurance program was put into place. Trays were marked for repair or refurbishment, and for next year, the hospital committed to more scheduled upgrades and the purchase of EndoTowers. Repairs are now done in the Sterile Processing Department. By the end of the project, the flash load metric was hovering around zero.

As a direct result of the flashing assessment, a flow problem was noted in the way materials were dispensed to surgery. Cases were picked randomly and routed from one of three departments through multiple hands before they made it to surgery, often arriving late. Duplicate excess inventory amounted to thousands of dollars. Hospital administration made a bold move to streamline the process and move Materials Management and Sterile Processing responsibilities under the auspices of the Surgical Services Department to eliminate duplicate materials and staff. A meeting was held with the Materials Director, Sterile Processing Department, buyers, technicians and key staff nurses. They worked collaboratively to painstakingly roadmap a new process for materials flow that reduced volume and cost and realigned jobs so only one person picked cases and delivered upstairs, instead of many. Materials were now to be delivered to, inventoried and dispensed from Sterile Processing. That required literally knocking out walls and rebuilding to handle the new space requirement in Sterile Processing.

They next worked with IT to set up a new system of electronic documentation to help capture more charges and to maintain par levels in inventory. A goal of an annual reduction in supply costs was set at $100,000. At this time, construction is underway, and supply costs have already been reduced by $10,000 per month. Physician and Staff Satisfaction improved, and lost revenue is being recovered.

As productivity increased, more beds were needed. This increased communication between the floors. Physicians and hospital personnel across the board became a team. Bed hold times dropped from 9 hours on average to 6.

At a point in the project, a backslide in on-time starts was showing up in the data. Most of the late starts were attributed to issues with the anesthesia team. The newly incentivized surgeons confronted the anesthesiologists peer-to-peer and began to hold them accountable for delays.

“At the outset, physicians were skeptical that change would actually take place, but now they have been impressed with room turnaround time, case scheduling, instrumentation availability, and lab work/Pre-Op coordination. Physician Satisfaction is up to 99.5%,” added Klaustermeyer.

In spite of efforts, interviews with outside physicians revealed the effect the slow economy was having on case volumes. According to the interviews, patients who would normally have elective surgery were holding back and the uninsured were putting off primary care. Postponement of primary care was creating an upsurge of more critical cases in need of surgery. Cases were now running longer and parallel staff was made available. A new metric was added: Severity of Cases.

After six months of mentoring, piloting and implementing, the following results were achieved:

  • OR Volume Hours increased 8.5%
  • Room turnaround time was reduced from 17.8 minutes to 13 minutes
  • Staff overtime was decreased by 75%
  • SCIP Core Measures improved from 81% to 97.28% compliance
  • Physician Satisfaction was at 99.5%
  • Patient Satisfaction scores increased from the 74th to the 94th percentile
  • On-time starts are up to 84%
  • Staff Satisfaction scores increased 15.8%
  • Cancellations decreased 13% based on improved pre-admission testing
  • Two new positions were carved out of existing staff:
  • Surgical Nurse Liaison and Charge Nurse

Klaustermeyer concluded, “The Compirion consultants met all expectations. They were excellent working with staff. They did their groundwork in understanding the culture. I appreciate everything that they did.”

Perry added, “Compirion’s most important achievement was that two managers grew in their ability to take more on. They improved as managers and in knowing what they needed to do. They improved communications, understood and set expectations. The Dashboard gave positive reinforcement or indicated a need to improve. This all happened very fast in spite of the Joint Commission coming, the holidays and the state Health Department coming through with a validation survey! Compirion’s people were very professional and helpful in facilitating a lot of changes. They gave excellent feedback. It felt like I got three times the amount of work done. That is the part I am going to miss.”

The Compirion method is a process of continual improvement. The dedicated surgical staff at Anderson’s Surgery Center continues to monitor, problem solve and implement solutions. Scores and revenue continue to climb, even in these times of economic stress.

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 Services, 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.

For more information on Compirion’s sustainable healthcare solutions, call 1-866-661-4677 or visit http://www.compirion.com/surgical.

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