Building a Culture of Patient Safety in Today’s Healthcare Environment A Discussion of the Tools and Healthcare Policies Driving Improvements in Patient Safety
PANELISTS Paul Hiltz, MHA, FACHE Kelly E. Curry
⦿ Discus uss toda oday’s cul ulture ure of pa of patient nt safe fety a and nd how how i it has evo evolved lved ⦿ Developi oping ng score orecards rds t to be o begi gin n enga ngagi ging ng staff ff and nd bui buildi ding a ng a cul ulture ure of s of safe fety ⦿ Ide dent ntify fy a and nd unde unders rstand nd the he re real fi fina nanc ncial i impa pacts of of Hos ospi pital Acqui quire red C d Condi onditions ons (HACs) ⦿ Def efin ine th e the to e tools ls a and preven eventio tion str trateg tegies ies th that t will will ma make th e the e mo most t imp impact to t to HACs Cs ⦿ Discus uss wha hat the he fut future ure hol holds ds for for the hese a are reas
A CULTURE OF PATIENT SAFETY What is it and how has it evolved?
Patient Harm & Medical Errors - Statistics The third highest cause of death in the U.S. is medical error. • Accounts for 10% of all U.S. deaths • Centers for Disease Control and Prevention (CDC) statistics show • that in the U.S., 1 in 25 patients will contract an HAI while in care, with close to 75,000 of these patients dying annually. CDC figures also show that HAIs cost the United States • healthcare industry upwards of $30 billion dollars annually.
Healthcare Transparency Aims for More Accountability & Less Patient Harm 1999 999 20 2015-20 2016-20 2017 To Err I rr Is Human HAC AC Redu ductio ion pe penal altie ies for worst-performing hospitals 2009 009 published begin to reduce Medicare reimbursements by 1% AC ACA A enacted Josie King Medicare reimbursements dr drop p Death for providers with high 2001 001 preven eventa table r e rea eadmi missi ssions 20 2012
To Err is Human: Building a Safer Health System 1999 report issued by the U.S. Institute of • Medicine credited with raising awareness of U.S. medical errors Concluded that bet between 4 een 44,000 t to o 98,000 • peopl people e di die e ea each h yea ear as a a r res esul ult of of pr prev event entabl ble e medi medical er error ors. Lays out a comprehensive strategy by which • government, health care providers, industry, and consumers can reduce preventable medical errors.
18-Month Old Josie King Dies of Medical Error Josie King dies of preventable dehydration while in • Johns Hopkins Hospital being treated for burns. Parents seek damages from Johns Hopkins • Settlement dollars helped establish the Jo Josie ie King King • Found undatio ion n whose mission is “to prevent to prevent patients from dying or being harmed by medical errors.” Cha hang nges inc includ lude: upgraded computer systems; • implementation of patient safety checklists; improved collaboration of medical staff; improved accuracy and availability of patient data; increased efforts to reduce hospital-acquired infections; and more.
SCORECARDS & PATIENT SAFETY CULTURE Can scorecards help us reinforce patient safety attentiveness?
Score Card Levels Department ➧ Hospital ➧ State ➧ National medicare.gov/hospitalcompare
Dashboards: Daily Scorecards for Front Line Staff Source: www.healthcatalyst.com
Explore Score Cards from Other States for Best Practices • Provi vide de a a nati ational al be benchmar ark • Foste ter a c a compe peti titi tive ve pe perspe pecti tive ve • Other departments • Facility-wide
FINANCIALS OF HOSPITAL ACQUIRED CONDITIONS (HACS) How do Hospital Acquired Conditions impact a hospital financially?
The Cost Equation • Cost of patient’s extended stay and treatment • + drug cost • + additional care • +3 days no complications; +6 days with complications • Cost of RNs and/or labor loss • + double the cost for temp workers HAC Penalty of up to 1% of CMS reimbursement •
Cost of Hospital Acquired Infections: Published Study References EXCESS ADDED LOS REFERENCE ARTICLE COST $ (DAYS) R. Douglas Scott. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits $7,766 N/A C. diff CDC of Prevention. Center for Disease Control & Prevention, March 2009 APIC Cost Calculator for Medium Sized Hospital (Developed in collaboration with Texas Medical Institute of C. diff $10,577 6.7 APIC Technology) APIC Cost Calculator for Small Sized Hospital (Developed in collaboration with Texas Medical Institute of C. diff $10,963 7.9 APIC Technology) Eyal Zimlichman, MD, MSc; Daniel Henderson, MD, MPH; Orly Tamir, PhD, MSc, MHA; Calvin Franz, PhD; Peter $11,285 3.3 C. diff Song, BSE; Cyrus K. Yamin, MD; Carol Keohane, BSN, RN; Charles R. Denham, MD; David W. Bates, MD, MSc. JAMA Health Care-Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System APIC Cost Calculator for Medium Sized Hospital (Developed in collaboration with Texas Medical Institute of MRSA $6248 4.5 APIC Technology) $7,752 2 MRSA APIC Cost Calculator (Data from National Studies) APIC Eyal Zimlichman, MD, MSc; Daniel Henderson, MD, MPH; Orly Tamir, PhD, MSc, MHA; Calvin Franz, PhD; Peter SSI $20,785 11.2 Song, BSE; Cyrus K. Yamin, MD; Carol Keohane, BSN, RN; Charles R. Denham, MD; David W. Bates, MD, MSc. JAMA Health Care-Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System R. Douglas Scott. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits SSI $23,272 N/A CDC of Prevention. Center for Disease Control & Prevention, March 2009 Stosor V, Petersonb LR., Postelnick M, Noskin, GA. Enterococcus faecium Bacteremia Does Vancomycin Arch Intern $27,190 18.1 VRE Resistance Make a Difference? ARCH INTERN MED/VOL 158, MAR 9, 1998 Med Pelz RK, Lipsett, PA, Sowboda, SM, Diener-West M, Powe NR, Brower RG, Perl TM, Hammond JM, Hendrix CW. Intensive VRE $33,251 22 Vancomycin-sensitive and vancomycin-resistant enterococcal infections in the ICU: attributable costs and Care Med outcomes
HAI RATE REDUCTION TOOLS Which tools can most effectively reduce HAI rates?
Hand Hygiene EVS Stewardship
Q: Isn’t housekeeping good enough? A: No. ~50% surfaces missed.
Hydrogen Peroxide Vapor Effective in reducing Long process - 1 to 8 hours to • • environmental contamination complete decontamination when compared to • Cannot be used in routine cleaning conventional cleaning process - only targeted disinfection practices • Chemical costs after initial Room is cleaned. Ventilation expense • ducts are sealed along with entire room which will receive the vapor Lower initial equipment cost •
Ultraviolet Light Disinfection vs Single Spectrum Multi Spectrum (multiple manufacturers) (Xenex) SINGLE-SPECTRUM UV MULTI-SPECTRUM UV 254nm 100nm to 400 nm Bulb Type Mercury vapor (continuous) Xenon gas (pulsed) Intensity Low Intensity High Intensity C. Diff Varies; BETR-D study recently concluded 5 minutes x 3 cycles Kill Time 55 minutes average C. diff room time 4 minute model also available 3 studies from different manufacturers: BETR-D Study – Mixed outcomes 10 HAI rate reduction peer-reviewed studies, Effectiveness (found no C. diff impact) all from hospitals using pulsed xenon UV 2 HAI rate reduction studies
Pulsed Xenon UV Disinfection • Studies demonstrate clinical effectiveness in decreasing microbial burden and reduction in HAI rates • Effective at reducing rates of • MRSA • VRE • C. difficile • SSI • 5-minute cycles in 2 to 3 positions • 4 minute model available also
Pulsed Xenon UV Disinfection: Peer-Reviewed HAI Rate Reduction Studies 71% d 71% drop in UTI rates, and 10 100% % in skin infection 39 39% dr drop p in C. diff rates in 6 month rates, 5 54% dro rop in ho in hospit ital l re readmis issio ions ns from controlled study nursing home APIC Conference Poster/June 2016 (Folkert, Mayo Clinic Rochester) BMC Infectious Diseases /March 2017 (Kovach, Jewish Home and Care Ctr) 57% re reduc uctio ion n in MRSA infection rates after 46% re reduc uctio ion n in Class I SSIs, $478 78,0 ,055 s 55 saved 18 months AJIC/February 2016 (Catalanotti, Lowell General Hospital) JIP/June 2013 (Simmons, Moses Cone Health) 87% re reduc uctio ion n in ICU VRE infection rates, 29% 9% 70% 0% r redu educti ction in ICU C. diff infection rates AJIC/September 2015 (Nagaraja, Westchester Medical Center) facility wide/ 61 61% % ICU reduction in combined 57% re reduc uctio ion n in C. diff infection rates in an VRE+ MRSA + C. diff infection rates, 39 390 bed da 0 bed days LTAC generated, $730, 30,000 s 000 saved ed AJIC/September 2015 (Miller) AJIC/October 2015 (Vianna, South Seminole Hospital – Orlando Health) 10 100% re reduc uctio ion n in total joint SSIs and 53% 3% r redu educti ction in C. diff infection rates after 12 $290 90,990 ,990 s saved in 12 months months AJIC/September 2015 (Fornwalt, Trinity Medical Center) AJIC/May 2013 (Levin, Cooley Dickinson Hospital)
FUTURE OF PATIENT SAFETY What does the future hold?
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