THA Hospital Improvement Innovation Network (HIIN) Monthly Check-In - PowerPoint PPT Presentation

THA Hospital Improvement Innovation Network (HIIN) Monthly Check-In 2-21-18

Reminders • Site Visits • Contact List • Workforce Resilience Webinar Series • Sepsis Webinar Series • Sepsis Consultation Service • Success Story Articles • HIIN Quarterly Survey — due to jmcitosh@tha.com by March 9

Health Equity and Addressing Disparities

TCPS HIIN Health Equity Survey *Diversity can include racial, ethnic, gender, cultural, language, socioeconomic or other relevant factors. THA Responses: 57 / 77 hospitals (74%) HRET Responses: 1,315 / 1,683 hospitals (78%) Source: THA HIIN Quarterly Survey conducted Nov. 2017

TCPS HIIN Health Equity Survey

TCPS HIIN Health Equity Survey

TCPS Performance with Updated Baselines Includes Only Tennessee Partners * MRSA and CDIFF SIR are calculated on a quarterly basis. Data shown is for January – September This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272 .

Hospital Claims and PSI Harms THA Partners and HRET HIIN Rate Comparison January – September 2017 HRET Topic Reporters Events Rate Rate Readmissions - 30 Day 123 50,880 8.486 8.473 Readmissions - Medicare 121 30,304 11.318 11.246 Sepsis - Postoperative 79 211 0.399 0.4177 Sepsis - Hospital Onset Mortality 104 1,975 35.656 21.173 Sepsis - Overall Mortality 104 5,408 20.425 12.568 VTE 88 336 3.142 3.000 Data Source: THA HIN and HRET Comprehensive Data System: Tennessee hospitals This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.

HIIN Self-Reported Measures THA HIIN and HRET HIIN Rate Comparison February – October 2017 HRET Topic Reporters Events Rate Rate ADE – Anticoagulation* 58 3,343 15.019 3.381 ADE – Glycemic* 52 15,283 19.014 4.634 ADE - Opioids 55 2,810 1.097 0.584 Falls with injury 62 844 0.568 0.693 Pressure Injuries 53 242 0.091 0.219 WS - Patient Handling 52 420 0.119 0.122 WS - Workplace Violence 53 184 0.051 0.081 * Measure definition differs between THA HIIN and HRET HIIN Data Source: THA Report Distributor and HRET Comprehensive Data System: Tennessee hospitals only This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.

Adverse Drug Events (ADE)

Adverse Drug Events (ADE) Opioids • HRET HIIN measure for opioid ADE – Numerator = Number of patients treated with opioids who received naloxone – Denominator = Number of patients who received an opioid agent – Includes inpatient and outpatient – Excludes Emergency Department

Adverse Drug Event – Opioids 2017 TN Harms TN Rate HRET Rate February 322 1.14 0.54 March 302 1.00 0.52 April 339 0.95 0.52 May 316 1.12 0.63 June 302 1.06 0.58 July 328 1.28 0.65 August 319 1.07 0.61 September 298 1.23 0.58 October 284 1.18 0.63

Number of patients who received an Opioid reversal De-identified Hospitals

Number of patients who received an Opioid reversal De-identified Hospitals

Number of patients who received an Opioid reversal – Rate per 100 HRET National Average: 0.584 ------------------------------------------------------------------------------------------------------ De-identified Hospitals

Number of patients who received an Opioid reversal – Rate per 100 ------------------------------------------------------------------------------------------------------ HRET National Average: 0.584 De-identified Hospitals

ADE Questions • Are there particular areas of the hospital with high Narcan use to target? – Procedure areas, ICU, wards? • Are there specific patient populations? – Opioid naïve, post-surgical patients, patients on pain pumps? • Are we doing sedation assessments on patients?

Sepsis Measures • THA HIIN data: – From inpatient claims - provisional – 66 TN hospitals • Three metrics: – Post-operative sepsis rate (AHRQ PSI-13) – Hospital-onset sepsis mortality rate – Overall sepsis mortality rate

Sepsis Data Definitions • Mortality – Inpatient sepsis deaths only – Patients aged 18-89 years – Primary discharge diagnosis = an ICD-10 code for severe sepsis or septic shock utilizing AHRQ PSI-13 criteria – Hospital- onset sepsis identified by “No” on “Present on Admission” flag • Post-op Sepsis – AHRQ PSI-13 criteria Data pull: 1-19-2018

Sepsis Mortality October 2016 through September 2017 Mortalities Cases Mortality Rate Hospital Onset Sepsis 1728 5180 33.36% Mortality Overall Sepsis Mortality 5211 27889 18.68% 18.6% of the total sepsis cases are hospital onset sepsis, but account for 33.2% of the sepsis mortalities.

Post-op Sepsis Rate - 10/16 thru 9/17 THA HIIN Hospitals (n=49) Comparison to HRET HIIN Hospitals (n=904) THA HRET 3.00 2.50 2.00 1.50 1.00 0.61 0.50 0.41 0.00 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17

Sepsis Questions • Are you tracking overall sepsis and hospital- onset ? Are you seeing the same prevalence and trends? – If so, is hospital onset sepsis medical vs surgical population? – Associated with devices or specific procedures? – ICU or floors at diagnosis? – Are EHR/clinical systems triggering alerts effectively? • Would committee members be willing to review 10 of your charts for root causes to better understand the issue and design interventions?

Upcoming Events • Care Transitions Coordinator Coalition Meeting – Thurs., March 8 • Medication Safety Summit – Thurs., April 26 • TCPS Regional Meetings – Tues., April 10 – Knoxville – Thurs., April 12 – Nashville – Tues., April 17 - Memphis • Sepsis Readmissions Workshop – Weds., May 9 • Health Equity Summit – Thurs., May 17 (tentative)

HIIN Participation Recognition Retractable pen pull with dry erase marker Request the number that you need by contacting Teresa Benedetti at tbenedetti@tha.com or 615.401.7414.

Questions and comments?