Quality and Safety. David V. Condoluci, DO., M.A.C.O.I.
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1 Quality and Safety David V. Condoluci, DO., M.A.C.O.I.
2 Objectives: Quality and Safety What does it mean? 1. What is quality and safety in medical care 2. What is a High Reliable Organization 3. Help me to understand why everyone is bugging me for quality today
3 Disclosures I have no disclosures to report or conflict of interest
4
5 Crossing the Chasm This report from the IOM got the ball rolling on quality of care in medicine An urgent call for change to close quality gap Recommended a redesign of the medical system Started to set performance expectations for the 21 st century
6 Core Principles Safety: avoid injuries to patients Facts: Unintended surgical injuries such as retention of foreign body, wrong patient wrong site surgery, falls with injury, suicides, delay in treatment, op/post op complications, medication errors
7 Core Principles Effective care: practice based on best practice, refrain from services not beneficial to the patient In other words not providing care that is futile or even harmful
8 Core Principles Patient-centered: care that is respectful of and responsive to patient preferences, needs and values Patient values should guide clinical care
9 Core Principles Timely: avoid harmful delays Efficient: avoid waste and unnecessary tests and procedures Equitable: avoid variation in care because of gender, ethnicity, location and socioeconomic status
10 Awards, Certifications & Accolades
11 Awards, Certifications & Accolades
12 Awards, Certifications & Accolades
13 Health Care Harm, Harm, Harm, Harm, Harm, harm Wrong site surgery example Wrong medication example Wrong person example Wrong pipes carrying O2 Wrong blood transfusion HAI: CLABS, CAUTI, C.diff
14 Awards, Certifications & Accolades
15 To be Human is to fail To be human is to fail, even the best of us still have failures in health care Always a risk/benefit ratio Need to create an environment to lower the risks High Reliability creates a culture to minimize errors Improve process and create systems to avoid harm
16 Significant Harm When you look at quality measures required for reporting it is because we have failed to monitor our profession and processes Sanitizing hands Improperly gowning and gloving in isolation rooms DVT prevention Lines, Lines, Lines
17 Quality Improvement Self reflection: Do you look at your data in aggregate. This is the missed opportunity for improvement. Miss the forest for the trees Evidence based medicine
18 Quality Improvement Look at systems of care and measure the gaps Many gaps in care are systematic and not related to human error per se Near Misses Root Cause Analysis
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22 Kennedy Health Home Page
23 Regulatory Burden Increased regulatory burden in your days to achieve quality 21% of physicians total work hours are spent in non-clinical paperwork I am very sympathetic to what is required of you today but it is where we are at in 2017
24 OPPE
25 General Internal Medicine(Aggregate) Attending Role Compared to System January-July, 2017 Crimson Is a risk adjusted data base that captures severity of illness and risk of mortality (comorbidities) Can run by Aggregate of by Individual Practitioner Takes the claims based patient data from documentation to capture metrics Documentation is critical to accuracy and validity of physician outcomes
26 General Internal Medicine Attending Role Quality Metrics 30 day readmission for any reason 30 day readmission for same diagnosis
27 Compare by System, Campus, and include Resident Level Detail
28 Claims Level Patient Detail By Encounter Including POA
29 Practitioner for OPPE Example OPPE Individual Profile run and reviewed every six months Metrics : displayed as green displayed as yellow >1.0 displayed as red
30 Conclusion There is no priority higher than patient safety. If there is a conflict between safe practice and speed, efficiency or volume, then safety wins-hands down. James Anderson Cincinnati Children's Hospital Always do what is right for the patient then everything that follows will be for the right reason
31 Awards, Certifications & Accolades
32 Thank You
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