NOTICE. November 3, 2017

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1 November 3, 2017 NOTICE The Board of Directors of the Kaweah Delta Health Care District will meet in an open Quality Council Committee meeting at 7:00AM on Thursday November 9, 2017, in the Kaweah Delta Medical Center Acequia Wing Executive Office Conference Room {400 W. Mineral King, Visalia}. The Board of Directors of the Kaweah Delta Health Care District will meet in a Closed Quality Council Committee meeting immediately following the 7:00AM Open Quality Council Committee meeting on Thursday November 9, 2017, in the Kaweah Delta Medical Center Acequia Wing Executive Office Conference Room {400 W. Mineral King, Visalia} pursuant to Health and Safety Code & All Kaweah Delta Health Care District regular board meeting and committee meeting notices and agendas are posted 72 hours prior to meetings in the Kaweah Delta Medical Center, Mineral King Wing entry corridor between the Mineral King lobby and the Emergency Department waiting room. The disclosable public records related to agendas are available for public inspection at the Kaweah Delta Medical Center Acequia Wing, Executive Offices (Administration Department) {1st floor}, 400 West Mineral King Avenue, Visalia, CA and on the Kaweah Delta Health Care District web page KAWEAH DELTA HEALTH CARE DISTRICT Lynn Havard Mirviss, Secretary/Treasurer Cindy Moccio Board Clerk, Executive Assistant to CEO DISTRIBUTION: Governing Board Legal Counsel Executive Team Chief of Staff West Mineral King Avenue Visalia, CA (559)

2 KAWEAH DELTA HEALTH CARE DISTRICT BOARD OF DIRECTORS QUALITY COUNCIL Thursday, November 9, 2017 Kaweah Delta Medical Center Acequia Wing 400 W. Mineral King Avenue, Visalia, CA Executive Conference Room ATTENDING: OPEN MEETING 7:00AM Herb Hawkins Committee Chair, Board Member; Nevin House, Board Member; Gary Herbst, CEO; Tom Rayner, SVP & COO; Regina Sawyer, RN, VP & CNO; Edward Hirsch, MD, CMO/CQO; Douglas Leeper, VP & CIO; Harry Lively, MD, Chief of Staff; Byron Mendenhall, MD, Professional Staff Quality Committee Chair; Monica Manga, MD, Secretary/Treasurer; Dan Boken, MD, Past Chief of Staff; Lori Winston, MD, DIO; Tom Gray, MD, Quality and Patient Safety Medical Director; Sandy Volchko, Director of Quality and Patient Safety; Evelyn McEntire, Director of Risk Management; Ben Cripps, Compliance Officer, Rose Newsom, Director of Nursing Practice; and Heather Goyer, Recording. Call to order Herb Hawkins, Committee Chair & Board Member Public / Medical Staff participation Members of the public wishing to address the Committee concerning items not on the agenda and within the subject matter jurisdiction of the Committee may step forward and are requested to identify themselves at this time. Members of the public or the medical staff may comment on agenda items after the item has been discussed by the Committee but before a Committee recommendation is decided. In either case, each speaker will be allowed five minutes. 1. Telemetry Management Quality Focus Team Report Status report on improvements made to the telemetry management process. Jon Knudsen, Director of Renal and Oncology Services. 2. Report from Throughput Committee Regarding Medical Staff Related Items- A Review of key medical staff initiatives that impact patient throughput- Nicole Seitz, Director of Care Management 3. Healthgrades- Review of October Healthgrades report- Sandra Volchko, Director of Quality and Patient Safety 4. Approval of Quality Council Closed Meeting Agenda Kaweah Delta Medical Center Blue Conference Room immediately following the open Quality Council meeting o Quality Assurance pursuant to Health and Safety Code and 1461, report of Professional Staff Quality Committee (Pro-Staff) Byron Mendenhall, MD, and Professional Staff Quality Committee Chair; Herb Hawkins Zone I Lynn Havard Mirviss Zone II John Hipskind, MD Zone III Carl Anderson Zone IV Nevin House Zone V Board Member Secretary/Treasurer Board Member President Board Member

3 o Quality Assurance pursuant to Health and Safety Code and 1461, report of Professional Staff Quality Committee (Pro-Staff) Evelyn McEntire, Director of Risk Management. Adjourn Open Meeting Herb Hawkins, Committee Chair & Board Member CLOSED MEETING Immediately following the 7:00AM open meeting Call to order Herb Hawkins, Committee Chair & Board Member 1. Quality Assurance pursuant to Health and Safety Code and 1461, report of Professional Staff Quality Committee (Pro-Staff) Byron Mendenhall, MD, and Professional Staff Quality Committee Chair 2. Quality Assurance pursuant to Health and Safety Code and 1461, report of Professional Staff Quality Committee (Pro-Staff) Evelyn McEntire, Director of Risk Management.. Adjourn Open Meeting Herb Hawkins, Committee Chair & Board Member In compliance with the Americans with Disabilities Act, if you need special assistance to participate at this meeting, please contact the Board Clerk (559) Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to ensure accessibility to the Kaweah Delta Health Care District Board of Directors committee meeting. Thursday November 9, 2017 Quality Council Page 2 of 2 Herb Hawkins Zone I Lynn Havard Mirviss Zone II John Hipskind, MD Zone III Carl Anderson Zone IV Nevin House Zone V Board Member Secretary/Treasurer Board Member President Board Member

4 Ordering of Telemetry Telemetry Quality Focus Team

5 So what s the issue? # of Teles Active Orders Expired Orders No Orders 2N % % % 2S % 0 0.0% % 3N % % 1 6.7% 3S % % 0 0.0% 4N % % % 4S % % % 4T % % % TOTAL % % %

6 Not enough tele boxes Triaging patients off telemetry Calling physicians, with/without order Indefinite order Monitoring for just in case

7 QFT Dr. Lively, Jon Knudsen Nurse Managers Nurse Educators and APNs Telemetry Technicians Quality and Patient Safety Staff

8 Telemetry Orders 2 classes with indications Class 1 = 72 hours Class 2 = 48 hours Nursing communication order: will allow for removal when order expires based on criteria

9

10 Physician/Staff education Medical Executive Committee Medical staff departments of: Surgery, Critical Care, Anesthesia, Cardiology, Family Practice, Hospitalists Hospital Staff Department staff meetings Online Net Learning course Go Live July 6, 2017

11 Results

12

13 Additional Benefits Reduced telemetry monitoring Allowing better ratios (48:1) Now monitoring ER patients Room for growth, 5T, ER expansion No need to purchase more monitors; currently available daily ($2,500 each) Every 12 hour report for reconcillation

14 Throughput October 2017

15 Throughput Workgroups 1. PRIME - Public Hospital Redesign & Incentives in Medi-Cal Ryan Gates & Sonia Duran Aguilar 2. Supply Utilization Management Steve Bajari/Alison Mitchell 3. Bed Management Justin Bryant 4. Clinical Resource & Ancillary Management Gordon Ah-Tye 5. Mental Health Throughput Mary Laufer/Jaime Hinesly 6. Diabetes Management Dr. Gray/Rose Newsome 7. Retail Pharmacy James McNulty 8. Post-Acute Strategic Group Lisa Harrold 9. ED Surge Group Dan Allain 10. D/C Management Group Nicole Seitz 11. Cardiac Service Line Benton Duckett 12. Outpatient CDI Rebekah Foster 13. Colon Surgery/Peripheral Vascular Surgery Length of Stay Kari Knudsen 14. Hip Fracture Length of Stay Jag Batth 15. Sepsis Length of Stay Dan Allain 16. Heart Failure/AMI Length of Stay Tracey Salsa

16 Throughput Success Fiscal Year 16/17 our throughput workgroups started with 58 initiatives. 13 initiatives were completed by the end of fiscal year. 4 new initiatives were added during the year Other initiatives are in various stages of progress.

17 Completed Initiatives Establishing Chronic Disease Medicine Center-CDMC Expand scope of services at CDMC to include internal medicine/cardiology services CDMC accepting low risk chest pain patients from the ER to prevent admission Expanding Diabetes Management at CDMC Increase volume at our Family Medicine Clinic Increase Social Work in house coverage to 24/7 Adding RN Diabetes Educator to assist with diabetes management for inpatients. Expand Rehab liaison coverage to 7 days a week to help with admission to Acute Rehab/Short Stay and TCS Increase Physical Therapy Services on the weekend Improving turnaround time goals for CT- inpt & ED and MRI ED 24 hour MRI service 24 hour ECHO services and moving outpatient ECHO to West Willow Initiating Milliman Criteria for Case Management

18 Overall Length of Stay Year to Date Results FY 2016 FY 2017 Difference between FY 2016 vs 2017 Acute Med-Surgical 5.11 days 4.73 days 0.38 days Medicare Acute Medical-Surgical 5.77 days 5.31 days 0.46 days Medi-Cal Acute Medical-Surgical 5.23 days 4.83 days 0.40 days

19 How can we continue our success? Continued Medical Staff support of our initiatives. Continued focus around length of stay and earlier discharges.

20 Questions?

21 Healthgrades

22 Healthgrades Methodology Summary Ratings based on 3 years of Medicare claims data ( ) Measures risk adjusted mortality (inpatient and 30 day) or surgical complications in 34 different diagnoses or procedures Star ratings are presented as: better 5 star (top 15%) as expected 3 star (middle 70%) worse 1 star (bottom 15%)

23 New Awards 2018

24

25

26

27

28

29 Results Summary Better or as expected in all diagnoses or procedures measured Went from 3 to 5 stars in knee replacement complications Went from 5 to 3 stars in defibrillator procedures, spinal fusion surgery, back surgery & chronic obstructive pulmonary disease (COPD)

30 QUESTIONS?

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