Preface. Nurse Staffing and Inpatient Hospital Mortality. Context. Context for presentation. Context
|
|
- Betty Garrett
- 5 years ago
- Views:
Transcription
1 Preface Nurse Staffing and Inpatient Hospital Mortality Asked to discuss recent research on staffing and mortality Invited to expand discussion to other issues Jack Needleman, PhD FAAN Professor of Health Services, UCLA School of Public Health Associate Director, UCLA Patient Safety Institute Presented at 5 th Nursing Economic$ Summit June 7, for presentation Bending the cost curve/searching for value About to enter new period of cost containment in health care 1980s-1990s: Hunterization of cost containment Nursing as cost center, rather than service line New era perhaps more sophisticated Ambulatory: Accountable care s, medical homes Inpatient: Pay for performance, nonpayment for never events Nursing sensitive conditions as never events Res Implications Need for nursing to establish Service line Contribution to value for (business case) Need to change policy/payment to value what patients value 3 4 March 17,
2 Why we did this study Address concerns raised about prior studies that questioned relationship of staffing and patient outcomes, including mortality: Cross-sectional studies comparing high and low staffed hospitals Open to alternative explanation of association with other factors correlated with staffing but not staffing Imprecise nurse staffing measurement Lack of adjustments for patient acuity Do not reflect intuitive sense of what short staffing is Alternative conceptualization and measure: Gap between actual and target staffing Compare actual staffing to target staffing Hospital established staffing targets: Unit specific Nursing care model Driven by census and patients need for nursing Other factors influencing nursing work load, such as patient turnover on unit Allows each to accommodate al nuances rather than fixed staffing targets applied to all s 7 8 We address these concerns by Constructing individual patient experience of low staffing based on day-to-day, shift-to-shift variations in staffing at the unit level Not institutional or unit annual or monthly average Same units, staff, technology, physicians We address these concerns by Constructing individual patient experience of low staffing based on day-to-day, shift-to-shift variations in staffing at the unit level Not institutional or unit annual or monthly average Same units, staff, technology, physicians Conducting study in a single institution that has: Lower-than-expected mortality High average nurse staffing levels Recognized for high quality by the Dartmouth Atlas, US News and World Report, and Magnet hospital designation Including extensive controls for potential sources of an increased risk of death Patient diagnosis and surgical status Patient demographics Unit admitted to 9 10 Data Sources Merged data from Patient classification/staffing system Patient classification data =>target/recommended staffing Staffing data =>actual staffing data Discharge abstracts, administrative data support system Patient demographics, diagnosis, discharge status Patient assigned unit by time during stay Anesthesia database to identify time not on assigned unit because in OR or other anesthesia related procedure Key measures of low staffing Below target shift Target staffing on a shift 8 hours or more below target 16% of all shifts Most likely on ICUs (but average hours/shift also higher) Evenly distributed across ICU shifts, more likely days and evenings on med-surg unit shifts Below-target shift High turnover shift Turnover for unit 1 standard deviation above day shift mean Turnover = (adm + disch + transfers)/census *2 7% of shifts Most on day, rare on night 11 12
3 Patient level measure of exposure to low staffing Cumulative count of below target and high turnover shifts Total count Count over first five days of Count over 6 shifts prior to discharge or death Use survival models for analysis with time varying covariates Allows us to incorporate information on changes in patient location (type of unit) and exposure to low staffing over Sample Large tertiary academic medical center 197,961 s over inpatient units General care units (28) Step down (7) Intensive care units (8) 1,897,424 unit-shifts Exposure to Below-Target & High Turnover Shifts Exposure to Number of Shifts with Actual Staffing Eight or More Hours Below Target Staffing, and to Number of Shifts with High turnover Exposure over first 30-days of % of Patients Exposure over first five days of % of Patients # shifts Below-target High-turnover Below-target High-turnover 0 319% 397% 343% 449% 1 197% 322% 214% 346% 2 137% 155% 149% 145% 3 92% 62% 99% 43% Increased Risk of Death With Exposure to Lower RN Staffing and Higher Patient Turnover Increased risk associated with each shift with RN staffing belowtarget or high turnover, 30 day cumulative exposure Shifts with RN staffing 8 or more hours below target Shifts with high patient turnover Increased risk associated with each shift with RN staffing belowtarget or high turnover, first 5 days cumulative exposure Shifts with RN staffing 8 or more hours below target Shifts with high patient turnover 2%/shift 4%/shift 3%/shift 7%/shift Key findings Patient Mortality Even in a high quality hospital that generally meets its staffing targets and manages patient turnover, and extensive controls for the influence of other factors, we still could detect the effects of staffing and high patient turnover Effects are comparable to those observed in comparisons of high to low staffed hospitals Implications for Hospital Management No free passes for hospitals with high average staffing Need to strive to hit targets every shift Findings should also apply to hospitals less successful in routinely meeting nursing needs of patients Patients at higher average risk Operational implications Nursing service line, not just cost center Need systems for: Identifying target staffing Managing staffing against target Staffing for anticipated turnover Smoothing turnover 17 18
4 Challenges to applying within hospitals and to public reporting and research Standards for target staffing Basis for setting targets Opportunities for gaming or low-balling Measures Is 8 hours below target right for all units? How to incorporate patient turnover into analysis of adequate staffing Developing summary, cumulative measures of hospital experience Do we try to characterize and report each patient s experience Validation of measure with experience from other hospitals What do public reporting, regulatory and accreditation bodies do in response to these findings? Factors leading to redesign of work Sicker patients Nursing shortage Changing technology with new opportunities, new demands EHR Smart beds and easier, more routine telemetry eicu Bending the cost curve will increase the scrutiny on nursing Under current payment systems and nursing models, increasing staffing to assure value to patients may not pay for hospitals Avoided Days and Adverse Outcomes Associated with Raising Nurse Staffing to 75 th Percentile Estimates from Needleman/Buerhaus, Health Affairs, 2006 RN Proportion Licensed Hours Do Both Avoided Days 1,507,493 2,598,339 4,106,315 Avoided Adverse Outcomes Cardiac arrest and shock, pneumonia, upper gastrointestinal bleeding, deep vein thrombosis, urinary tract infection 59,938 10,813 70,416 Avoided Deaths 4,997 1,801 6, Net Cost of Increasing Nurse Staffing Estimates from Needleman/Buerhaus, Health Affairs, 2006 RN Proportion Licensed Hours Both Cost of higher nursing $ 811 Million $ 75 Billion $ 85 Billion Avoided costs (full cost) $ 26 Billion $ 43 Billion $ 69 Billion Short term cost increase (save 40% of average) ($ 24 Billion) $ 58 Billion $ 57 Billion As % of hospital costs -01% 15% 14% 23 Factors leading to redesign of work Sicker patients Nursing shortage Changing technology with new opportunities, new demands EHR Smart beds and easier, more routine telemetry eicu Bending the cost curve will increase the scrutiny on nursing Under current payment systems and nursing models, increasing staffing to assure value to patients may not pay for hospitals Need to embrace quality-based payment and step up to claim ownership of task of improving care Redesign work for efficiency as well as improved safety & reliability 24
5 Challenges of redesigning work and sustaining change require nurses involvment Nonlinearity of work Ebright managing the stack Time? Completion and missed work? Accuracy/errors? Improving care requires integration of practices, not simply adopting best practices Need to sustain effective practices Not automatic Key roles in coordination invisible to patient and often other staff Gerri Lamb INQRI grant UCLA LOS and multi-disciplinary rounding Burden Spaghetti diagram of nurse movement during 50 minutes of a shift Challenges to redesigning work and sustaining change require nurses involvment Nonlinearity of work Ebright managing the stack Time? Completion and missed work? Accuracy/errors? Improving care requires integration of practices, not simply adopting best practices Need to sustain effective practices Not automatic Key roles in coordination invisible to patient and often other staff Gerri Lamb INQRI grant UCLA LOS and multi-disciplinary rounding Burden Source, Institute for Healthcare Improvement, TCAB How-to Manual on Nurse Time in Direct Patient Care, We understand how to build a culture of improvement that engages the front line Leadership engagement and commitment Organizational commitment to safety and reliability Alignment of improvement goals and institutional goals Engagement, orientation and training of front line and clinical staff All above subject of pre-work in Michigan Keystone Weakening hierarchical relationships and empowering staff Respect the local wisdom of frontline providers Engaging front line staff requires addressing their concerns Adoption of methods for designing, testing and adapting innovations Plan-Do-Study-Act popular tool for rapid cycle testing Complements longer and more formal methods of analysis and designing innovation Commitment and capacity to collect and use data Not just culture but institutionalization of improvement work into work week and expectations 29
Practical steps for applying. in acuity-based staffing
Practical steps for applying Lillee Gelinas, MSN, RN, FAAN (Moderator) System Vice President and Chief Nursing Officer Clinical Excellence Services CHRISTUS Health Irving, Texas Editor-in-Chief, American
More informationStaffing and Scheduling
Staffing and Scheduling 1 One of the most critical issues confronting nurse executives today is nurse staffing. The major goal of staffing and scheduling systems is to identify the need for and provide
More informationExecutive Summary Leapfrog Hospital Survey and Evidence for 2014 Standards: Nursing Staff Services and Nursing Leadership
TO: FROM: Joint Committee on Quality Care Cindy Boily, MSN, RN, NEA-BC Senior VP & CNO DATE: May 5, 2015 SUBJECT: Executive Summary Leapfrog Hospital Survey and Evidence for 2014 Standards: Nursing Staff
More informationSchool of Nursing Applying Evidence to Improve Quality
Applying Evidence to Improve Quality Linda A Dudjak PhD RN Associate Professor University of Pittsburgh School of Nursing Compare Two Alternatives Implement a Test of Change (Experiment) to Fix a Broken
More informationNursing Resources, Workload, the Work Environment and Patient Outcomes
Nursing Resources, Workload, the Work Environment and Patient Outcomes NDNQI Conference 2010 Christine Duffield, Michael Roche, Donna Diers Study Team Professor Christine Duffield Michael Roche Professor
More information2018 Press Ganey Award Criteria
2018 Press Ganey Award Criteria Guardian of Excellence Award SM This award honors clients who have reached the 95th percentile for patient experience, engagement or clinical quality performance. Guardian
More informationThe dawn of hospital pay for quality has arrived. Hospitals have been reporting
Value-based purchasing SCIP measures to weigh in Medicare pay starting in 2013 The dawn of hospital pay for quality has arrived. Hospitals have been reporting Surgical Care Improvement Project (SCIP) measures
More informationCritical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care
Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care April 29, 2011 Waltham, MA Presented by Lisa Payne Simon, MPH Cheryl H. Dunnington, RN, MS 1 FAST Initiative Overview 2004-2010
More informationDetermining Like Hospitals for Benchmarking Paper #2778
Determining Like Hospitals for Benchmarking Paper #2778 Diane Storer Brown, RN, PhD, FNAHQ, FAAN Kaiser Permanente Northern California, Oakland, CA, Nancy E. Donaldson, RN, DNSc, FAAN Department of Physiological
More informationCase-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System Designed Specifically for International Quality and Performance Use A white paper by: Marc Berlinguet, MD, MPH
More informationNew Research That Illuminates Policy Issues: Balancing Nursing Costs and Quality of Care for Patients
Charting A Publication of the Robert Wood Johnson Foundation Nursing s Future Reports on Policies That Can Transform Patient Care New Research That Illuminates Policy Issues: Balancing Nursing Costs and
More informationSTAFFING: The Pivotal Role of RNs
STAFFING: The Pivotal Role of RNs RN Staffing Standards: Medicare Requirements and the Joint Commission Standards November 16, 2007 Patients go to the hospital for an intervention and stay in the hospital
More informationUnderstanding Readmissions after Cancer Surgery in Vulnerable Hospitals
Understanding Readmissions after Cancer Surgery in Vulnerable Hospitals Waddah B. Al-Refaie, MD, FACS John S. Dillon and Chief of Surgical Oncology MedStar Georgetown University Hospital Lombardi Comprehensive
More informationSaving Lives with Best Practices and Improvements in Sepsis Care
Success Story Saving Lives with Best Practices and Improvements in Sepsis Care EXECUTIVE SUMMARY Although Thibodaux Regional Medical Center had achieved sepsis mortality rates below the national average,
More informationThe Safe Staffing for Quality Care Act will have a profound impact on the Advanced
Anne Marie Holler NUR 503 Group Project- Safe Staffing for Quality Care Act 11/21/11 Impact of Safe Staffing for Quality Care Act The Safe Staffing for Quality Care Act will have a profound impact on the
More informationEHR Enablement for Data Capture
EHR Enablement for Data Capture Baylor Scott & White (15 min) Bonnie Hodges, RN University of Chicago Medicine(15 min) Susan M. Sullivan, RHIA, CPHQ Kaiser Permanente (15 min) Molly P. Clopp, RN Tammy
More informationBEDSIDE NURSES KNOW: The Patient Safety Act. Fewer Patients = Better Healthcare. A Toolkit for Massachusetts RNs. How you can help make safe limits
The Patient Safety Act BEDSIDE NURSES KNOW: Fewer Patients = Better Healthcare A Toolkit for Massachusetts RNs How you can help make safe limits on RN patient loads a reality This booklet provides you
More informationChapter 39. Nurse Staffing, Models of Care Delivery, and Interventions
Chapter 39. Nurse Staffing, Models of Care Delivery, and Interventions Jean Ann Seago, Ph.D., RN University of California, San Francisco School of Nursing Background Unlike the work of physicians, the
More informationAcute Care Workflow Solutions
Acute Care Workflow Solutions 2016 North American General Acute Care Workflow Solutions Product Leadership Award The Philips IntelliVue Guardian solution provides general floor, medical-surgical units,
More informationAdvancing Accountability for Improving HCAHPS at Ingalls
iround for Patient Experience Advancing Accountability for Improving HCAHPS at Ingalls A Case Study Webconference 2 Managing your audio Use Telephone If you select the use telephone option please dial
More informationPart 4. Change Concepts for Improving Adult Cardiac Surgery. In this section, you will learn a group. of change concepts that can be applied in
Change Concepts for Improving Adult Cardiac Surgery Part 4 In this section, you will learn a group of change concepts that can be applied in different ways throughout the system of adult cardiac surgery.
More informationSENATE, No. 989 STATE OF NEW JERSEY. 218th LEGISLATURE INTRODUCED JANUARY 16, 2018
SENATE, No. STATE OF NEW JERSEY th LEGISLATURE INTRODUCED JANUARY, 0 Sponsored by: Senator JOSEPH F. VITALE District (Middlesex) Senator LORETTA WEINBERG District (Bergen) Co-Sponsored by: Senator Gordon
More informationMissed Nursing Care: Errors of Omission
Missed Nursing Care: Errors of Omission Beatrice Kalisch, PhD, RN, FAAN Titus Professor of Nursing and Chair University of Michigan Nursing Business and Health Systems Presented at the NDNQI annual meeting
More informationSupplementary Online Content
Supplementary Online Content Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.
More informationGantt Chart. Critical Path Method 9/23/2013. Some of the common tools that managers use to create operational plan
Some of the common tools that managers use to create operational plan Gantt Chart The Gantt chart is useful for planning and scheduling projects. It allows the manager to assess how long a project should
More informationUsing the Trauma Quality Improvement Program (TQIP) Metrics Data to Change Clinical Practice Abigail R. Blackmore, MSN, RN Pamela W.
Using the Trauma Quality Improvement Program (TQIP) Metrics Data to Change Clinical Practice Abigail R. Blackmore, MSN, RN Pamela W. Bourg, PhD, RN, TCRN, FAEN Learning Objectives Explain the importance
More informationWhy try to reduce hospitalizations? How many are avoidable?
Joseph G. Ouslander, MD Professor of Clinical Biomedical Science Associate Dean for Geriatric Programs Charles E. Schmidt College of Biomedical Science Professor (Courtesy), Christine E. Lynn College of
More information19th Annual. Challenges. in Critical Care
19th Annual Challenges in Critical Care A Multidisciplinary Approach Friday August 22, 2014 The Hotel Hershey 100 Hotel Road Hershey, Pennsylvania 17033 A continuing education service of Penn State College
More informationReview for Required Monitors
Review for Required Monitors The Joint Commission Hospital Accreditation Manual, 2009 Medicare Conditions of Participation, Hospitals Update: February 2009 Indicator / Monitor Restraint, Medical (non-specific
More informationPopulation Health Management in the Safety Net Elaine Batchlor, MD, MPH CEO, Martin Luther King, Jr. Community Hospital
Population Health Management in the Safety Net Elaine Batchlor, MD, MPH CEO, Martin Luther King, Jr. Community Hospital November 5, 2013 Martin Luther King, Jr. Community Hospital Page 1 11/05/2013 Agenda
More informationProvincial Surveillance
Provincial Surveillance Provincial Surveillance 2011/12 Launched first provincial surveillance protocols Establishment of provincial data entry & start of formal surveillance reports Partnership with AB
More informationReliability of Evaluating Hospital Quality by Surgical Site Infection Type. ACS NSQIP Conference July 22, 2012
Reliability of Evaluating Hospital Quality by Surgical Site Infection Type ACS NSQIP Conference July, 01 Surgical Site Infection Common cause of patient morbidity 5%-6% for colorectal procedures Significant
More informationRESCUE EVENTS IN MEDICAL AND SURGICAL PATIENTS: IMPACT OF PATIENT, NURSE & ORGANIZATIONAL CHARACTERISTICS. Andrea Schmid
RESCUE EVENTS IN MEDICAL AND SURGICAL PATIENTS: IMPACT OF PATIENT, NURSE & ORGANIZATIONAL CHARACTERISTICS by Andrea Schmid Bachelors of Science in Nursing, Carlow College, 1993 Masters of Science in Nursing
More informationRunning head: FAILURE TO RESCUE 1
Running head: FAILURE TO RESCUE 1 Failure to Rescue Susan Headley Ferris State University FAILURE TO RESCUE 2 Introduction Quality improvement in healthcare is a continuous process that evaluates care
More informationDan Bronson-Lowe, PhD, CIC
Dan Bronson-Lowe, PhD, CIC Senior Clinical Manager Baxter Healthcare Corporation No conflicts of interest to disclose. Clinic A Clinic B 20 vaccinated 5 vaccinated 100 total 5 total 20% vaccinated 100%
More informationMassachusetts ICU Acuity Meeting
Massachusetts ICU Acuity Meeting Acuity Tool Certification and Reporting Requirements Acuity Tool Certification Template Suggested Guidance Acuity Tool Submission Details Submitting your acuity tool for
More informationPENN Medicine. National Health Policy Forum. The Cost of Hospital Care. Keith A. Kasper
PENN Medicine National Health Policy Forum The Cost of Hospital Care Keith A. Kasper SVP & Chief Financial Officer University of Pennsylvania Health System October 8, 2010 0 PENN Medicine Organizational
More informationNurse-Patient Assignments: Moving Beyond Nurse-Patient Ratios for Better Patient, Staff and Organizational Outcomes
The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based
More informationHow Data-Driven Safety Culture Changes Can Lower HAC Rates
How Data-Driven Safety Culture Changes Can Lower HAC Rates Session #226, February 23, 2017 Holly O Brien & Abby Dexter Children s Hospital of Wisconsin 1 Speaker Introduction Holly O Brien, MSN RN Safety
More informationAdmissions and Readmissions Related to Adverse Events, NMCPHC-EDC-TR
Admissions and Readmissions Related to Adverse Events, 2007-2014 By Michael J. Hughes and Uzo Chukwuma December 2015 Approved for public release. Distribution is unlimited. The views expressed in this
More informationWriting Manuscripts About Quality Improvement: SQUIRE 2.0 and Beyond
Writing Manuscripts About Quality Improvement: SQUIRE 2.0 and Beyond Author Marilyn H. Oermann, PhD, RN, ANEF, FAAN Thelma M. Ingles Professor of Nursing, Duke University School of Nursing Editor, Journal
More informationPerformance Scorecard 2013
NORTHWESTERN LAKE FOREST HOSPITAL Performance Scorecard 2013 updated May 2013 Northwestern Lake Forest Hospital is committed to providing the communities we serve the highest quality health care through
More informationTRANSLATING CARINGTHEORY INTO PRACTICE
TRANSLATING CARINGTHEORY INTO PRACTICE Session C631 ANCC National Magnet Conference October 5, 2011 2:45-3:45 PM Kristen Swanson PhD, RN, FAAN UNC Chapel Hill School of Nursing Chapel Hill, NC Mary Tonges,
More informationOverview. Improving Safety with Health Information Technology. Prioritizing Safety. Question 22/10/2013
Improving Safety with Health Information Technology ISQua 2013, Edinburgh David Bates, MD, MSc Chief Quality Officer, Chief, Division of General Internal Medicine, Brigham and Women s Hospital Medical
More information"Nurse Staffing" Introduction Nurse Staffing and Patient Outcomes
"Nurse Staffing" A Position Statement of the Virginia Hospital and Healthcare Association, Virginia Nurses Association and Virginia Organization of Nurse Executives Introduction The profession of nursing
More informationSame day emergency care: clinical definition, patient selection and metrics
Ambulatory emergency care guide Same day emergency care: clinical definition, patient selection and metrics Published by NHS Improvement and the Ambulatory Emergency Care Network June 2018 Contents 1.
More informationFrequently Asked Questions (FAQ) CALNOC 2013 Codebook
Frequently Asked Questions (FAQ) CALNOC 2013 Codebook Maternal/Child and ED Service Lines QUESTION: Are the ED and Maternal/Child measures mandatory? What are the ramifications if we choose not to add
More informationHIMSS Nicholas E. Davies Award of Excellence Case Study Nebraska Medicine October 10, 2017
HIMSS Nicholas E. Davies Award of Excellence Case Study Nebraska Medicine October 10, 2017 Nebraska Medicine $1.2 billion academic health system 8,000 employees More than 1,000 affiliated physicians Primary
More informationPG snapshot Nursing Special Report. The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes
PG snapshot news, views & ideas from the leader in healthcare experience & satisfaction measurement The Press Ganey snapshot is a monthly electronic bulletin freely available to all those involved or interested
More informationCreating a No Wait ED
This presenter has nothing to disclose Creating a No Wait ED Karen Murrell, MD, MBA, FACEP Physician Lead-Emergency Medicine, Kaiser Northern California Assistant Physician in Chief- Process Improvement
More informationHow Allina Saved $13 Million By Optimizing Length of Stay
Success Story How Allina Saved $13 Million By Optimizing Length of Stay EXECUTIVE SUMMARY Like most large healthcare systems throughout the country, Allina Health s financial health improves dramatically
More informationNORTHWESTERN LAKE FOREST HOSPITAL. Scorecard updated September 2012
NORTHWESTERN LAKE FOREST HOSPITAL Performance Scorecard 2012 updated September 2012 Northwestern Lake Forest Hospital is committed to providing the communities we serve the highest quality healthcare through
More informationTomorrow s Healthcare: Better Quality, More Affordable, More Accessible
Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible Victor J Dzau, MD President, National Academy of Medicine September 23, 2016 Fung Healthcare Leadership Summit Global Challenges
More informationOrganization: Meritus Medical Center, Hagerstown, Maryland. Solution Title: Routine Vital Sign Protocols: Putting Evidence-Based Practice into Motion
Organization: Meritus Medical Center, Hagerstown, Maryland Solution Title: Routine Vital Sign Protocols: Putting Evidence-Based Practice into Motion Problem/Goal: The problem is the risk to quality patient
More informationObjectives 2/23/2011. Crossing Paths Intersection of Risk Adjustment and Coding
Crossing Paths Intersection of Risk Adjustment and Coding 1 Objectives Define an outcome Define risk adjustment Describe risk adjustment measurement Discuss interactive scenarios 2 What is an Outcome?
More informationANA Nursing Indicators CALNOC
Medication Errors, Patient Falls, and Pressure Ulcers: Improving Outcomes Over Time Patricia A. Patrician, PhD, RN, FAAN Colonel, US Army, Retired Associate Professor and Donna Brown Banton Endowed Professor
More informationThe Administrative Limb: The Clinician s View. Michael A. DeVita, M.D., FACP Clinical Professor University of Pittsburgh School of Medicine
The Administrative Limb: The Clinician s View Michael A. DeVita, M.D., FACP Clinical Professor University of Pittsburgh School of Medicine The value of Rapid Response Systems Overview Critical safety failure
More informationPay-for-Performance. GNYHA Engineering Quality Improvement
Pay-for-Performance GNYHA Engineering Quality Improvement The Writing Is On The Wall IOM Report - Rewarding Provider Performance: Aligning Incentives In Medicare 9/21/06 Medicare P4P and quality improvement
More informationICU Research Using Administrative Databases: What It s Good For, How to Use It
ICU Research Using Administrative Databases: What It s Good For, How to Use It Allan Garland, MD, MA Associate Professor of Medicine and Community Health Sciences University of Manitoba None Disclosures
More informationMatching Capacity and Demand:
We have nothing to disclose Matching Capacity and Demand: Using Advanced Analytics for Improvement and ecasting Denise L. White, PhD MBA Assistant Professor Director Quality & Transformation Analytics
More informationUnderstanding Patient Choice Insights Patient Choice Insights Network
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding Patient Choice Insights Patient Choice Insights Network SM www.aetna.com Helping consumers gain
More informationObjectives 10/09/2015. Screen and Intervene: Improved Outcomes From a Nurse-Initiated Sepsis Protocol C935
Screen and Intervene: Improved Outcomes From a Nurse-Initiated Sepsis Protocol C935 2015 ANCC National Magnet Conference October 9, 2015 Kristin Drager MSN RN CNL CEN William S. Middleton Memorial Veterans
More informationWilCo Wellness Alliance. Summit Presentation. Cara Woodard Account Manager. April 25, 2017
WilCo Wellness Alliance Summit Presentation Cara Woodard Account Manager April 25, 2017 Background and Overview Healthy Communities Institute Mission Headquarters Improve the health, vitality and environmental
More informationNurse-to-Patient Ratios
N U R S I N G M A T T E R S Nursing Matters fact sheets provide quick reference information and international perspectives from the nursing profession on current health and social issues. Nurse-to-Patient
More informationAF4Q and TCAB: An Introduction
AF4Q and TCAB: An Introduction July 13, 2011 Ellen Interlandi, MHM, RN, NE-BC Patricia Montoya, MPA, BSN 1 What is Aligning Forces for Quality? An unprecedented commitment by the Robert Wood Johnson Foundation
More informationClinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services
Clinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services Clinical Documentation: Beyond The Financials Key Points of
More informationThe Nature of Emergency Medicine
Chapter 1 The Nature of Emergency Medicine In This Chapter The ED Laboratory The Patient The Illness The Unique Clinical Work Sense Making Versus Diagnosing The ED Environment The Role of Executive Leadership
More informationJULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING
JULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING About The Chartis Group The Chartis Group is an advisory services firm that provides management
More informationNurse Managers Role in Promoting Quality Nursing Practice
Nurse Managers Role in Promoting Quality Nursing Practice Mission Critical: Nurse Manager Summit Fredericton, New Brunswick April 30, 2015 Jeanne Besner, C.M., PhD, RN 1 Outline of Presentation Background
More informationQuality Measure Indicators +Throughput Metrics + Automated Dashboard = Innovation to Improve Quality Goals
Quality Measure Indicators +Throughput Metrics + Automated Dashboard = Innovation to Improve Quality Goals DMC Harper- Hutzel Hospital The DMC is an 8 facility academic medical center Harper-Hutzel is
More informationSelf-assessment surveys details & definitions
Self-assessment surveys details & definitions Completing the Paradigm self assessment surveys is the very first step in achieving the Paradigm Award. Only organizations who complete the self assessment
More informationSCORING METHODOLOGY APRIL 2014
SCORING METHODOLOGY APRIL 2014 HOSPITAL SAFETY SCORE Contents What is the Hospital Safety Score?... 4 Who is The Leapfrog Group?... 4 Eligible and Excluded Hospitals... 4 Scoring Methodology... 5 Measures...
More informationScaling Up and Validating a Nursing Acuity Tool to Ensure Synergy in Pediatric Critical Care
Scaling Up and Validating a Nursing Acuity Tool to Ensure Synergy in Pediatric Critical Care Jean Connor PhD, RN, CPNP, FAAN Director of Nursing Research, Cardiovascular and Critical Care Services Boston
More informationQuality Management Building Blocks
Quality Management Building Blocks Quality Management A way of doing business that ensures continuous improvement of products and services to achieve better performance. (General Definition) Quality Management
More informationBegin Implementation. Train Your Team and Take Action
Begin Implementation Train Your Team and Take Action These materials were developed by the Malnutrition Quality Improvement Initiative (MQii), a project of the Academy of Nutrition and Dietetics, Avalere
More informationImpact of hospital nursing care on 30-day mortality for acute medical patients
JAN ORIGINAL RESEARCH Impact of hospital nursing care on 30-day mortality for acute medical patients Ann E. Tourangeau 1, Diane M. Doran 2, Linda McGillis Hall 3, Linda O Brien Pallas 4, Dorothy Pringle
More information1. Recommended Nurse Sensitive Outcome: Adult inpatients who reported how often their pain was controlled.
Testimony of Judith Shindul-Rothschild, Ph.D., RNPC Associate Professor William F. Connell School of Nursing, Boston College ICU Nurse Staffing Regulations October 29, 2014 Good morning members of the
More informationDiagnostics for Patient Safety and Quality of Care. Vulnerable System Syndrome
Diagnostics for Patient Safety and Quality of Care Carol Haraden, PhD September 2012 This presenter has nothing to disclose. Vulnerable System Syndrome Three core pathologies: - Blame - Denial - And the
More informationA Resident-led PICU Morbidity and Mortality Conference
A Resident-led PICU Morbidity and Mortality Conference James Moses, MD, MPH Associate Program Director Boston Combined Residency Program Director of Patient Safety and Quality Department of Pediatrics
More informationAccomplishments Fiscal Year UPMC Passavant
Accomplishments Fiscal Year 2015 UPMC Passavant UPMC Passavant Summary of Significant FY15 Accomplishments Continue employee engagement initiatives that are aligned with UPMC Passavant s Mission, Vision,
More informationA Quiz. I am comfortable going to any healthcare provider or hospital in my city/town.
A Quiz I am comfortable going to any healthcare provider or hospital anywhere in the country. I am comfortable going to any healthcare provider or hospital in my city/town. I am comfortable going to my
More informationUSE OF NURSING DIAGNOSIS IN CALIFORNIA NURSING SCHOOLS AND HOSPITALS
USE OF NURSING DIAGNOSIS IN CALIFORNIA NURSING SCHOOLS AND HOSPITALS January 2018 Funded by generous support from the California Hospital Association (CHA) Copyright 2018 by HealthImpact. All rights reserved.
More informationTeleICU And What It Means To You
Vanderbilt Department of Anesthesiology TeleICU And What It Means To You Dr. L. Weavind MBBCh Associate Professor Anesthesia and Surgery Director Critical Care Fellowship Vanderbilt University Former Director
More informationTransformational Patient Care Redesign Project
Transformational Patient Care Redesign Project Kaveh Houshmand Azad 1 Summary In 2008 2009, Providence Holy Cross Medical Center, a 340- bed hospital located in Mission Hills, California embarked upon
More informationImproving Care and Managing Costs: Team-Based Care for the Chronically Ill
Improving Care and Managing Costs: Team-Based Care for the Chronically Ill Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org High Cost Beneficiaries: What Can
More informationFY 13 Pillar Goal Update and FY 14 Pillar Goals
FY 13 Pillar Goal Update and FY 14 Pillar Goals Summer Leadership Assembly C. Wright Pinson, MD, MBA Deputy Vice Chancellor, Health Affairs CEO, Vanderbilt Health System June 19, 2013 Staying Focused on
More informationNORTHWESTERN LAKE FOREST HOSPITAL. Scorecard updated May 2011
NORTHWESTERN LAKE FOREST HOSPITAL Performance Scorecard 2011 updated May 2011 Northwestern Lake Forest Hospital is committed to providing the communities we serve the highest quality health care through
More informationTargeted Solutions Tools
TARGETED SOLUTIONS TOOL NOW AVAILABLE FOR OUR INTERNATIONAL CUSTOMERS! Joint Commission Center for Transforming Healthcare Targeted Solutions Tools Hand Hygiene Safe Surgery Hand-off Communications Preventing
More informationSystematic Determination of Transplant In-Patient Acuity, Patient and Nurse Satisfaction. Objectives. Overview
Systematic Determination of Transplant In-Patient Acuity, Patient and Nurse Satisfaction Michelle Floyd, RN Pre Transplant Coordinator and Presenter Ruth Tutor PhD, RN, APN, CCRN, CCNS, APRN-BC Critical
More informationTHE AMERICAN BOARD OF PATHOLOGY PATIENT SAFETY COURSE APPLICATION
THE AMERICAN BOARD OF PATHOLOGY PATIENT SAFETY COURSE APPLICATION Requirements: Component I Patient Safety Self-Assessment Program Programs must meet the following criteria to be an ABP approved Patient
More informationReconciling Abstracted to Electronic Quality Measures
Reconciling Abstracted to Electronic Quality Measures Tuesday, March 1, 2016 Keith F. Woeltje, PhD, MD, VP and Chief Medical Information Officer BJC HealthCare Center for Clinical Excellence Liz Richard,
More informationScoring Methodology FALL 2016
Scoring Methodology FALL 2016 CONTENTS What is the Hospital Safety Grade?... 4 Eligible Hospitals... 4 Measures... 5 Measure Descriptions... 7 Process/Structural Measures... 7 Computerized Physician Order
More informationN.E.W.T. Level Measurement:
N.E.W.T. Level Measurement: Voldemort or Dumbledore? Nathan Spell, MD, FACP Chief Quality Officer, Emory University Hospital Georgia Chapter Scientific Meeting American College of Physicians Savannah,
More informationOver the past decade, the number of quality measurement programs has grown
Performance improvement Surgeon sees standardization and data as keys to higher value healthcare Over the past decade, the number of quality measurement programs has grown exponentially as hospitals respond
More informationMoving the Needle on Hospital Throughput: Breaking Through the Status Quo. Session ID: 325
Moving the Needle on Hospital Throughput: Breaking Through the Status Quo Session ID: 325 Objectives Objective 1: Demonstrate how two common strategies can be deployed to maximum benefit to support improvements
More informationClaims Denial Management: What Are Third Party Payers Really Telling You about Your Documented Quality-of-Care and Compliance?
Claims Denial Management: What Are Third Party Payers Really Telling You about Your Documented Quality-of-Care and Compliance? Betty Bibbins, MD, CHC, CPEHR, CPHIT President & Chief Medical Officer Website:
More informationTRANSLATING INSTITUTIONAL DATA INTO UNIT SPECIFIC OUTCOME METRICS USING CUSTOMIZED NURSING SCORECARDS
TRANSLATING INSTITUTIONAL DATA INTO UNIT SPECIFIC OUTCOME METRICS USING CUSTOMIZED NURSING SCORECARDS Debra Campbell, BSN, RN, CPHQ Mary Stevie, MS, RN Cincinnati, Ohio Est. 1889 About TCHHN 621 Bed Tertiary
More informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationDefinitions/Glossary of Terms
Definitions/Glossary of Terms Submitted by: Evelyn Gallego, MBA EgH Consulting Owner, Health IT Consultant Bethesda, MD Date Posted: 8/30/2010 The following glossary is based on the Health Care Quality
More informationEmergency Department Throughput
Emergency Department Throughput Patient Safety Quality Improvement Patient Experience Affordability Hoag Memorial Hospital Presbyterian One Hoag Drive Newport Beach, CA 92663 www.hoag.org Program Managers:
More information