Improving Patient Safety Across Illinois Hospital Improvement Innovation Network (HIIN) August 3, 2016
Agenda HEN 2.0 and Progress Introduction to HIIN Proposal IHA HIIN Approach Open Forum
MHA-IHA HEN 2.0 Initiative Sep 2015 Sep 2016
MHA-IHA HEN 2.0 Harms Prevented and Costs Saved to date HEN 2.0 Harms Prevented and Costs Baseline Performance Performance Performance Performance % Expected # Events Cost per Positive Cost Measure Baseline Period N N Saved Rate Period Numerator Denominator as of 7/9/16 Change of Events Prevented Event ($) Savings Measure Adverse Drug Events ADE-3 (gly) 2015 (Q3) 4.4858 121 2016 (Q1) 4303 102695 4.1901 157 6.59% 4,606.70 303.70 5000 $ 1,518,498 ADE-3 (gly) ADE-4 (opioids) 9/2015-11/2015 2.0552 96 2016 (Q1) 4037 226546 1.7820 142 13.29% 4,655.99 618.99 5000 $ 3,094,927 ADE-4 (opioids) CAUTI CAUTI-2a 2012 (Q1) 1.6926 154 1/2016-3/2016 226 249426 0.9061 170 46.47% 422.18 196.18 1000 $ 196,178 CAUTI-2a CLABSI CLABSI-2a 2012 (Q1) 0.8350 157 1/2016-3/2016 127 192396 0.6601 168 20.95% 160.65 33.65 17000 $ 572,061.22 CLABSI-2a Falls Falls-1 2015 (Q3) 0.5301 152 1/2016-3/2016 704 1414961 0.4975 171 6.15% 750.09 46.09 7234 $ 333,441.08 Falls-1 OB-2 (PSI-18) 2010 135.8401 183 2015(Q3) 182 1663 109.7708 164 19.19% 225.90 43.90 92 $ 4,038.99 OB-2 (PSI-18) OB Adverse Events OB-3 (PSI-19) 2010 19.8279 183 2015(Q3) 429 29480 14.6391 177 26.17% 584.53 155.53 158 $ 24,573.05 OB-3 (PSI-19) OB-6 (hemorrhage) 2015 (Q3) 0.2570 99 1/2016-3/2016 84 36958 0.2273 111 11.55% 94.97 10.97 3000 $ 32,905.68 OB-6 (hemorrhage) Pressure Ulcers PrU-1 (PSI-03) 2010 0.4915 213 2015 (Q3) 397 83633 0.4753 206 3.29% 411.05 14.05 17000 $ 238,921.98 PrU-1 (PSI-03) Surgical Site Infections SSI-2 (rate) 2012 (Q1) 1.9794 154 1/2016-3/2016 226 12677 1.7828 143 9.93% 250.93 24.93 21000 $ 523,499.30 SSI-2 (rate) VTE VTE-1 (PSI-12) 2010 7.0498 211 2015 (Q3) 549 80037 6.8596 202 2.70% 564.25 15.25 8000 $ 121,986.33 VTE-1 (PSI-12) VAE VAE-1 2015 (Q1) 7.6578 88 1/2016-3/2016 295 46507 6.3431 124 17.17% 356.14 61.14 21000 $ 1,284,004.92 VAE-1 Readmissions READ-1 (same) 4/2011-6/2011 10.2257 198 6/2015-8/2015 31290 343098 9.12 211 10.78% 35,084.19 3,794.19 8808 $ 33,419,211.52 READ-1 (same) Total Number of Estimated Events/Harms Prevented: 5,319 Total Estimated Cost Savings: $41,364,247.49
Hospital Improvement Innovation Network (HIIN) On April 22 notification of the Hospital Improvement Innovation Networks (HIIN) grant proposal, an extension of HEN, was announced. The priority of HIIN will be to focus on the 11 core areas of harm identified in HEN, without OB, and support the work of the QIN-QIO 11th Scope of Work. HIIN will also engage hospitals, providers and broader care-giver communities to implement and spread well-tested, evidence-based, and measured best practices. Hospitals to report 4 clinical outcome measures: 3 Adverse Drug Event Metrics and 1 Falls metric. 5
HIINs 11 Areas of Harm 1. Adverse drug events (ADE)- opioid safety, anticoagulation safety, and glycemic management 2. Central line-associated blood stream infections (CLABSI)-in all hospital settings, not just Intensive Care Units (ICUs) 3. Catheter-associated urinary tract infections (CAUTI)-in all hospital settings, including avoiding placement of catheters, both in the ER, and in the hospital 4. Clostridium difficile (C. diff)- including Antibiotic Stewardship 5. Injury from falls and immobility 6. Pressure Ulcers 7. Sepsis and Septic Shock 8. Surgical Site Infections (SSI)-to include measurement and improvement of SSI for multiple classes of surgeries 9. Venous thromboembolism (VTE)-including all surgical settings 10. Ventilator-Associated Events (VAE)-to include Infection-related Ventilator- Associated Complication (IVAC) and Ventilator-Associated Condition (VAC) 11. Readmissions 6
Hospital Improvement Innovation Network (HIIN) Goals: 1. 20% reduction in all-cause patient harm (to 97 Hospital- Acquired Conditions [HACs]/1,000 discharges) from 2014 interim baseline (of 121 HACs/1,000 patient discharges); and 2. 12% reduction in 30-day readmissions as a population-based measure (readmissions per 1,000 people). Interventions may include: 1. Learning collaboratives 2. Data sharing networks 3. Peer-to-peer training among hospitals 4. Conference calls, webinars, and site visits 7
Differences Between HEN 2.0 and HIIN RFPs QIN-QIO More teamwork and collaboration Increased efficiencies Baseline New baseline of 121 harms/1000 discharges Expectation of significant improvement (97 harms/1000 discharges) New goals 20% reduction in HACs 12% in 30-day readmissions 8
Differences Between HEN 2.0 and HIIN RFPs Recruitment Must happen within 90 days of contract award Language Preventable harm changed to all harms Performance Period September 2016 September 2018 One year option period 9
IHA HIIN Approach High reliability Person and family engagement Data and results driven Participant value and patient safety Peer engagement
Data and Results Driven 11
High Reliability Engagement of HIIN hospitals in a journey towards High Reliability in partnership with the Center for Transforming Healthcare More than 20 hospitals have embarked upon the journey towards high reliability with IHA in HEN 2.0 to date The HIIN will use the ORO 2.0 assessment tool to identify hospitals level of advancement toward HRO Hospitals will receive support to address identified opportunities for improvement and develop an action plan to take specific steps that can leverage organizational strengths to achieve high reliability. Chassin MR, Loeb JM. High-Reliability Health Care: Getting There from Here. Milb Q 2013;91(3):459-90 12
Person and Family Engagement The IHA HIIN will incorporate the best practices for improving PFE identified by the PfP and the QIN-QIOs Peer learning to understand successful strategies Learn to implement checklist for patients with planned admissions Including families in rounds, huddles, and bedside reporting Encouraging families to ask questions Providing families with a diary, and encouraging personal belongings in room Using whiteboards that hold more information 13
Peer to Peer Engagement For HEN 2.0, a Peer to Peer Learning Network was established as a resource forum This network will be continued and used as a platform for the sharing of best practices and to spread improvement across the HIIN https://www.alliance4ptsafety.org/hen/resources/peertopeerlearningnetwork.aspx 14
Innovative HIIN Offerings Quality Improvement Innovation Challenge-Hospitals and community partners will be awarded funding each year to pilot an approach or ramp up an existing program that aims at reducing avoidable harm or readmissions. Each hospital that is awarded funding must come to the table with a committed community partner in order to be awarded funding. Simulation Trainings-IHA is exploring offering simulation trainings open to all members of the HIIN. These simulation trainings would be regionally spread throughout the state so HIIN hospitals would have the opportunity to attend at the simulation training in their region or travel to another if they choose. Midwest Alliance for Patient Safety (MAPS) Safe Tables-IHA will be offering quarterly in-person Safe Table events focused on a different HAC each quarter. 15
Next Steps 1. As soon as we hear from CMS regarding HIIN awards, we will be letting you know and sending out Commitment Letters! 2. In the meantime, as applicable, pass along the HIIN and HRO one-pagers to your Senior Leadership and brief them on the HIIN 3. Any questions? Please contact Adam Kohlrus (Akohlrus@teamiha.org) or Brigette Bucholz (Bbucholz@team-iha.org) Thank You! We look forward to beginning/continuing our Quality/Safety partnership with you! 16
Please help us evaluate HEN 2.0! If you are a HEN 2.0 hospital, we need your feedback - please complete our HEN 2.0 Evaluation: https://www.surveymonkey.com/r/t9pz5dn 17