Melissa Gale, MBA Avera St. Benedict Health Center Quality Coordinator CEO Landmann-Jungman Memorial Hospital Avera
Project start date with Great Plains Quality Innovation Network was May 1, 2015 Goal of working on the Million Hearts initiative and improving our EMR optimization Gain a better understanding of data
Understanding how quality data can be useful for process improvements Learning to use the trends Understanding that not everyone likes data or change to their processes
Monitoring data for integrity on the cardiovascular measures We did not share this until we knew data was right Ongoing work in progress
Workflow from when the patient is checked in through the rooming process Workflow from when the patient walks in the front door to when they are ready for the nurse Nursing Staff Office Staff
Continuous process improvement Opening up communication between staff Taking suggestion and giving people permission to try things differently
Drill downs Trouble shooting the data Auditing charts Cross referencing data sources Identifying exceptions Improving documentation so the measure is captured
Once we were confident in the data. Teaching staff what data means and some simple fixes to improve their numbers Med staff Clinic staff Hanging them up Reports to the hospital board Individual follow up with providers and nurses Getting credit for things that are done routinely
Using dashboard patients registries as they became available: Diabetes Preventative health Well child Discharge follow ups Hypertension
Having providers understand that we can only control what WE scan in Putting a process in place to scan more accurately Using 1 person to scan Pulling data out of scanned documents and putting them in EMR before scanning them Paps, mammos, colons, diabetic retinopathy, VA labs, CPAP compliance reports
100.00% 91.95% Breast Cancer, Screening 90.00% 80.00% 70.00% 60.00% 60.83% 62.18% 62.73% 64.79% 57.34% 50.00% 40.00% Rate HP 2020 Practice Goal Baseline 2014 30.00% 20.00% 10.00% 0.00%
Continued reinforcement and re-teaching on documentation, better EMR usage, scanning, patient recalls Using many opportunities to reinforce Meetings, daily line up, individual conversations, etc
Monthly quality meetings with team rotations CFO, Quality staff, Clinic business manager, nursing manager at all meetings Team rotation includes 1 front desk staff PCP with his/her nurse(s) Discuss ongoing projects, quality data, data dashboards, new areas to address End with monthly quality goal Minutes are hung up, passed out, emailed out
Aspirin=70% Blood Pressure control=70% Cholesterol management=70% Smoking Cessation=70% Aspirin=71% Blood Pressure control=74% Cholesterol management= Smoking Cessation=83% Million Hearts Goal Practice Goal
Most room for improvement Started capturing all blood pressure readings: No Charge BP checks at clinic No charge BP checks at hospital Adding a 2 nd set of vitals in the workflow Documentation Pushing the use of templating for HTN follow ups
Concerns that the machines ran high 1 nurse did a side by side manual vs auto study for 2 weeks Checked to see if machines could or needed calibration Getting nurses the tools they needed Getting rid of manual wall cuffs Ordered manual set of cuffs for each exam room that included all sizes of cuffs Centralized supplies for patient home monitoring
80.00% starting PDSA with elec cuffs Blood Pressure Control 70.00% 66.04% 60.00% 53.46% 55.98% 57.61% 59.12% 57.71% 50.00% 40.00% HTN Protocol new wkflow10/30 Rate MH Goal Practice Goal 30.00% Baseline 2014 20.00% 10.00% 0.00%
Communication can be visual as well as verbal
It is real, but. Reinforcing that the goal for BP control is not 100% The goal gives us room for people that truly do have white coat hypertension Reinforcing the use of at home monitoring to see if it is really WC or if it is truly uncontrolled Making the environment more relaxing for patients
Continued quality improvement Continue to add trackable data point Improved integration of health care analytics Continue documentation improvement More open conversations about fixing areas of concern Building on quality infrastructure
Contact Great Plains Quality Innovation Network if you would like more information Melissa Gale, MBA Melissa.Gale@avera.org