Partnership for Patients Hospital Engagement€¦ · Partnership for Patients Hospital Engagement...

Partnership for Patients Hospital Engagement Network Final ReportDec. 9, 2011 – Dec. 8, 2014

(Solicitation #APP111513, Contract #HHSM-500-2012-0012-C)

Minnesota Hospital Association2550 University Ave. W., Ste. 350-SSaint Paul, MN 55114-1900(651) 641-1121 | mnhospitals.org

Tania Daniels, VP, patient safety(651) 603-3517 | [email protected]

(The contents of this report is based on the past 3 years of the Partnership for Patients Initiative)

Table of contentsHigh-Level Summary of Progress for the 3 Year PfP Campaign .......... 1Administrative Progress ....................................................................... 2Project Progress and Success

Adverse Drug Events .................................................................. 3 Catheter-associated urinary tract infections ................................ 6 Central line-associated blood stream infections ......................... 8 Injuries from falls and immobility ................................................10 Obstetrical adverse events, including Early Elective Delivery ....12 Pressure Ulcers .........................................................................14 Surgical Site Infections ..............................................................16 Venous Thromboembolism ........................................................18 Ventilator-Associated Events .....................................................20 Readmissions ............................................................................22 Cost Savings Associated with HEN-level Harm Reduction ........24 All Other Forms of Harm (LEAPT) Patient and Family Engagement (PFE) ...........................25 Physician and Leadership Engagement ..........................27 Severe Sepsis and Septic Shock .....................................28 Clostridium Difficile Infection (CDI) ..................................30 Delirium ...........................................................................33 Employee Safety .............................................................35 Expanding the Reduction of Hospital-Acquired Conditions and Readmissions across the Health Care Community Falls Across the Community .................................38 Engaging Pharmacy Residents to Reduce ADE ...................................................40 Engaging Physician Residents to Reduce Pressure Ulcers ...................................................42 Engaging Patients to Reduce Readmissions .......43

Collaboration .......................................................................................45Appendix A: Participating Hospitals ....................................................46Appendix B: Pictures, Posters, other engagement activities ...............53Brief Program Survey ..........................................................................57

Page 1Minnesota Hospital Association

High-level summary of progress for the 3 year PfP campaignDuring the three years of the Partnership for Patients Campaign, Minnesota Hospital Association’s Hospital Engagement Network has made tremendous strides toward the partnership’s goals of reducing hospital acquired conditions (HACs) by 40 percent and readmissions by 20 percent. Even more, there is heightened emphasis on reduction of harm across the board as opposed to individual HACs. To date, 14 hospitals have been recognized for superior performance in patient safety for reducing six or more HACs by 40 percent and/or preventable readmissions by 20 percent. The hospitals have also implemented at least three patient and family engagement best practices and the four leadership best practices. More than 80 hospitals have reached benchmark on three or more HACs. Collectively, the 115 participating hospitals (see Appendix A) prevented nearly 12,000 patients from being harmed and saved more than $92 million. Sixty percent (70) of participating hospitals in Minnesota are critical access hospitals.

19%

Readmissions

54%

Pressure Ulcers

94%

Early Elective Deliveries

53%

Events Resulting in

INR>5

33%

Falls with Injury

Central Line-Associated

Blood Stream Infection

69%

15%

Venous Thrombo- embolism

Focus Area Results

21%

Falls

Catheter- Associated

Urinary TractInfection

HEN BASELINE7%*

*Represents the PPS hospital ICU rate; critical access hospitals have reported a 51% decrease in CAUTI.

MHA HEN improvement was calculated by analyzing the percent difference between the corresponding measure’s 2010 baseline and the most current data.

2014 Partnership for Patients Hospital Engagement Network FInal ReportPage 2

Administrative progressAccording to feedback MHA received during its evaluation, the MHA HEN has performed well on the administration of its contract. The HEN consistently delivers monthly reports on time, including highlights of the past 30 days such as conference calls, webinars, kick-off events, site visits and internal meetings. Its work has been characterized as always above average and high quality and the MHA HEN has demonstrated strong leadership not only within this contract, but also in the Partnership for Patients Campaign. MHA HEN has accurately reported all quarterly reports on time and continues to meet all deadlines and deliver a high quality product within budget. The HEN has submitted all deliverables in accordance with its statement of work and the deliverables are accurate, accepted the first time by the COR and comments from the Centers for Medicare and Medicaid Services (CMS) are incorporated into the deliverables when necessary.

The MHA HEN has maintained strong business relations throughout the contract. It routinely communicates with other CMS contractors, including weekly calls with all Partnership for Patients HENs and 1:1 calls with contract evaluators. MHA proactively coordinates and communicates with key stakeholders and hospitals within and outside the MHA network through weekly emails, listservs, its website and monthly webinars. MHA staff have volunteered and been invited to provide presentations for convening meetings, webinars and to other HENs, including Partnership virtual meetings and webinars, presentations on readmissions and ADE. MHA establishes and supports a learning collaborative, including finding custom solutions based on the local needs of Minnesota hospitals, facilitating the testing of best practices among hospitals, identifying high performing hospitals and sharing their lessons. The HEN develops data sharing networks and mechanisms to support peer-to-peer training among hospitals. MHA conducts regular conference calls and site visits to participating hospitals and provides support to participating hospitals through listservs, webinars, in-person meetings, consultant visits and through 1-1 conversations to address barriers to success. Finally, the MHA HEN continually assesses hospital support that will be most valuable to the hospitals.

I believe the MHA HEN has helped us as a small critical access hospital focus our quality improvement efforts by making excellent evidenced based tools available, providing web based and in-person education and supporting our efforts through monthly phone calls. Understanding that small facilities do not have exhaustive resources (our quality department has a staff of one), MHA worked with a group of CAHs to develop a SAFE CARE Road Map that identified the most important elements of all the initiatives and packaged them in a way that allows a small facility to get started on the HEN journey without being overwhelmed.

— CHI St. Joseph’s Health


1,977 fewer potential adverse drug events have occurred statewide as a result of the program

Adverse drug eventsIn an effort to reduce the nearly 50 percent of all adverse drug events in hospitals each year that are preventable, Minnesota hospitals have implemented the Road Map to a Medication Safety program. This road map of best practices focuses specifically on anticoagulants, hypoglycemic agents and opioids. Adverse drug events involving these medications account for up to two-thirds of emergency hospital admissions for older Americans and most often intersect with other hospital-acquired conditions, most notably readmissions, falls and venous thromboembolism. Since its inception, an estimated 1,977 fewer events have occurred. This is equivalent to 77 fewer events per month or 2.6 fewer events per day.

Hospitals participatingSee Appendix A: Table 1 for a list of participating hospitals.

Project updatesThe following represents key highlights of achievements during the past 3 years:

• 73 percent of eligible hospitals submitted data

• 69 percent of hospitals completed the ADE Road Map

• 51 percent of CAH hospitals completed the SAFE Care ADE Road Map

• The work brought together best practices that align with reducing ADE, VTE, readmissions, and other events, and are effectively packaged including educational materials to provide a “one stop shop” for hospitals to improve their drug safety practices across several dimensions, both adaptive and technical.

• The Medication Safety Road Map has been easily adopted by other hospitals, hospital systems and HENs. It is presented in a clear, replicable format, and is flexible in that it does not require a particular electronic medical system. It can be used by varying sized facilities and be introduced in stages. The SAFE infrastructure also gives hospitals the flexibility to address other ADEs beyond the original three focus areas.

• Designed to allow sustainability even after the MHA initiative; hospitals work to embed best practices so that they become part of the permanent culture and infrastructure.

Interventions and tests of change • Development of Road Map to a Medication Safety Program with

associated tools and resources• Provides a comprehensive set of best practices and tools that

incorporates research and learnings from national and local efforts.


• SAFE Infrastructure Component: Foundational strategies to embed leadership and cultural best practices within the organization. Practices include: safety coordination; accurate and concurrent reporting; facility culture and accountability, and patient and family engagement.

• Clinical Component: Focused on three high-risk drug classes: anticoagulants, diabetic agents, and narcotics, with strategies for assessment, detection, mitigation, therapy, critical thinking and knowledge, and patient and family medication specific education.

• ADE portion of the SAFE Care Road Map

• In-person networking and educational events

• Bi-monthly webinars and pharmacist-hosted virtual “Office Hours”

• 1:1 consultations

Lessons learned• Using proxy measures has been less than ideal for measuring

impact. Based on data gathered from hospitals at the start of the project, MHA knew that many weren’t measuring ADEs, primarily due to data gathering constraints. The goal was to “shine a light” on ADE so that hospitals could begin to understand where their issues were, and then act upon them.

• Biggest strides were seen in INR >5. Anticoagulants have been a National Quality Forum (NQF) goal for several years; that work likely provided a solid foundation to allow more rapid improvement.

• Naloxone use is the newest measure for hospitals to tackle and has remained essentially flat for the duration of the project.

• Moving forward, MHA will be helping hospitals learn to take a deeper dive in studying their ADE data, using both manual processes and automation (e.g., EMR report generation), and thus increase the speed of improvements.

The MHA HEN is committed to making quality and patient safety a top priority. At our facility the HEN work has helped us be more mindful and to look at ADEs and HAIs. It has helped us look at these areas to find where we need improvements so we can offer the safest quality care to all our patients.

— Appleton Area Health Services


Measures/results

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INR9% reduction

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2.5

3.0

3.5

4.0

Q42010

(n=62)

Q12014

(n=73)

Q42013

(n=73)

Q32013

(n=70)

Q22013

(n=65)

Q12013

(n=65)

Q42012(n=0)

Q32012(n=0)

Q22012(n=0)

Q12012

(n=61)

Q42011

(n=60)

Q32011

(n=60)

Q22011

(n=60)

Q12011

(n=60)

Q32014

(n=74)

Q22014

(n=77)

Data starts — 12/1/2010

INR >5 Rate (per 1000 pt days)

40% reduction

No data collected

ADE Advisory Group convened — 2/23/2012

ADE Subgroups convened — 3/1/2012

ADE kick off in person event — 11/29/2012

In person ADE event — 6/24/2014

PFP HEN contract starts — 12/8/2011

Bi-monthly webinars begin — 2/26/2013

Bi-monthly office hours begin — 1/24/2013

3.5

1.6


Catheter-associated urinary tract infectionsTo develop a consistent statewide approach to the prevention of healthcare-associated infections (HAI), including catheter-associated urinary tract infections (CAUTIs), MHA joined forces with Stratis Health, the Minnesota Department of Health (MDH) and the Minnesota Association for Professionals in Infection Control (MN-APIC) to create the Collaborative Healthcare-Associated Infections Network (CHAIN). CHAIN developed a road map of clinical best practices for HAIs with a comprehensive CAUTI gap analysis to help hospitals evaluate prevention capabilities and form an action plan to guide improvement activities. The building blocks of the HAI road map include:

• Hand hygiene

• Transmission precautions

• Injection practices

• Antimicrobial stewardship

• Environmental cleaning



• 7 percent reduction of CAUTI among PPS hospital ICUs

• 51 percent reduction among critical access hospitals

• 73 percent of Minnesota critical access hospitals are enrolled in the National Healthcare Safety Network (NHSN) and reporting CAUTI data

Interventions• Development of HAI Road Map with comprehensive CAUTI gap

analysis

• Inclusion of CAUTI in SAFE Care Road Map for critical access hospitals

• On the CUSP: Stop CAUTI Cohorts 6, 7 and 8 (23 hospitals)

• On the CUSP: Stop CAUTI Buddy Up! (ED and inpatient units) approach for Cohorts 7 and 8.

7% CAUTI reduction among PPS hospital ICUs

51% CAUTI reduction among critical access hospitals


Measures/results

Lessons learned• According to Team Check Up Tool data from Minnesota

hospitals participating in On the CUSP: Stop CAUTI, physician engagement is a significant barrier to implementing CAUTI prevention strategies. This finding was incorporated into our 2015 sustainment plan with increased physician engagement and education strategies.

• CAUTI prevention resource allocation is challenging to secure as a high volume, low severity HAC, but a consistent and persistent message is paying off.

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CAUTI webinar event — 3/16/2013

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CAUTI on the CUSP cohort 7 kick off —12/4/2013

CAUTI7% reduction: PPS

51% reduction: CAH

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4.0 PPS (per 1000 cath days)

CAH (per 1000 pt days)

Safe from HAI & CAUTI gap analysis kick off event— 9/7/2012 CHAIN fall conference

— 9/10/2014

CAUTI on the CUSP cohort 6 kick off — 6/5/2013

CAUTI on the CUSP cohort 8 kick off — 6/4/2014

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3.23

.31

.15


294 central line-associated blood stream infections have been prevented for a

cost savings of $5 million

69% reduction in CLABSI among MN HEN hospitals

Central line-associated blood stream infectionsCentral line-associated bloodstream infections (CLABSI) are serious infections that can result in longer hospital stays, increased costs, and increased risk of death. These infections are among the most deadly types of healthcare-associated infections. The HAI road map developed by the CHAIN collaborative also included a comprehensive central line-associated blood stream infections (CLABSI) gap analysis to help hospitals evaluate prevention capabilities and form an action plan to guide improvement activities. To accelerate improvement, MHA awarded mini-grants to six hospitals to develop and pilot a CLABSI bundle and tool kit in an area of the hospital other than the ICU where central line insertion or maintenance are done frequently, such as the emergency department or infusion therapy. Led by Hennepin County Medical Center, participating hospitals successfully developed the Checking CLABSI insertion, maintenance and monitoring bundles and tool kit and piloted the bundles using rapid cycle improvement methodology.



• Minnesota hospitals maintain CLABSI rates well below national average.

• According to PSI 7, hospitals achieved a 69 percent decrease in CLABSI rates.

Interventions• Development of HAI Road Map with comprehensive CLABSI gap

analysis

• Collection of CLABSI tools and resources on MHA website

• Inclusion of CLABSI in SAFE Care Road Map for critical access hospitals

• Development of Checking CLABSI bundles, a streamlined and succinct approach to CLABSI prevention designed for use both in and outside the ICU; will be incorporated into the CLABSI section of the SAFE Care Road Map in 2015


Measures/results

Lessons learned• MHA’s promotion of the On the CUSP: Stop BSI bundle prior to

Partnership for Patients placed Minnesota hospitals well above average in CLABSI prevention.

• Spread of CLABSI prevention beyond the ICU promotes further improvement.

• Availability of a more comprehensive gap analysis provides a more rigorous CLABSI prevention resource for hospitals that need more rapid improvement.

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CLABSI69% decrease

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1.2

Q42010

(n104)

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(n115)

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(n113)

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(n111)

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(n111)

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(n110)

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(n104)

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(n104)

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(n104)

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(n104)

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(n104)

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(n104)

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(n104)

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(n104)

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(n115)

CHAIN HAI roadmap & CLABSI gap analysis kick off — 9/7/2012

O/E rate

National average

40% reduction

CHAIN CLABSI webinar — 3/5/2014

Checking CLABSI pilot project begins — 7/8/2014

Checking CLABSI

Webinar — 11/20/2014

.47

.14


Injuries from falls and immobilityAccording to the National Center for Injury Prevention and Control, falls are the most common adverse event in hospitals. Using the SAFE from FALLS Road Map, which provides hospitals with resources and best clinical practices to prevent patient falls, Minnesota hospitals have experienced a 21 percent reduction in fall rates and a 33 percent reduction in the rate of falls with injury. Hospitals have prevented 227 injuries from falls for a cost savings of $2.5 million.


Project updates The following represents key highlights of achievements during the past 3 years:

• More than 80 percent of hospitals reporting fall and fall with injury rates

• 21 percent decrease in fall rates

• 33 percent decrease in fall with injury rates

• Development of recommendations and guidelines for new construction, remodeling, and retro-fitting hospital bathrooms and pathways to prevent toileting-related falls

Interventions • Development and implementation of:

• Safe from Falls 2.0 Road Map and Tool Kit• Behavioral Health Falls Gap Analysis and Tool Kit• Anti-thrombotics Gap Analysis and Tool Kit• Innovative model for risk screening, risk assessment and

linked interventions customized to individual patients

227 fewer injuries from falls for a

cost savings of $2.5 million

1,359 fewer patients experienced a fall not resulting in injury

33% reduction in falls with injury


Measures/results

Lessons learned• The risk factors that increase a patient’s risk for injury if a fall does

occur are as important to understand and address as fall risk factors.

• Identification and mitigation of risk factors cannot rely solely on a risk score with a “one size fits all” approach to fall prevention interventions.

• If toileting-related falls continue to contribute to approximately 40 percent of inpatient falls, we need to find new and innovative approaches to address this issue and keep patients safe when toileting.

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(n=54)

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(n=97)

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(n=98)

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(n=93)

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(n=89)

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(n=98)

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(n=65)

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(n=64)

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(n=53)

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(n=60)

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(n=57)

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(n=52)

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(n=49)

Q12011

(n=51)

Q32014

(n=90)

Q22014

(n=95)

Partnership for Patients data starts — 12/1/2010

Falls and falls with injury21% reduction in falls

33% reduction in falls with injury

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FALLS

FALLS W/INJURY

Safe from Falls 2.0 kick-off — 2/1/2011

Regional meetings - increased focus on fall injury — 6/1/2012

Individual risk factor algorithm disseminated — 10/1/2012

Fall injury safety alert — 6/1/2012

Anti-thrombosis gap analysis disseminated — 5/1/2014

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40% Reduction FALLS

40% Reduction FALLS W/INJURY

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2.8.61

.41


Obstetrical adverse events, including early elective deliveryMinnesota hospitals have placed a strong focus on eliminating early elective deliveries and have reduced the number of elective deliveries prior to 39 weeks gestation by 94 percent. Of the 115 hospitals in the MHA HEN, 86 provide obstetrical services with approximately 46,000 deliveries per year. Nearly all (85 of 86) birthing hospitals have adopted a hard stop policy, as required by law, restricting inductions prior to 39 weeks unless medically necessary. These 85 hospitals account for 99.81 percent of deliveries in Minnesota. The final hospital is awaiting approval of its policy by the Minnesota Department of Human Services.

In addition to working toward zero early elective deliveries in Minnesota, hospitals have made good progress improving other obstetrical adverse events. Both on site in-situ training and simulation training educational opportunities offer obstetrical hemorrhage emergency training as well as early recognition, diagnosis, treatment and management of preeclampsia. The MHA Perinatal Safety Road Map includes best practices for managing hypertension and postpartum hemorrhage emergencies.

Hospitals participating: See Appendix A: Table 1 for a list of participating hospitals.


• 94 percent reduction of early elective deliveries

• 85 of 86 HEN birthing hospitals implemented hard stop policy

• Strengthened hospital partnership with the March of Dimes in support of the Healthy Babies are Worth the Wait campaign

• As of Q2 2014, Road Map adoption at 85 percent for the state

Interventions • Simulation Training

• Perinatal Safety Road Map that includes patient education/nurse training on key areas to prevent adverse events, including standardization of the management of oxytocin and use of vacuum extractors for operative vaginal deliveries.

• Benchmarking – peer group and statewide via an OB data dashboard with WAOS score, PSI 17, 18, 19, EED, preeclampsia and hemorrhage rates.

94% reduction in elective deliveries <39 weeks

1,752 early elective

deliveries have been avoided in Minnesota hospitals since 2010

98% of HEN birthing hospitals have

implemented a hard stop policy


Measures/results

Lessons learned• Having a ‘perfect storm’ of clinical guidance, focused attention,

legislative and payment reform made the reduction of non-medically indicated early elective deliveries a success.

• The Partnership for Patients work has brought a new focus to data in obstetrics care in Minnesota

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Early elective deliveries94% decrease

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(n=66)

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(n=71)

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(n=71)

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(n=71)

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(n=72)

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(n=74)

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Q22012

(n=50)

Q12012

(n=51)

Q42011

(n=45)

Q32011

(n=45)

Q22011

(n=44)

Q12011

(n=44)


EED40% reduction

Q22014

(n=67)

Convene Perinatal Advisory Group — 1/1/2011

Kick off perinatal safety work and release roapmap — 12/4/2011

Evidence-based perinatal program law goes into effect — 1/1/2012

Simulation training begins— 1/8/2013

MHA partners with March of Dimes for Healthy Babies Are Worth the Wait Campaign banners — 6/6/2013

MHA releases OB data summaries

208

11


Pressure UlcersSince 2007, hospitals in Minnesota have been participating in the SAFE SKIN Road Map that provides hospitals with best clinical practices to prevent pressure ulcers. The MHA HEN sought to drive down the incidence of pressure ulcers even further through the development of SAFE SKIN 2.0, which provides best practice recommendations for the operating room and preventing device-related pressure ulcers. In addition, a focused SAFE SKIN in the ICU campaign provides guidance to hospitals to prevent pressure ulcers in complex and critically ill patients.



• More than 80 percent of hospitals are reporting concurrent pressure ulcer rates (real-time vs. quarterly P&I rates)

• 54 percent decrease in pressure ulcer rates (Stages II, III, IV and unstageable) based on concurrent reporting

• 26 percent increase in implementation of SAFE SKIN 2.0 to a current rate of 94 percent of best practices in place across hospitals

Interventions • Development and implementation of:

• Safe Skin 2.0 Roadmap and Tool Kit• Cervical Collar Gap Analysis and Tool Kit• Respiratory Device Gap Analysis and Tool Kit• Operating Room Gap Analysis and Tool Kit• ICU campaign for preventing pressure ulcer in complex

patients

Lessons learned• Device-related pressure ulcers account for approximately 40

percent of Stage III, IV, and unstageable pressure ulcers. A multi-disciplinary team needs to be involved in prevention related to devices.

• Unstageable pressure ulcers account for a significant percentage of serious pressure ulcers (70 percent on average) and device-related pressure ulcers and should be included in pressure ulcer rates and prevention activities.

1,008 fewer patients developed a

pressure ulcer for a cost savings of more than $2.2 million

54% reduction in stage II – unstageable pressure ulcers


• Even though device-related pressure ulcers account for a high percentage of pressure ulcers, pressure ulcers that develop on the coccyx and sacrum continue to account for the highest number of pressure ulcers and work needs to continue to understand and implement effective strategies for repositioning medically complex patients. Promising strategies include: micro-shifting, proactive placement on appropriate support surfaces, and collaboration with physicians to identify patients that truly cannot be repositioned with daily re-assessment vs. assuming critically ill patients cannot be repositioned to some degree.

Measures/results

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

Device-related PU best practices disseminated — 10/1/2010

Pressure ulcers54% decrease

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Q42010

(n=21)

Q12014

(n=92)

Q42013

(n=88)

Q32013

(n=83)

Q22013

(n=75)

Q12013

(n=83)

Q42012

(n=45)

Q32012

(n=42)

Q22012

(n=32)

Q12012

(n=36)

Q42011

(n=28)

Q32011

(n=26)

Q22011

(n=22)

Q12011

(n=23)

Q32014

(n=84)

Q22014

(n=91)


SAFE SKIN 2.0 kick-off — 2/1/2011

ICU campaign — 3/1/2012

PU regional meetings — 4/1/2012

Micro-training education — 8/1/2013

Complex patients education — 2/1/2014

Rate (per 1000 pt days)

40% reduction

.73

.33


Surgical site infectionsSurgical site infections are the most common and most costly healthcare-associated infection with at least 160,000 occurring each year in the U.S. To address this serious infection, the HAI road map developed by the CHAIN collaborative also included a comprehensive surgical site infection (SSI) gap analysis to help hospitals evaluate prevention capabilities and form an action plan to guide improvement activities. To accelerate improvement, MHA awarded mini-grants to six hospitals to develop and pilot the Slashing SSI bundle and tool kit using rapid cycle improvement methodology. The bundle is a succinct approach to SSI prevention for all surgeries performed in the operating room involving skin incision. The bundle will be incorporated into the SAFE Care Road Map in 2015.



• 44 percent decrease in abdominal hysterectomy SSI

• Established SSI reporting for CAH on the MHA data portal with 42 percent of CAH reporting

• 8 percent decrease in CAH SSI

• Continuing Medical Education (CME)-approved Slashing SSI webinar in October 2014 was promoted widely to surgeons in partnership with MMIC, with over 300 participants.

Interventions • Development of HAI Road Map with comprehensive SSI gap

analysis

• Collection of SSI tools and resources on MHA website

• Development of SSI section of SAFE Care Road Map

• Analysis of 64 abdominal hysterectomy SSI cases reported to NHSN in coordination with several Minnesota hospitals

• Development of Slashing SSI bundles, a streamlined and succinct approach to SSI prevention for all surgeries involving a skin incision and performed in the OR, that will be incorporated into the SSI section of the SAFE Care Road Map in 2015

44% reduction in SSI related to abdominal hysterectomy

8% reduction in SSI among critical access hospitals


Measures/results

Lessons learned• Where there is not definitive evidence related to individual SSI

prevention strategies, bundled care approaches combining evidence-based and theoretically sound interventions have proven successful.

• Widening the scope of the SSI bundle to all surgeries performed in the operating room involving a skin incision provides a performance improvement tool useful to hospitals of all sizes.

• Surgeon engagement is a critical component to SSI prevention.

Q12014

Q42013

Q32013

Q22013

Q12013

Q42012

Q32012

Q32014

Q22014

Q42014

CHAIN HAI roadmap & SSI gap analysis kick off — 9/7/2012

CHAIN SSI webinar — 12/11/13

CHAIN SSI subgroup convened — 7/23/2013

SSI AH analysis completed — 12/31/2013

CHAIN SSI subgroup meeting with MN surgeons — 3/5/2014

Slashing SSI bundle introduced at CHAIN Fall Conference — 9/10/2014

Slashing SSI bundle kick off webinar — 10/14/2014

Surgical site infections (SSI)

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0 PPS HYST SIR

PPS COLO SIR

CAH (per 1000 pt days)

1.5

.84 .94

.76

1.0

.89


Venous thromboembolismEach year, there are more than 30 million surgeries performed in the U.S. and venous thromboembolisms (blood clots) are one of the most common postoperative complication. While postoperative venous thromboembolisms (VTE) are considered a hospital-acquired condition, they can often be prevented by following a few evidence-based guidelines.

In consultation with some of the leading experts on preventing VTE, the MHA HEN incorporated into the Adverse Drug Events road map evidence-based practices to increase the number of surgical patients who receive appropriate VTE prophylaxis within 24 hours prior to surgery to 24 hours after surgery. The MHA HEN also developed a VTE prevention strategies gap analysis that guides hospitals through key elements of VTE prevention, including:

• Patient and family engagement strategies

• Assessment and prevention strategies

• Implementation of defined therapeutic strategies

• Mitigation strategies

• Critical thinking and knowledge strategies

Hospitals participating See Appendix A: Table 1 for a list of participating hospitals.


• Prevention of 160 VTEs for a cost savings of $3.5 million

• Minnesota hospitals maintain VTE rates well below national average

• 15 percent decrease in VTE rates according to PSI 12

Interventions• Development of VTE gap analysis

• Collection of VTE tools and resources on MHA website

15% reduction of venous thromboembolisms

Prevented 160 venous thromboembolisms

for a cost savings of $3.5 million


Measures/results

Lessons learned• Minnesota hospitals have been working on VTE for a number of

years and the state average was already significantly below the national average.

• Alignment of VTE work with other ADE work helped hospitals streamline efforts.

• For those hospitals struggling with VTE, 1:1 calls were a helpful intervention option.

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

VTE

0.2

0.4

0.6

0.8

1.0

1.2

Q42010

(n104)

Q12014

(n114)

Q42013

(n113)

Q32013

(n110)

Q22013

(n110)

Q12013

(n110)

Q42012

(n104)

Q32012

(n104)

Q22012

(n104)

Q12012

(n104)

Q42011

(n104)

Q32011

(n104)

Q22011

(n104)

Q12011

(n104)

Q22014

(n114)

O/E rate

National average

40% reduction

15% decrease

.82

.70


Ventilator-associated eventsMechanical ventilation is an essential, life-saving therapy for patients with critical illness and respiratory failure. Studies have estimated that more than 300,000 patients receive mechanical ventilation in the U.S. each year. These patients are at high risk for complications. To address this serious infection, the HAI road map developed by the CHAIN collaborative also included a comprehensive ventilator-associated event (VAE) gap analysis to help hospitals evaluate prevention capabilities and form an action plan to guide improvement activities. To accelerate improvement, MHA awarded mini-grants to six hospitals to develop and pilot the Vanishing VAE bundle using rapid cycle improvement methodology. The bundle is a succinct approach to VAE prevention for hospitals of all sizes. The bundle will be incorporated into the SAFE Care Road Map in 2015.

Hospitals ParticipatingSee Appendix A: Table 1 for a list of participating hospitals.


• 23 percent decrease in VAE reported to NHSN

• Established VAE reporting on the MHA portal for CAH

Interventions and tests of change • Development of HAI Road Map with comprehensive VAE gap

analysis

• Collection of VAE tools and resources on MHA website

• Development of VAE section of SAFE Care Road Map

• Development of Vanishing VAE bundle, a streamlined and succinct approach to VAE prevention for hospitals of all sizes that will be incorporated into the SAFE Care Road Map in 2015

23% decrease in ventilator-associated events reported to NHSN

43 VAP events prevented

for a cost savings of $903,000


Measures/results

Lessons learned• Promotion of the IHI VAP bundle prior to Partnership for Patients

positioned Minnesota hospitals well for VAE prevention.

• Engagement of ICU intensivists and respiratory therapists has been a successful approach to designing and promoting an updated Vanishing VAE bundle for Minnesota hospitals of all sizes.

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

VAE23% decrease

0.5

1.0

1.5

2.0

2.5

3.0

Q42013

(n=38)

Q32013

(n=38)

Q22013

(n=38)

Q12013

(n=38)

Q42012(n=37

Q32012

(n=37)

Q22012

(n=37)

Q12012

(n=37)

Rate (per 1000 device days)40% reduction

2.1

1.6


ReadmissionsEach year in the U.S., unplanned readmissions cost Medicare $17.5 billion. In Minnesota, nearly one in five Medicare patients is readmitted within 30 days. To meet the Partnership for Patients goal of reducing preventable readmissions by 20 percent by the end of 2014, MHA partnered with the Institute for Clinical Systems Improvement and Stratis Health to form the RARE Campaign—Reducing Avoidable Readmissions Effectively. The RARE Campaign focuses on five key areas that if if not managed well, are known to be main contributors to avoidable hospital readmissions:

1. Comprehensive discharge planning2. Medication management3. Patient and family engagement4. Transition care support5. Transition communications

The RARE work centers around three primary interventions: Care Transitions Intervention, Project RED (ReEngineered Discharge) and the SAFE Transitions of Care Road Map.

Hospitals participating See Appendix A: Table 1 for a list of participating hospitals.


• 35,000 more nights of sleep at home for Minnesotans • 19 percent reduction in Potentially Preventable Readmissions

(PPR)• 8,773 avoided readmissions

Interventions • RARE Campaign

• Care Transitions Intervention (CTI)• Project RED• SAFE Transitions of Care Road Map

Lessons learned• Having a ‘perfect storm’ of clinical guidance, focused attention,

strategic community partnerships, legislative and payment reform made the reduction of readmissions possible.

• Partnerships• The RARE Campaign developed a framework that included

organizational assessments, gap analysis, a website, data

19% reduction in Potentially Preventable Readmissions

8,773

readmissions prevented

35,000

more nights of sleep at home for Minnesotans


reporting, webinars, materials, learning sessions, coaching, and relevant programming offerings such as the three learning collaboratives: Care Transitions Intervention®, Project RED, and SAFE Transitions of Care. This allowed the organizations to utilize already-developed resources while gathering them under the umbrella of one name. The three operating partners have involved their broad networks and connections with this campaign, bringing in a large variety of providers, agencies, and community organizations to provide education and endorsement of the campaign.

• Multiple interventions: Combinations of activities• The same depth of information across hospitals was highly

variable for activities and interventions. However, it was still of interest to qualitatively examine any trends or themes in interventions that might also be connected to success in reducing readmissions. To explore this, quarterly progress reports and interventions were pulled from the top-performing hospitals by PPR data. While these hospitals reported a range of readmissions-related interventions, they most frequently reported the following focus areas in combination: care coordination across the continuum and the community and clinic-hospital partnership.

Measures/results

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

CTI training — 6/18/2014

Readmissions19% decrease

.65

.7

.75

.8

.85

.9

.95

1.0

Q12014

(n=92)

Q42013

(n=88)

Q32013

(n=83)

Q22013

(n=75)

Q12013

(n=83)

Q42012

(n=45)

Q32012

(n=42)

Q22012

(n=32)

Q12012

(n=36)

201120102009 Q32014

(n=84)

Q22014

(n=91)

In person learning day — 6/17/2014

Mental helath mid-point meeting — 10/14/2014

In person learning day — 11/1/2013In person

learning day — 4/1/2013


Rate

40% reduction

Mental Health Collaborative kick off — 2/25/2013

Safe Tranisitions of Care Roadmap launched — 10/1/2009

PPR data baseline 12/1/2008

RARE Campaign planning started — 11/3/2009


Project Red training — 10/1/2010

CTI Training — 10/21/2010

Campaign kick off — 11/10/2010

In person learining day — 11/1/2010




.98

.81


Cost Savings associated with HEN-level harm reductionThe MHA HEN estimates that the 115 participating hospitals prevented more than 13,000 patients from being harmed and saved more than $93 million. This calculation includes the following topic area savings:

Hospital-acquired condition Number of patient harm prevented . SavingsFalls ...................................1,359 ....................................... $ 124,991Falls with injury ..................227 .......................................... $ 2,564,616Pressure ulcers ..................1,008 ....................................... $ 2,260,196Early elective deliveries .....1,752 ....................................... $ 1,374,422CLABSI ..............................294 .......................................... $ 5,003,684VTE ....................................160 .......................................... $ 3,555,100Readmissions ....................8,773 ....................................... $ 77,273,230VAP ....................................43............................................ $ 903,000TOTAL ...............................13,616 ..................................... $ 93,059,239

The HEN work began December

2011. The rate before HEN work began was 2.67. Since Q3 2012 the rate is 1.68, a decrease of

37 percent.

37%Minnesota Harm Across the Board

Q42010

Q12011

Q22011

Q32011

Q42011

Q12012

Q22012

Q32012

Q42012

Q12013

Q22013

Q32013

Q42013

Q12014

Q22014

Q42014

3.0

2.5

2.0

1.5

1.0

0.5

0.0

80

70

60

50

40

30

20

20

Rat

e

Aver

age

# ho

spita

ls re

port

ing

Reporting a single rate per 1,000 discharges is not feasible since varying denominators were reported. The HAC rate is calculated per 1,000 denominator units. Units include patient days, surgeries, or instrument days, where applicable.

Baseline Q4 2010 - Q4 2011

Improvement Q1 2012 -Q4 2014

There are many of us that wear multiple hats within our organization and having the HEN be the organizing force behind the patient safety programs makes it feasible for us to accomplish what is best for patient safety.

— CentraCare Health-Paynesville

Minnesota harm across the board


Patient and family engagement (PFE)MHA recognizes the importance of including patients and families as part of the care team and on committees and boards. In an effort to help Minnesota hospitals improve engagement of patients and families, MHA has formed a Patient and Family Advisory Committee (PFAC), which began meeting in June 2013. The PFAC is comprised of patients, patient advisors and a representative from Weber Shandwick; the committee’s purpose is to provide recommendations and help to oversee the PFE work on a statewide level. Additionally, MHA has a patient and family engagement advisor who serves as chair of the PFE advisory committee. The PFE advisor has contacted hospitals to evaluate and educate hospitals on patient and family engagement and the PFE five best practice criteria. To date, 57 percent HEN hospitals have implemented three or more of the best practices.

Measures/results• In the past year, the number of hospitals that have implemented

P2 increased from 39 percent to 60 percent.

• In the past year, the number of hospitals that have implemented P3 increased from 21 percent to 48 percent. A plan is being implemented to increase participation to 100 percent by 2015.

• The number of hospitals meeting all five criteria has increased from 3 to 10.

Interventions• CMS PFE 1-5 scoring criteria

• Patient and family engagement education session with Sue Collier and patient

• Patient education video under development

• MHA Patient and Family Advisory Council

• PFE Patient advisor• Provides MHA Partnership for Patients (PfP) staff and

members expertise and guidance to engage patients and families

• Incorporates learnings from conferences and webinars• Amplifies PFE as a regional education topic• Conducts 1:1 consults with HEN hospitals

Lessons learned • Health care workers have been trained for many years to take

care of patients, to do to and for them. We are asking them to completely transform their thinking to partner with patients and

Over 100%

increase in hospitals with a PFE advisor (21% to 48%)

57% of hospitals have implemented three or more PFE best practices:P1: Prior to admission, hospital staff provides and discusses with every patient that has a scheduled admission, allowing questions or comments from the patient or family, a planning checklist that is similar to CMS’s Discharge Planning Checklist.

P2: Hospital conducts shift change huddles and does bedside reporting with patients and family members in all feasible cases.

P3: Hospital has a dedicated person or functional area that is proactively responsible for patient and family engagement and systematically evaluates patient and family engagement activities.

P4: Hospital has an active Patient and Family Engagement Committee OR at least one former patient that serves on a patient safety or quality improvement committee or team.

P5: Hospital has at least one or more patient(s) who serve on a governing or leadership board and serves as a patient representative.


families to create, implement and manage health care. This is a process. Each hospital is at a unique place in that process.

• Implementation of PFE cannot be a “one size fits all” approach. Hospitals are finding more success if they consider their community needs and unique characteristics as they make this critical transition.

• There are many effective tools, resources and videos available for PFE implementation, but hospitals seem to struggle with the foundation of PFE and need coaching prior to capitalizing on the resources.

• One of the biggest barriers to effective PFE is when a hospital already thinks it is doing it when it is not. The transformational thinking does not occur via tool kits, checklist and reports.

• Multiple health care workers are expressing that they truly believed they knew what PFE was until they attended an IPFCC conference, heard a patient story, participated in a 1:1 PFE consult or listened to webinars that included the patient perspective.

• Hospitals may have had a negative experience with a patient story and are fearful about moving in that direction again.

• Champion doctors can support the culture change by being early adopters of the PFE strategies that can include shared decision making, rounding at the bedside, and much more.

• Leadership support and buy-in is critical to success.

• Hospitals are open to new ideas and have been energized by innovative approaches to the PFE work and there is a great desire to do something that brings health care back to the heart of what they do.

• Initially, hospitals tended to make their dedicated staff person the quality manager. Now, hospitals are using a wide range of professionals to drive this critical work. The most important characteristic of the dedicated staff is a passion for patients and families and a desire to include them in everything that the hospitals do.

• The lack of data attributing PFE to outcomes is a barrier.

• Hospitals have been more receptive when given guidelines/best practices and inspired to craft patient and family advisory councils and other PFE interventions unique to their communities and hospitals.


Physician and leadership engagementLeadership support is critical to moving the needle on patient safety and quality across the organization. The MHA HEN enjoys strong support from the MHA Board of Directors, which has exercised bold action to commit to patient safety. Since 2000, MHA’s strategic plan has included patient safety and quality improvement as a top priority. Hospitals have made great strides in this area, and 63 percent of MHA HEN hospitals have implemented all four best practices for engaging leadership and 76 percent of hospitals have implemented at least three (see box for criteria). In partnership with its member hospitals, MHA HEN is working to identify, develop and facilitate strategies to further engage physicians and executive leaders to improve patient safety and quality of care.

Interventions• Collaborate with MHA’s education department to provide

continuing education

• MHA Physician Leadership Council serves as an advisory group and sounding board for physician engagement

• MHA President CEO is actively recruiting a physician to join the organization

• Employee Safety hospitals are engaging leadership and physicians with the WISER training through Duke University Health System and Dr. Bryan Sexton

• Physician advisor:• Provides MHA Partnership for Patients staff with expertise

and guidance on addressing culture primarily focusing on engaging physicians, leaders and teams

• Serves as a resource for members through group training/education and resources

• Provides 1:1 consultations

Lessons learned• Engaging physicians to address a safety culture is foundational

• Physician to physician is required for credibility

63% of hospitals have all four leadership criteria in place

76% of hospitals have at least 3 best leadership criteria in place:

L1 Hospital has regular quality review aligned with the Partnership for Patients goals.

L2 Hospital has a public commitment to safety improvement with transparency in sharing more than CORE measurement data with the public.

L3 Hospital staff, all or nearly all, have a role or perceived goal in patient safety (e.g., can be explicit in HR goals or a group bonus based on a patient safety target).

L4 Hospital board of trustees has a quality committee established with regular review of patient safety data, including review and analysis of risk events.


Severe sepsis and septic shockMentor hospitals• Avera, Sioux Falls, SD (mentoring health system)

• Ridgeview Medical Center, Waconia (M)

• St. Cloud Hospital (M)

See Appendix A: Table 2 for a list of participating hospitals.

Interventions • A Seeing Sepsis tool kit based on the Surviving Sepsis Campaign

Bundle was developed, piloted and disseminated to Minnesota hospitals, which includes:

• Sepsis screening tool• Severe sepsis/septic shock screening tool• Algorithm to streamline detection and treatment processes• Transfer tool for the ED and Med-Surg Unit and for critical

access hospitals• Sepsis order sets• Documentation and coding tool• Sepsis simulation tools for critical access hospitals • Staff education videos in 3- 5 minute segments to allow

tailoring content to audience

• A Seeing Sepsis CME-approved physician simulcast was provided before the roll out to hospitals to stimulate physician leadership in early detection and treatment of sepsis. The Seeing Sepsis Tool Kit was shared at the Minnesota Academy of Family Practitioners 2014 Spring Conference as an exhibit, and a Seeing Sepsis mentor hospital physician will provide a presentation at the same event in 2015. An article on Seeing Sepsis was published in “Minnesota Physician” in May 2014.

• A hardcopy folder of the Seeing Sepsis Tool Kit was mailed to HEN hospitals leads and an electronic copy was posted on the MHA website.

• On April 2nd MHA hosted the Seeing Sepsis kick-off to roll out the sepsis Tool Kit to all MHA HEN hospitals. 25 non-LEAPT hospitals, seven LEAPT hospitals and more than 75 nurses, infection preventionists, pharmacists and physicians attended the kick-off.

• The Seeing Sepsis tool kit has been adapted for long term care, and shared with the Minnesota Department of Health (MDH), Stratis Health, Minnesota Homes and Housing for the Aged (MHHA), Care Providers of Minnesota, and at the Minnesota Directors of Nursing Association annual conference.

6% reduction in mortality related to sepsis in LEAPT hospitals

26% increase in lactate/blood culture ratio among hospitals submitting data to the MHA portal

11% decrease in hospital length of stay


• Sepsis early detection and treatment has been incorporated into CALS curriculum, and LEAPT sepsis mentor hospitals are working with EMS agencies and the Minnesota Time Critical Care Emergency Council.

• The Seeing Sepsis Tool Kit has been shared nationally on Partnership for Patients pacing events and with at least three other HENS on individual calls or learning events.

Measures/results

Lessons learned• Physician engagement is a key component to successful adoption

of sepsis early detection and treatment protocols.

• Establishing criteria for electronic medical record alerts for early detection of sepsis has been a challenge due to the tendency for over-triggering using SIRS criteria alone. One mentor hospital sepsis team has tested a set of criteria that they feel is very close as we finalize the project.

• Established sepsis order sets easily accessible to physicians improve compliance with the sepsis early detection and treatment protocols.

(See Appendix B: Figures 1 and 2)

In-hospital mortality rate among patients with severe sepsis and septic shock diagnosis for LEAPT sepsis hospitals

(Data source: hospital-reported claims based data using ICD9 codes 785.52 and 995.92)

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

10%

20%

30%

40%

50%

60%

Apr.2013

Apr.2014

Mar.2014

Feb.2014

Jan.2014

Dec. 2013

Nov. 2013

Oct.2013

Sep.2013

Aug.2013

Jul.2013

Jun.2013

May2013

May2014

(n=73)

Jul.2014

(n=74)

Jun.2014

(n=77)

The toolkits and conference calls are invaluable. The opportunity to network with other facilities to share things that have worked at their facilities has helped us move forward with implementing the initiatives.

— Glencoe Regional Health Services

23%

22%


Clostridium difficile infection (CDI)Mentor hospitals participating• Park Nicollet Methodist Hospital, Saint Louis Park (M)

• United Hospital, part of Allina Health, Saint Paul (M)

• University of Minnesota Medical Center, Minneapolis (M)

See Appendix A: Table 2 for a list of participating hospitals.

InterventionsControlling CDI Human Factors Approach to Hand Hygiene tool kit• Canadian Patient Safety Institute Human Factors Approach to

Hand Hygiene tool kit

• Additions and changes that mentor hospitals felt would be easier and more effective to use in Minnesota hospitals.

• Popular “Sticker Placement Activity” that has been successful in engaging staff, physicians and patients

• World Health Organization Hand Hygiene Staff Survey

• Modifications for questions pertaining to human factors approach to hand hygiene.

• Inclusion of questions to identify barriers and facilitators to hand hygiene compliance.

• Controlling CDI Hand Hygiene tool kit materials were sent in hardcopy form to all MHA HEN hospitals and the tool kit is available on the MHA website.

• MHA hosted a 5-webinar kick-off lunch series on the Hand Hygiene tool kit in May 2014

• Webinar 1: Anjum Chagpar presented on the Human Factors Approach to Hand Hygiene. Chagpar is a Systems Design and Clinical Engineer with the Centre for Global eHealth Innovation at the University of Toronto Health Network.

• Webinar 2: Hand Hygiene Auditing

• Webinar 3: Staff Perceptions Survey

• Webinar 4: Sticker Placement Activity and the Environmental Assessment Tool

• Webinar 5: Performance Improvement Tools

• “Approach and Coach” video added to tool kit on website, provided by Abbott Northwestern Hospital to assist with staff education on reminding peers to perform hand hygiene.

• “Five rules for hand hygiene auditing” teaching sheet has been added to the tool kit on the MHA website, provided by United Hospital to assist with staff education on hand hygiene monitoring.

14% decrease in CDI rates among LEAPT hospitals

52% improvement in high touch surface cleaning


Controlling CDI Environmental Services Cleaning Training and Monitoring tool kit• Allina Health – United Hospital’s Environmental Services Cleaning

education and monitoring program

• Complete curriculum for new staff orientation/training and annual refresher training

• Includes a UV Gel cleaning monitoring protocol and education tools

• Association for the Healthcare Environment top-bottom room cleaning videos for environmental services cleaning staff education

• Adapted resources to address language barriers and disparities for educating staff where English is not a first language.

• “Not Just a Maid” video shared on MHA website to foster relationships between nursing staff and environmental services staff

• Newly added OR and ED cleaning education and monitoring tools

• MHA hosted a simulcast to kick off the Environmental Services tool kit in June 2014

• Dr. Philip Carling from the Steward Health Care System in Boston presented on CDI best practices in environmental cleaning for the Controlling CDI Environmental Cleaning Kick-off in June.

• LEAPT mentor and exploratory hospitals presented the components of the tool kit

• An electronic version of the tool kit with webinar recordings of the presentations is on the MHA website.

• Environmental Services Cleaning resources for OR and ED are in preparation for publication on MHA website

Lessons learned• The hospitals identified that conducting the Sticker Placement

Activity before the CPSI Environmental Tool allowed for the analysis of both the sticker placement and environmental tool at the same time and allows for changes to be made more efficiently in the hospital.

• Staff surveys in LEAPT hospitals revealed that most staff prefer to be given hand hygiene reminders by peers. “Approach and Coach” video helps empower staff to provide these reminders.

• Post tests were amended to comply with Health Literacy standards to accommodate the large number of Environmental Cleaning staff that use English as a second language.

• Patient satisfaction ratings have been observed to improve in conjunction with the Controlling CDI Environmental Services Cleaning Training.

• Creating opportunities to converse with physicians related to hand hygiene and invite their input into placement of products, etc. has improved physician engagement.

Through Controlling CDI, the facility transformed its environmental cleaning service to include training and quality measures that will be an on-going asset to the hospital for infection prevention. Increasing awareness and compliance with hand hygiene through this project while using and helping to refine the tools provided will help us to continually strive to achieve those best practices for preventing HAI. MHA is to be commended for the way they have drawn resources from the hospitals under their influence and given them a framework for creativity, problem solving and organizational adjuncts to improve patient care and safety.

— Minnesota Valley Health Center


• Creativity and enthusiasm in engaging staff enhances buy in.

• Training for hand hygiene auditors Hand hygiene and EVS monitoring data is more meaningful when auditors are trained.

• The Controlling CDI Hand Hygiene tools are applicable in many settings of health care and other types of equipment and supplies.

• The Controlling CDI Environmental Services Cleaning and Monitoring tool kit is readily applied to other settings of care such as long term care, and has been adapted for use in the OR and ED.

Measures/results

Rate of CDI (per 10,000 patient days) among LEAPT CDI hospitals

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

2

4

6

8

10

Base- line

(n=5)

Sep.2014 (n=5)

Aug.2014 (n=6)

Jul.2014(n=6)

Jun.2014(n=7)

May. 2014(n=6)

Apr. 2014 (n=6)

Mar.2014(n=7)

Feb.2014(n=7)

Jan.2014(n=7)

Dec.2013(n=6)

Nov.2013(n=6)

Oct.2013(n=6)

12

14

16

8.4

7.2


DeliriumExploratory hospitals participating See Appendix A: Table 2 for a list of participating hospitals.

Interventions• MHA’s Delirium Detection, Prevention and Management Road

Map and Tool Kit provides a comprehensive set of best practices and tools that incorporates research and learnings from national and local efforts.

• The roadmap includes foundational strategies to embed best practices within the organization. Practices include: safety coordination; accurate and concurrent reporting; facility expectations, staff education and accountability; and engagement of patients and families.

• The roadmap incorporates and streamlines delirium identification, intervention and management strategies from a number of different sources to address delirium across inpatient and outpatient settings.

• An algorithm outlining the process from initial delirium screening for older adult patients through assessment, diagnosis and intervention.

• A bundle of practices for “not perpetuating delirium” in the emergency department.

Lessons learned• The rate of antihistamine and benzodiazepine use for both the

elderly population and patients that have been diagnosed with delirium is surprisingly high. There are significant opportunities to reduce the use of these medications.

• Education and strong intervention strategies are needed on pharmacological management of patients with delirium or at-risk for delirium. A guiding set of principles for pharmacological management of patients with behaviors related to delirium, as well as an algorithm, have been developed and are being used in the hospitals.

• Debate continues on the use of delirium screening due to: 1) Reliability in the use of the CAM tool continues to be low; 2) Interventions that have been identified to prevent delirium are proving to be interventions that should be put in place for all older adult patients; all ICU patients; 3) Knowing a patient is at higher risk for delirium does not significantly change these identified interventions: and 4) Medications do not treat delirium – the focus for medications is appropriate use of medications that perpetuate delirium and appropriate use of medications to treat behaviors such as agitation.

6% decrease in rate of iatrogenic delirium.

10% decrease in rate of benzodiazepines and antihistamines given to patients in the at-risk population.

31% decrease in rate of benzodiazapines and antihistamines given to delirious patients.


• Continued trialing of different methods of tracking delirium outcomes is needed.

Measures/results

Rate of benzodiazapines and antihistamines given to delirious patients

(per 100 discharges)

10

20

30

40

50

60

70

Jan.2014(n=3)

Sep. 2014(n=4)

Aug. 2014 (n=4)

Jul.2014(n=3)

Jun.2014(n=3)

May2014(n=4)

Apr.2013(n=4)

Mar.2014(n=4)

Feb.2014(n=4)

80

Rate of delirium incidence in older adults (per 100 discharged)

1

2

3

4

5

6

7

Jan.2014(n=3)

Sep. 2014(n=4)

Aug. 2014 (n=4)

Jul.2014(n=3)

Jun.2014(n=3)

May2014(n=4)

Apr.2013(n=4)

Mar.2014(n=4)

Feb.2014(n=4)

8

64.7

44.4

6.96.5


Employee SafetyHospitals participating See Appendix A: Table 2 for a list of participating hospitals.

Project updatesThe following represents key highlights of achievements:

• Resiliency training through Duke University• MHA LEAPT hospitals are looking at employee resilience as

a method of measuring incidence of harm, which is typically a difficult measure to capture.

• LEAPT hospitals found the resilience training to be incredibly beneficial in providing opportunities to improve safety culture for employees, decrease burn out, and improve focus and clarity for care of their patients.

• Blood and body fluid exposure injuries are often related to employees not anticipating the event

• Underreporting of workplace violence incidents is a huge barrier to change – this is a cultural shift. Leadership must stress the importance of reporting workplace violence incidents, and ensure that staff feel safe and empowered to do so.

• How hospitals have been aligning this work with other initiatives:• Organizational meetings: sharing employee safety stories,

along with patient safety stories • Encouraging increasing incident reporting: more is better• Infection prevention: hand-washing• Targeting improvement goals related to AHRQ survey

results: teamwork within and across units, administrative transparency, supervisor expectations for safety

Interventions • Development of Workplace Violence Prevention Road Map with

associated tools and resources• Developed in partnership with Minnesota Department of

Health, Minnesota Nurses Association, Minnesota Medical Association and many other stakeholders

• Provides a comprehensive set of best practices and tools that incorporates research and learnings from national and local efforts.

• Includes foundational strategies to embed best practices within the organization. Practices include: safety coordination; accurate and concurrent reporting; facility culture and accountability, and staff education. Additionally, the road map includes gap analyses for risk identification; linked interventions; incidence response; and learning from events.

17.6% decrease in OSHA TRIR rates

15.8% decrease in DART rates. This decrease represents $156,000 savings


• Development of employee safety tools and resources on MHA website

• Employee slips, trips and falls• Blood and body fluid exposure• Safe patient handling

• Development of measures to help track employee safety

• Resiliency training through Duke University

Lessons learned • Hospitals have found the measures useful:

• Very helpful to look at trends over time vs. a snapshot in time (monthly/quarterly/annually)

• Sharing data within the organization has been useful in bridging departmental silos

• Hospitals are looking at future measures to further evaluate employee safety and resiliency/burnout: Staff turnover, sick calls, employee engagement, FMLA

• Data have been volatile from baseline through current results. Over the last five months, in departments where LEAPT employee safety work has been implemented, the rates have been steadier than in the past, compared to each hospital’s overall rates where volatility remains an issue. It is probable that this work is preventing large jumps in injury rates in the departments focused on this LEAPT work.


Measures/results

OSHA TRIR incidence rate among hospital departments participating in LEAPT

(# OSHA reportable incidents / employee hours worked * 200,000)01

/01/

1112

/01/

10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

2

4

6

8

10

12

14

16

Base-Line

Sept.2014

Aug.2014

Jul.2014

Jun.2014

May2014

Apr.2014

Mar.2014

Feb.2014

Jan.2014

Dec.2013

Nov.2013

Oct.2013

Pilot incidence rate

10% OSHA incidence rate reduction25% OSHA incidencerate reduction

DART incidence rate among hospital departments participating in LEAPT

(# OSHA incidents resulting in DART / employee hours worked * 200,000)

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

07/0

1/12

06/0

1/12

08/0

1/12

09/0

1/12

10/0

1/12

11/0

1/12

12/0

1/12

01/0

1/13

02/0

1/13

04/0

1/13

03/0

1/13

05/0

1/13

06/0

1/13

07/0

1/13

08/0

1/13

09/0

1/13

10/0

1/13

11/0

1/13

01/0

1/14

12/0

1/13

02/0

1/14

03/0

1/14

04/0

1/14

05/0

1/14

06/0

1/14

07/0

1/14

08/0

1/14

10/0

1/14

09/0

1/14

11/0

1/14

12/0

1/14

1

2

3

4

5

6

7

Base-Line

Sept.2014

Aug.2014

Jul.2014

Jun.2014

May2014

Apr.2014

Mar.2014

Feb.2014

Jan.2014

Dec.2013

Nov.2013

Oct.2013

Pilot DART rate

10% DART rate reduction

25% DART rate reduction

4.5

3.7

1.51.3


Expanding the reduction of hospital-acquired conditions and readmissions across the health care community

Falls across the community Project updatesThe following represents key highlights of achievements:

• Development of a statewide dashboard to track progress in fall prevention across communities.

• Screening of older adult clinic patients with 12 to 29 percent of patients being identified as a high falls risk.

• These vulnerable patients that would likely not otherwise have been screened for fall risk are now being referred to services within the health care system and the community.

Interventions • Created a model for identifying individuals at risk and referring

them to appropriate services which include:• Develop fall risk screening process• Develop an effective referral process for services• Develop an integrated and streamlined network of services

and resources with a goal of providing evidence-based care and programming to reduce falls and improve strength, balance, and fitness.

• Tested and refine models and tools in three Minnesota communities.

• Created and implemented a Community Falls Gap Analysis and tool kit

Measures/results• Up to 29% of older adult patients coming in for a clinic visit were

identified as high-risk for falling. These patients were referred to internal and community-based services.

• One of the tests of change of the Community Falls Project has been to identify and test models for tracking progress in reducing falls and fall injuries across a community that can be sustained over time. MHA has finalized a partnership the Minnesota Department of Health to develop dashboards for each participating


community that includes: 1) Fall with injury data identified through hospital e-codes; 2) Falls identified through death records; 3) Falls that resulted in specific injuries as identified through the trauma/TBI/Spinal Cord Injury registry data; and 4) Future reports from EMS data once that database is available to the state.

• Screening older adult patients coming in for clinic visits appears to be an effective approach to identifying older adults at-risk for falling and proactively referring them to programs and services within the health care system and the community. Up to 29 percent percent of older adult patients coming in for a clinic visit that were screened for fall risk were identified as high-risk for falling and were offered a referral to programs within the health system and to community-based programs.

Lessons learned• Hospitals are an important player in the community for falls

prevention but have varying levels of leverage within the community to engage other partner organizations to engage in the topic. It is important to partner with other organizations such as the Area Agencies on Aging and community health to leverage and coordinate resources and expertise.

• There are many organizations, such as the local EMTs and firefighters, that play a significant role in prevention and community education that have previously not been engaged in this effort but are very enthusiastic participants.

• Initial data from the clinic screening process is showing an alarming rate of patients coming in to the clinic setting that are not able to pass mobility/balance tests and are at very high risk for falling.

• The hospitals are beginning to see referrals of the patients leading to more robust participation in programs. Historically there have been a number of programs available for fall prevention but they have not been well attended.

• There are significant challenges to gather all of the programs and funding opportunities available at the state and federal level. These efforts are often offered in “silos” and are not sustained.

• It is important but challenging to establish a community falls coalition/partnership to create a successful, well-rounded program. The pilot hospitals have used both existing partner meetings that can be expanded to meet the needs of a “falls coalition” as well as creating new coalitions as successful strategies to meet this need.

(See Appendix B: Figure 3)


Engaging pharmacy residents to reduce ADEThe aim was to reduce ADEs greater than 40 percent by educating resident pharmacists in primary care clinics with methods to effectively meet with patients post hospitalization to identify, prevent and resolve drug therapy problems.

Interventions • Successfully incorporating PharmD into clinic workflow

• Utilizing new tools to identify patients in order to achieve automatic referral for PharmD

• Identifying colleague/champion from inpatient pharmacy service to refer patients to ambulatory PharmD for follow up

• Automatic PharmD visit scheduled at hospital discharge


• The pharmacy residents across the six sites were very engaged with this project, and as a result were able to cycle through many PDSA cycles and try new processes in order to get patients into clinic post hospital discharge.

• Several of the sites were able to implement an automatic referral process, which generated many more patient visits at their sites.

• The most successful automatic referrals occurred at the point of hospital discharge, and the appointment to see the pharmacist was established prior to leaving the hospital.

• The residents were able to see a large number of patients over the course of a 10-month period, considering the resources allocated for this study.

• The sites met monthly to discuss learnings from the previous month, which was very effective for the sites to be able to share their successful PDSA cycles.

• Preliminary data was presented in October at the National Annual Meeting of the American College of Clinical Pharmacy (ACCP) in the form of a research poster and at the Minnesota Alliance for Patient Safety conference in the form of a podium presentation.

• A research paper will be drafted and submitted for publication to the American Journal of Health-System Pharmacy (AJHP) which will reach a national audience.

• The results of this project will be provided to the participating sites in order for them to learn from the trends identified with the data they have submitted. These trends will allow the MTM pharmacists to provide feedback to their acute care counter-parts, based on


their population of focus, to improve the transition of patients out of the acute care setting as well as to prevent avoidable drug therapy problems post-hospital discharge.

Measures/results

Lessons learned • Breaks in communication may have a large impact on success of

an intervention.

• Automatic health system referrals to PharmD may be one of the most effective and efficient referral methods.

• The sites that participated in this grant had diverse demographics; therefore comparing data between sites is difficult. The sites also identified their own population of focus, which was not consistent across the sites.

• When the data collection tool was created, data analysis was not in mind; therefore data analysis has been difficult as the data is not in the same language that most software programs speak.

• In the middle of the year, the residents graduated and a new set of residents were trained and incorporated into this study. This may have slowed progress down in the summer months, but a fresh perspective was added to each site.

Categories of drug therapy problems identified post-discharge (N = 986)

01/0

1/11

12/0

1/10

02/0

1/11

03/0

1/11

04/0

1/11

05/0

1/11

06/0

1/11

07/0

1/11

08/0

1/11

10/0

1/11

09/0

1/11

11/0

1/11

12/0

1/11

01/0

1/12

02/0

1/12

03/0

1/12

04/0

1/12

05/0

1/12

06/0

1/12

50

100

150

250

Convenience

200

300

350

400

450

Efficacy Indication Safety

17%

23%

39%

21%


Engaging physician residents to reduce pressure ulcersHospitals participating See Appendix A: Table 2 for a list of participating hospitals.


• Collaboration among five hospitals to design, produce, deliver and evaluate a training effort aimed at improving patient safety.

• Training completed by 588 residents and fellows (44 percent of those invited to participate).

• Strong agreement among participants that the pressure ulcer training was effective in 1) enhancing their understanding of their role in prevention; 2) increasing their understanding of their responsibility to document; 3) increasing their confidence in their role within the care team.

• Post-training quiz scores improved by 20 percentage points over pre-training quiz scores.

Interventions and tests of change• A comparison of pre-training quiz scores versus post-training

quiz scores demonstrates a 20 percentage point increase in understanding.

• Monthly pressure ulcer rates are being monitored by hospitals and will be compared to pre-training baseline measures. It is not known if the training will have any impact that can be correlated directly to a change in pressure ulcer rates. Data is still coming in on for the months immediately following the training period, so it is too soon to identify any potential changes in patterns.

Measures/results• 2013 monthly pressure ulcer rates by hospital serve as the

baseline.

• Monthly pressure ulcer rates for June through December 2014, will serve as a comparison.

• The bulk of the training took place in late June through early August 2014.

• At the time of this update, data was still being collected for August.

• Rates are reported for Stage 1, 2, 3, 4, unstageable and device related pressure ulcers, as well as suspected deep tissue injury.


Lessons learned• Not surprisingly, residency programs with more direct oversight

and control tended to have the highest participation rates.

• The training was more highly rated by newer trainees than seasoned trainees.

• The training was designed to focus on the essential information a resident physician needs to know to prevent, identify and manage a pressure ulcer. This proved to be a successful strategy, with additional resources available for those who had time and interest in going deeper into the subject.

Engaging patients to reduce readmissionsHospitals participating See Appendix A: Table 2 for a list of participating hospitals.

Interventions and tests of change • 500 hours of patient research conducted

• Patient education packets designed and distributed

• Website designed and implemented (www.ownbestmedicine.mn)

• ADA 508 compliance achieved

• Radio ads created and implemented

• Print ads designed and circulated

• Online access button designed and marketed

• Smart phone app designed and applied

• Tablet app designed and applied

• Survey designed, distributed and results compiled

Measures/results:• Packets: 1,000 packets were distributed throughout the 12 pilot

sites.

• Media consisted of:• Radio ads on: WCCO and Minnesota Public Radio• Print ads in: the Pioneer Press, the Star Tribune, Good Life,

Live to Age Well and Good Age• Website www.ownbestmedicine.mn

• A 25 question survey was distributed with the 1,000 packets. Surveys could be returned electronically or via paper/mail.


Lessons learned:• Packets:

• Red packets were well liked and were seen being used on follow up visits to doctors

• Packet content was well received• Patient satisfaction scores were noted to increase during the

pilot• Patients often felt overwhelmed during the general discharge

process. The packets might be better received if distributed earlier in the care delivery process.

• Media campaign:• Media promoted website visits• Site visits clearly spiked when ads were running, and

decreased to nearly zero when ads were not running.• About 66 percent of visitors typed in the url directly, which

showed people are learning about the website from the ads. • Targeting toward older people, who are most likely to be

managing a complex medical condition(s), worked. • The website was most often visited by 55 to 64 year olds.• There were more female website visitors (59 percent) than

male (41 percent).

• Survey (57 replies):• Patients desired a shorter survey with fewer questions• Due to a low electronic return, paper surveys were added to

packets.• It was difficult to obtain survey responses and only paper

surveys were returned.• The campaign impacted patients. Due to information patients

received from MAPS, the following results were reported:• Asking for written/printed copies of major medical tests (32

percent)• Bringing written/printed copies of all major medical tests to

clinic visits (43 percent)• Keeping a list of all major warning signs associated with my

condition (36 percent)• Due to the MAPS materials given and/or the website visited;

patients were more actively gathering, organizing or sharing medical information with their health care team (51 percent agree or strongly agreed).

• High school graduates over the age of 65 most often utilized the information.

(See Appendix B: Figure 4)


Collaboration Some of the best quality improvement work has been accomplished by capitalizing on the power of partnerships and collaboration. The MHA HEN is leveraging expertise from a variety of state and community partners that provide access to the latest research and best practices in patient safety and allow us to capitalize on the collaborative spirit that is strong in Minnesota. Key partners include:

• Association for Professionals in Infection Control and Epidemiology (APIC)

• Institute for Clinical Systems Improvement (ICSI)

• March of Dimes

• Minnesota Alliance for Patient Safety (MAPS)

• Minnesota Department of Health (MDH)

• Minnesota Medical Association (MMA)

• Stratis Health (the state’s quality improvement organization (QIO))

• University of Minnesota Schools of Medicine, Pharmacy, and Nursing

MHA has regular communication and meetings with the Minnesota QIO, Stratis Health to collaborate and coordinate efforts on multiple HEN topics including readmissions, adverse drug events, culture, and infections. MHA and Stratis Health lead the two statewide improvement collaboratives, RARE and CHAIN. The partner organizations work together and collaborate on overall statewide strategy and planning—which has included CUSP training, an HAI conference, an antimicrobial stewardship conference, development of an HAI reduction road map, and a CHAIN website with resources and guidance for hospitals. All of these activities are planned and coordinated among the four partners in an effort to eliminate any duplication of effort and confusion for Minnesota hospitals.

There needs to be better communication, coordination, and balance between risk mitigation strategies to avoid duplication of effort with an environment that supports partnerships and collaborations among federal contractors. Effective collaborations and coordination can reduce required resources to achieve a common goal.


APPENDIX ATable 1

MHA HEN participating hospitals

HOSPITAL CITY

Abbott Northwestern Hospital Minneapolis

Allina Health - Regina Hospital Hastings

Appleton Area Health Services Appleton

Avera Marshall Regional Medical Center Marshall

Bethesda Hospital St. Paul

Bigfork Valley Hospital Bigfork

Buffalo Hospital Buffalo

Cambridge Medical Center Cambridge

CentraCare Health - Long Prairie Long Prairie

CentraCare Health - Melrose Melrose

CentraCare Health - Monticello Monticello

CentraCare Health - Paynesville Paynesville

CentraCare Health - Sauk Centre Sauk Centre

CHI Albany Area Health Albany

CHI LakeWood Health Baudette

CHI St. Francis Health Breckenridge

CHI St. Gabriel's Health Little Falls

CHI St. Joseph's Health Park Rapids

Chippewa County-Montevideo Hospital Montevideo

Community Memorial Hospital Cloquet

Cook County North Shore Hospital Grand Marais

Cook Hospital & C&NC Cook

Cuyuna Regional Medical Center Crosby

District One Hospital Faribault

Douglas County Hospital Alexandria

Ely-Bloomenson Community Hospital Ely

Essentia Health Northern Pines Aurora

Essentia Health St. Mary's Hospital-Detroit Lakes Detroit Lakes

Essentia Health-Ada Ada

Essentia Health-Deer River Deer River

Essentia Health-Duluth Duluth

Essentia Health-Fosston Fosston

Essentia Health-Graceville Graceville


Essentia Health-Sandstone Sandstone

Essentia Health-St. Joseph's Medical Center Brainerd

Essentia Health-St. Mary's Medical Center Duluth

Essentia Health-Virginia Virginia

Fairview Lakes Health Services Wyoming

Fairview Northland Medical Center Princeton

Fairview Ridges Hospital Burnsville

Fairview Southdale Hospital Edina

FirstLight Health System Mora

Glacial Ridge Health System Glenwood

Glencoe Regional Health Services Glencoe

Grand Itasca Clinic and Hospital Grand Rapids

Granite Falls Municipal Hospital & Manor Granite Falls

Hendricks Community Hospital Association Hendricks

Hennepin County Medical Center Minneapolis

Hutchinson Health Hutchinson

Johnson Memorial Health Services Dawson

Kittson Memorial Healthcare Center Hallock

Lake Region Healthcare Fergus Falls

Lake View Memorial Hospital Two Harbors

Lakeview Hospital Stillwater

Lakewood Health System Staples

LifeCare Medical Center Roseau

Madelia Community Hospital Madelia

Madison Hospital Madison

Mahnomen Health Center Mahnomen

Maple Grove Hospital Maple Grove

Mayo Clinic Health System in Red Wing Red Wing

Meeker Memorial Hospital Litchfield

Mercy Hospital Coon Rapids

Mercy Hospital Moose Lake

Mille Lacs Health System Onamia

Minnesota Valley Health Center Le Sueur

Murray County Medical Center Slayton

New Ulm Medical Center New Ulm

North Memorial Medical Center Robbinsdale

North Valley Health Center Warren

Northfield Hospital Northfield

Olmsted Medical Center Rochester


Ortonville Area Health Services Ortonville

Owatonna Hospital Owatonna

Park Nicollet Methodist Hospital St. Louis Park

Perham Health Perham

Phillips Eye Institute Minneapolis

Pipestone County Medical Center Pipestone

Rainy Lake Medical Center International Falls

Range Regional Health Services Hibbing

RC Hospital & Clinics Olivia

Redwood Area Hospital Redwood Falls

Rice Memorial Hospital Willmar

Ridgeview Medical Center Waconia

Ridgeview Sibley Medical Center Arlington

River Falls Area Hospital - Allina Health River Falls

River's Edge Hospital & Clinic Saint Peter

RiverView Health Crookston

Riverwood Healthcare Center Aitkin

Sanford Bagley Medical Center Bagley

Sanford Bemidji Medical Center Bemidji

Sanford Canby Medical Center Canby

Sanford Jackson Medical Center Jackson

Sanford Luverne Medical Center Luverne

Sanford Thief River Falls Medical Center Thief River Falls

Sanford Tracy Medical Center Tracy

Sanford Westbrook Medical Center Westbrook

Sanford Wheaton Medical Center Wheaton

Sanford Worthington Medical Center Worthington

Sleepy Eye Medical Center Sleepy Eye

St. Cloud Hospital Saint Cloud

St. Francis Regional Medical Center Shakopee

St. John's Hospital Maplewood

St. Joseph's Hospital St. Paul

St. Luke's Hospital Duluth

Stevens Community Medical Center Morris

Swift County-Benson Hospital Benson

Tri-County Health Care Wadena

Tyler Healthcare Center/Avera Tyler

United Hospital Saint Paul

United Hospital District Blue Earth


Unity Hospital Fridley

Windom Area Hospital Windom

Winona Health Winona

Woodwinds Health Campus Woodbury


Table 2

MHA LEAPT participating hospitals

TOPIC HOSPITAL CITY E/M*

CDI CentraCare Health System - Melrose Melrose E

CDI Cuyuna Regional Medical Center Crosby

CDI Essentia Health-St. Joseph's Medical Center Brainerd

CDI Glencoe Regional Health Services Glencoe

CDI Grand Itasca Clinic and Hospital Grand Rapids E

CDI Minnesota Valley Health Center Le Sueur E

CDI North Memorial Medical Center Robbinsdale

CDI Park Nicollet Health Services Minneapolis M

CDI Redwood Area Hospital Redwood Falls

CDI United Hospital St. Paul M

CDI University of Minnesota Medical Center Minneapolis M

CDI Windom Area Hospital Windom E

Delirium Essentia Health-St. Joseph's Medical Center Brainerd

Delirium Fairview Lakes Health Services Wyoming

Delirium Fairview Northland Medical Center Princeton

Delirium HealthEast Care System - St. John's Hospital St. Paul E

Delirium HealthEast Care System - St. Joseph's Hospital St. Paul E

Delirium HealthEast Care System - Woodwinds Health Campus Woodbury E

Delirium New Ulm Medical Center New Ulm E

Delirium Park Nicollet Health Services Minneapolis E

Delirium Rice Memorial Hospital Willmar E

Delirium Ridgeview Medical Center Waconia

Delirium St. Cloud Hospital Saint Cloud

Delirium Windom Area Hospital Windom

Employee safety Appleton Area Health Support Appleton E

Employee safety Buffalo Hospital Buffalo E

Employee safety CentraCare Health - Monticello Monticello E

Employee safety Essentia Health Northern Pines Aurora E

Employee safety Maple Grove Hospital Maple Grove E

Employee safety New Ulm Medical Center New Ulm E

Employee safety Ortonville Area Health Services Ortonville E

Employee safety Redwood Area Hospital Redwood Falls E

Employee safety Rice Memorial Hospital Willmar E

Employee safety Sanford Jackson Medical Center Jackson E


Engaging Patients to Reduce Readmissions

Arrowhead Area Agency on Aging (non-hospital partner)

Duluth

Engaging patients to reduce readmissions

Cambridge Medical Center Cambridge


Central Minnesota Council on Aging (non-hospital partner)

St. Cloud


The Colong at Eden Prairie Senior Living (non-hospital partner)

Eden Prairie


Essentia Health-St. Joseph’s Medical Center Brainerd


Fairview Lakes Medical Center Wyoming


Glacial Ridge Health System Glenwood


Land of the Dancing Sky Area Agency on Aging (non-hospital partner)

Warren


Metropolitan Area Agency on Aging (non-hospital partner)

North St. Paul


Minnesota River Area Agency on Aging (non-hospital partner)

Mankato


Southeastern Minnesota Area Agency on Aging (non-hospital partner)

Rochester


Benedictine Health Center at Innsbruck (non-hospital partner)

New Brighton

Engaging physician residents to reduce pressure ulcers

Gillette Children’s Specialty Healthcare Saint Paul


Hennepin County Medical Center Minneapolis


Regions Hospital Saint Paul


University of Minnesota Medical Center, Fairview Minneapolis


Minneapolis VA Health Care System Minneapolis

Falls across the community Lake Region Healthcare Fergus Falls

Falls Across the community Lakewood Health System Staples

Falls across the community Mille Lacs Health System Onamia

Sepsis Avera Marshall Regional Medical Center Marshall E

Sepsis Avera St. Mary’s Hospital Pierre, SD E

Sepsis CentraCare Health - Long Prairie Long Prairie E

Sepsis CentraCare Health - Melrose Melrose E


Sepsis CentraCare Health - St. Cloud St. Cloud M

Sepsis Chippewa County-Montevideo Hospital Montevideo

Sepsis Cuyuna Regional Medical Center Crosby

Sepsis Douglas County Hospital Alexandria

Sepsis Fairview Ridges Hospital Burnsville

Sepsis Glencoe Regional Health Services Glencoe

Sepsis Granite Falls Municipal Hospital & Manor Granite Falls

Sepsis Lake Region Healthcare Fergus Falls

Sepsis Madelia Community Hospital Madelia

Sepsis Meeker Memorial Hospital Litchfield

Sepsis Northfield Hospital Northfield

Sepsis Range Regional Health Services Hibbing

Sepsis Regions Hospital St. Paul

Sepsis Rice Memorial Hospital Willmar

Sepsis Ridgeview Medical Center Waconia M

Sepsis Sanford Jackson Medical Center Jackson

Sepsis St. Luke's Hospital Duluth

Sepsis Swift County-Benson Hospital Benson

Sepsis Tri-County Health Care Wadena E


Southeastern Minnesota Area Agency on Aging (non-hospital partner)

Rochester


Benedictine Health Center at Innsbruck (non-hospital partner)

New Brighton

E=Exploratory

M=Mentor


APPENDIX BFigure 1


Figure 2

And does the patient just not look right? Screen for sepsis and notify the physician immediately.

Is the patient’s temperature above 100?

Is the patient’s heart rateabove 100?

Is the patient’s blood pressure below 100?


Figure 3


Figure 4


Brief Program Survey1. On a scale of 1- 5 (1 being the lowest and 5 the highest), how would you rate your overall experience

as a Hospital Engagement Network (HEN) contractor working with the Partnership? 4

2. What would you say has been your HEN’s greatest contribution toward the achievement of the PfP 40/20 aims? Minnesota hospitals achieved a 94 percent reduction in early elective deliveries, 54 percent reduction in pressure ulcers, and 19 percent reduction in readmissions. The Reducing Avoidable Readmissions Effectively Campaign prevented 8,773 readmissions and allowed Minnesotans to spend 35,000 nights of sleep in their own beds, over $77 million dollars saved. The number of hospitals that have a dedicated patient-family advisor to lead patient and family engagement activities has increased more than 100 percent. Nearly half (48%) of Minnesota hospitals now have a dedicated person in place. In addition, MHA HEN hospitals that have three more PFE best practice criteria in place increased from 46 percent to 66 percent, a 43 percent increase.

3. What did you like most about the design of the PfP campaign? The Partnership for Patients model allowed for innovation at the local level and fostered collaboration among participants and HENs. There was a good balance between nationally standardized measures and local measures. The focus on safety across the board allowed HENs and hospitals to focus on the areas that they identified as areas of needed focus. There was creativity and a variety of technical assistance needs and assistance among the HENs. Thank you to the leadership of Dennis Wagner and Dr. Paul McGann. They were both motivating, inspiring, yet always challenging us to go further, faster. Who hoo!

4. What areas would you like to have seen improvement? There are a number of improvements I would recommend, including:

• Fewer and condensed reports that gather valuable information. Extensive resources went into writing reports that could have spent on improvement efforts.

• Less pacing events. There were too many events, too many speakers on each call, too much time spent prepping.

• Recommend fewer affinity groups.

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