Banner Health tracking new patient care and patient safety elements
As part of our 2010 Strategic Initiatives, Banner Health is now tracking patient care data for surgical care improvement, pediatric asthma and patient safety elements related to preventing sepsis and central line infections.
These measures, as approved by the Banner Health Board of Directors in 2009, were monitored during the first quarter of 2010 to provide a baseline for setting target and stretch target goals for the second half of the year.
The new Surgical Care Improvement Project (B), or SCIP (B), continues the emphasis on avoiding hospital-acquired infections. The initiative includes new publicly-reported metrics involving continuing use of beta blockers with cardiac surgery patients, urinary catheter removal and perioperative temperature management, along with manually-collected data from January-March 2010.
With first-quarter data collected from Banner hospitals showing a performance rate of 93.7 percent, Banner has established a base target of 94.6 percent for the second half of 2010, and a stretch target of 95.6 percent.
Banner will still monitor the elements of SCIP (A), which includes: use of prophylactic antibiotics prior to surgery, appropriate preventative antibiotic(s) received by surgical patients; prophylactic antibiotics discontinued following surgery; controlled post operative serum glucose levels for cardiac surgery patients; surgery patients with appropriate hair removal; venous thromboembolism (VTE) prophylaxis ordered for surgery patients; and VTE prophylaxis administered within 24 hours pre/post surgery.
Pediatric asthma (PA) affects 6.5 million children in the U.S. and has received national attention from the Centers for Medicare & Medicaid Services (CMS). Banner will monitor data obtained from Banner facilities providing inpatient pediatric care to track the three measures in the PA element:
- Reliever medication
- Systemic corticosteroid medication, and
- Home management plan of care.
With Banner baseline data from January-March 2010 showing a performance rate of 81.8 percent, Banner has established a base target of 95.3 percent for the second half of 2010, and a stretch target of 96.3 percent.
Banner has developed a new “Clinical Informatics for Process Improvement” (CIPI) model to reduce central line infections and sepsis mortality. This model uses the EMR data to help identify potential patients and improve patient care with “safe designs” (EMR documentation, tools and prompts; new work processes), ensuring “safe choices” and measuring the progress.
Among the processes for sepsis are hand hygiene, chlorhexadine skin antisepsis, daily review of line necessity with prompt removal of unnecessary lines, and others. The Sepsis Resuscitation bundle includes serum lactate levels, blood cultures prior to antibiotic administration, achieving optimal central venous pressure and central venous oxygen saturation, among other markers.
The Banner baseline data from January-March 2010 for sepsis showed a mortality rate of 40.4 percent and a process rate of 8.5 percent. Banner has established a base mortality target of 38.4 percent for the second half of 2010, with a stretch target of 36.4 percent; and a base process target of 10.0 percent for the second half of 2010, with a stretch target of 12.0 percent.
The Banner baseline data from January-March 2010 for central line infections showed a rate of 2.65 per 1,000 line days, while the process rate was not available. Banner has established a base infection target of 2.45 per 1,000 line days for the second half of 2010, with a stretch target of 2.00 per 1,000 line days; and a base process target of 30 percent for the second half of 2010, with a stretch target of 50 percent.
“The overriding goal of these initiatives is to harvest data from the EMR and to provide information to clinicians to improve care,” said Twila Burdick, Banner vice president for Organizational Performance. “This will allow Banner clinicians to recognize potential sepsis cases and initiate appropriate resuscitation; ensure appropriate central line insertions, management, and recognition of infection; assist clinicians in making safe choices for patients; and leverage electronic capabilities to improve care.
“We have seen widespread acceptance of these initiatives since the Banner Health Board adopted them,” Burdick added. “One of the highlights came this past May, when every Banner facility achieved 100 percent outcomes for treatment of acute myocardial infarction, a terrific accomplishment for all of our clinicians and hospitals.”