Embed Size (px)
Citation preview
LEAN Six Sigma and Patient Safety
Mary Reich Cooper, M.D., J.DChief Quality Officer, Lifespan Corporation
Edward W. Craven, MBA, CPHQNewYork-Presbyterian Hospital
Medicare Says It Won’t Cover Hospital Errors •Sign In to E-Mail or Save This
By ROBERT PEAR
Published: August 19, 2007WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.
WHY?
“For discharges occurring on or after October 1, 2008, the diagnosis-related group to be assigned shall be a diagnosis-related group that does not result in a higher payment based on the presence of a secondary diagnosis code”
WHY?
No Extra Payment
1. Serious Preventable Event - Object left in surgery2. Serious Preventable Event - Air embolism3. Serious Preventable Event - Blood incompatibility4. Catheter Associated UTI5. Pressure Ulcers (Decubitus Ulcers) . Vascular Catheter Associated Infection7. Surgical Site Infection - Mediastinitis after
Coronary Artery Bypass Graft (CABG) surgery8. Falls
WHY?
Transactional Level of Data Collection
Rewards for Each Time
74 Different Measures Available
Effectiveness and Safety
WHY?
Agenda
∀
WHY do we need to have this discussion?∀
WHO are we?
∀
WHEN did we start?∀
HOW have we approached this topic?
∀
WHAT have we achieved?
NewYorkNewYork--Presbyterian HospitalPresbyterian Hospital
Full asset merger of The New York Hospital, founded in 1771 and the 2nd oldest hospital in the US, and The Presbyterian Hospital of New York, founded in 1868, into one Article 28 corporation which includes:
2,224 Certified Beds 110,000 Discharges11,000 Births88,000 Surgeries1,036,000 Ambulatory Visits17,500 Employees $2.8 Billion Operating Budget
WHO?
Lifespan Corporation
Employees 10,941
Affiliated Physicians 2,519
Licensed Beds 1,174
Total Assets $1.77 Billion
Patient Discharges 52,680
Emergency Department Visits 198,447
Outpatient Visits 292,029
Net Patient Revenue $1.11 Billion
Research Funding $66.8 Million
Uncompensated Care at Cost $53.207 Million
WHO?
Experience in LEAN and Six Sigma
∀
Designed and implemented NYP plan∀
Hired and supervised forty black belts
∀
Program ongoing since 2002 ∀
$74 million in benefits through June 2007
∀
National award winners and speakers
WHEN?
Patient SafetyQuality Outcomes Define Measure Report Out
GE Healthcare Performance SolutionsDecember 13, 2004
HOW?
Quality Outcomes Pillars for Success
NYP/WC NYP/A NYP/WC NYP/CNYP/A
Blo
od S
trea
m In
fect
ions
Patie
nt F
alls
Pres
sure
Ulc
ers
Res
trai
nts
Dee
p Ve
in T
hrom
bosi
s
LOSCapacity Patient Care
Patient, Family, MD, Staff Satisfaction Malpractice Liability
HOW?
Project Approach
• Complete Literature Search
• Identify Best Practices
• Conduct GAP Analysis
• Prioritize GAPS
• Conduct Brainstorming Session to Identify Critical X’s
• Decide on DMAIC or Solution/Best Practice Implementation
• AIC or Work-Out and Change Acceleration Process
• Monitor progress
• Deliverables Met
• Project Transfer to NYPH
• On-going control
HOW?
BSI Site Selection Data
Benchmarks from National Nosocomial Infection Surveillance [NNIS];Major Teaching Hospital Med/Surg ICU; 50th percentile = 4.9, 90th percentile = 7.7
NYPH Adult ICU Central Line Related BSI2-year Average Rate (03 & 04)
2
3
4
5
6
7
8
9
10
CVC
-BSI
/1,0
00 C
VC D
ays
CTICU Cornell
MICU AllenCCU Columbia
SICU Columbia
CTICU Columbia
MICU Columbia
CCU Cornell
SICU Cornell
MICU Cornell
NYPH Adult ICU Central Line Related BSI2-year Average Rate (03 & 04)
2
3
4
5
6
7
8
9
10
CVC
-BSI
/1,0
00 C
VC D
ays
CTICU Cornell
MICU AllenCCU Columbia
SICU Columbia
CTICU Columbia
MICU Columbia
CCU Cornell
SICU Cornell
MICU Cornell
90th
50th
WHY?
Blood Stream Infection Project Opportunity
Tangible Benefits Intangible Benefits
Culture ObtainedFrom
Patient
CultureAnalyzed
BSI DetectedPatientTreated
InfectionRemoved
PatientDischarged
• Decreased length of stay (LOS) • Increase ICU Capacity• Reduce IV Antibiotics Usage
• Patients and family satisfaction is increased with decreased length of stay in ICU • Increase communication and best practice sharing between Epidemiology and Infection Control across campuses•Lowered legal burden from hospital malpractice claims and financial settlements/awards
Process
Problem StatementThe Weill Cornell CCU current has BSI rate of 8 BSI per 1000 catheter days. Based on 2003 and 2004 data the BSI rate was as high as 11 BSI’s per 1000 catheter days. The rate is approaching the National Nosocomial Infection Surveillance (NNIS) 90th
Percentile.
HOW?
Blood Stream Infection Project Scope/Enablers/Restrainers
Project Enablers Project Restrainers• Strong history of success in lowering
BSI rates in ICUs with focus and effort by Epidemiology and unit staff
• Causes and drivers of BSI are well established in medical literature
• Limited buy in and agreement to participate from specific staff.
This will be mitigated by using CAP tools early to communicate the necessity of pursuing this project. creating a shared need, shaping a vision and mobilizing commitment
Gaining consensus that there is a true problem will be necessary early and throughout the life of this project
In Scope:Weill Cornell CCU & SICU Central Line Catheter Related BSI’s. Catheters inserted both inside & outside of CCU & SICU
Out of Scope:Non central and other BSI’sOther locations: Columbia, Allen Pavilion, CHONY and other Weill Cornell ICU’sDays spent elsewhere within Hospital
HOW?
Critical X’s
∀
Technique∀
Training
∀
Supplies and Kits∀
Line Upkeep
2007: Central Line Infections
ICU’sNNIS DataPublicly Reported DataMystery Shoppers for Hand HygieneStandardized Protocol for InsertionsCarts, Barriers, and KitsEpiPortal
WHAT?
BSI ICU Results 2007 Months without an Infection
0
1
2
3
4
5
6
7BurnCCUCTICUMICUNEURO ICUPICUSICUNICU > 1500NICU > 2500m
WHAT?
QUESTIONS?
mcooper @ lifespan.org
edc9008 @ nyp.org
