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Samaritan Health Services Lisa Chiles, PMP, CSM
November 1, 2013
Samaritan Health Services
• Service area: 290,000 residents in Linn, Benton, Lincoln and portions of Polk and Marion counties – 5 Hospitals
– 70+ primary care and specialty physician clinics
• Employee base: 5,100
• Health plans: Three insurance plans serving more than 45,000 people
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Samaritan’s Lean Approach
• Seize the Opportunity
• Build a Lean Understanding
• Build a Lean Community
• Celebrate the Wins!!
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Seize the Opportunity
• Samaritan engaged with OAH and learned of the Purdue Lean Certification Training
• Lean opportunities recognized throughout the system
• Gained Samaritan executive sponsorship
• Thank you to Partnership for Patients!
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Build a Lean Understanding
• Teams of 6 from each of the 5 Samaritan hospitals sent to the Purdue Yellow Belt Lean Training
• 12 individuals from Samaritan sent to Purdue Green Belt Training
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Build a Lean Community
• Green Belts formed the Lean Community of Practice
• Our charter:
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Provide LEAN Training and Education to the SHS system
Communicate, Champion and Propagate the SHS LEAN Vision to the greater SHS Organization.
Manage the LEAN portfolio of projects.
Provide Leadership, Tools, and LEAN Expertise to the SHS Organization.
Community of Practice
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SHS CoP
GSRMC CoP
SAGH CoP
SLCH CoP
SNLH CoP
SPCH CoP
SHS CoP: - Monthly meetings
(2nd week of the month)
- Define common processes, metrics, tools ,etc.
- Provide updates on system wide Lean projects
- Provide consistent messages/goals to CoPs
Site CoPs: - Monthly meetings
(3rd or 4th week of the month)
- Provide updates on site-specific Lean projects
- Help in the site dissemination of Lean processes, tools and messages
Community of Practice
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Communicate Train & Educate
Tools & Expertise
Manage Lean Projects
Project Stats: 42 Requested 16 Active 11 Completed
Celebrate the Wins
• As a result of Lean projects at SHS we’ve realized the following: – Patient Care Improvements:
• Consistent documentation of assessment and ordering of VTE prophylaxis’s across system
• Standardized the reporting of ADR’s and removed paper reporting at LCH
• 30% reduction in wait time at our Pre-Op Clinic with minimal outliers
• Standardized Discharge process for Pneumonia patients (measuring reduced readmits)
• Standardized Follow up Scheduling for Discharged Patients (measuring reduced readmits)
• 2 months+ of no Falls at NLCH
– Financial Improvements:
• Increased revenue by hitting the 100% mark for the VTE core measure
• Increased thru put in the Pre-Op Clinic
– Process/Employee Productivity Improvements:
• Decreased steps for Medical Staff Providers with documentation of assessment and ordering
• Improved the delivery thru put of our Software Development team
• 5 day reduction in delivery of new Software Solutions
• Standardized the process for onboarding new Technology to our Service Desk
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Good Samaritan Regional Medical Center Jennifer Zeck, RN, BSN & Bill Howden, RN, MSN
November 1, 2013
About Us
Good Samaritan Regional Medical Center
• Largest hospital of five that are a part of Samaritan Health Services
• 188 Beds
• Level 2 Trauma Center
• Offers multiple comprehensive surgical specialties
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VTE Assessment & Ordering
Definition VTE
• Venous thromboembolism
What are they
• VTEs are the formation, development, or existence of a blood clot or thrombus within the venous system.
WHY
• CMS Requires Documentation on all adult inpatients except mental health, pediatric, comfort care after 2nd day, and OB.
• Lack of consistent documentation of assessment and ordering of VTE prophylaxis.
• We discovered we were unable to measure if assessment or ordering were completed on non-surgical & non-ICU patients.
• This became more apparent during the implementation of the new EMR.
• Excerpt from the Specification Manual for National Hospital Quality Measures version v4.2b, effective with January 1, 2013 discharges.
• • Risk assessment form
• • Transfer form
• NURSES:
• Risk assessment form
• SUGGESTED DATA SOURCES FOR PATIENT REFUSAL (other than physician/APN/PA or pharmacist) documentation of a reason for not administering VTE prophylaxis as above):
• • Medication administration record
• • Nurses notes
• Inclusion Guidelines for Abstraction:
• Reasons for not administering any mechanical or pharmacologic prophylaxis:
• • Patient at low risk for VTE
• • Explicit documentation that the patient does not need VTE prophylaxis
• • Patient/family refusal
• Exclusion Guidelines for Abstraction:
• None
Anecdotal Observation • ALP boots sitting on nurses’ station counter Pre Project Data Measurement For the patients sampled within the Surgical Care Improvement Project (SCIP) • 2012 – 590 Patients denominator for VTE prophylaxis ordered = 97 %
• 2012 – 589 Patients denominator for VTE prophylaxis timing (meaning the
nurses documented the ALPs were on or med given) = 96 %
For non-surgery patients on PCU 30 charts prior to EPIC were randomly selected from Jan and Feb 2013
• Risk assessment was documented 10 times in various places = 33% • VTE prophylaxis was order 23 times = 76%
Solutions
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• Find Provider Champions
• Adopt new assessment tool
• Adopt new order process driven by assessment tool
• Obtain Provider ownership
• Implement into EMR (build in Epic is currently under construction)
Advice for Others & Lessons Learned • Make sure you have physician champions.
• What appears to be a simple problem is often more complex.
• Changes to the EMR take longer than anticipated.
• Make sure to involve all stakeholders early on.
• Pick deadline and stick to it.
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Plan for Spread
• Education
• Implementation in system EMR
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Next Steps
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• Assessment is Hard STOP
• Assessment links to orders
• Provider Champions, VTE process team will educate al 10/01-11/01
• Go Live in November
• Measure monthly a sample of qualifying patients for 100% assessment and order done
• Findings reported to Quality Council
• If measurement doesn’t show sustained improvement, the team will reconvene to make further corrections
Next Steps (cont’d)
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• Focus on order to implementation phase
– Once VTE prophylaxis is ordered how is it getting to the patient on a consistent basis?
Contact Info
• Bill Howden, RN, MSN
• 541-768-6787
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• Jennifer Zeck, RN, BSN
• 541-768-6966
Jennifer Zeck, Gillian Hyde, Maureen Murphy, Janell Anderson, Bill Howden
Not shown: Michel Bryant
