Quality and safety are front and center
In the eight years since the Institute of Medicine’s landmark report, To Err is Human, named medical mistakes as the eighth leading cause of death in America, hospitals across the country have begun a process of self-examining, public reporting, and systematically improving health care quality and safety.
At University of Rochester Medical Center hospitals, the focus is on optimizing our structure (facilities, technology, and people) and processes in order to achieve the best possible outcome for each patient. We’ve made calculated investments in facilities improvements and redoubled our efforts to ensure the ideal mix of clinicians and professional staff. At the same time, we’ve used Lean Six Sigma techniques to fine-tune our care processes to ensure high reliability. Throughout our hospitals, we’ve employed clinical pathways, careful protocols and computerized provider order entry to reduce variation. We constantly measure ourselves against national benchmarks, looking for ways that we can both improve and set the pace for other institutions.
That discipline has resulted in significant improvements such as those that enabled Strong Memorial Hospital to be one of the first five hospitals to go for more than one year without a ventilator-associated pneumonia in its medical intensive care units. Like so many successful process improvements, the key lies not in costly technology but in simple, easy-to-replicate checklists of preventive steps consistently applied by all members of the care team. Dozens of U.S. hospitals are now using the same Institute for Healthcare Improvement (IHI)-developed process to achieve similarly dramatic reductions in pneumonias among patients on ventilators.
Strong Memorial has also adopted another IHI initiative, Rapid Response Teams (RRTs), a process that aggressively intervenes when a patient first begins to show signs of serious decline. These teams have helped hundreds of patients avoid being admitted to intensive care, and have cut stays for those who must be admitted. Strong is also one of a handful of U.S. hospitals to allow family members on selected units to alert RRT if they become concerned about their loved one.
In the years ahead, URMC hospitals will turn their attention to increased infection surveillance and intervention – particularly to prevent deadly line infections.
Patient Care Facilities Investments
The Medical Center's 2007-2012 Strategic Plan acknowledges the critical importance of the clinical enterprise in advancing science and teaching. In the end, it’s about advancing human health and leveraging our intellectual capital to benefit the region’s growth – and that requires an open door to patients seeking our care.
Unfortunately, after helping to absorb the patient loads of two now-closed Rochester hospitals, URMC has been left with serious patient care capacity constraints. The partnership with Highland Hospital and the addition of more observation beds have provided some relief, yet both Strong Memorial Hospital and Highland Hospital now function at full capacity, and often beyond. When the demand approaches our limit of providing safe, appropriate care, the hospitals are forced into “Code Red,” diverting ambulances to other facilities.
Nearly one-third of patients traveling to Strong come from outside of the county as smaller, outlying hospitals have come to rely on us, particularly our intensive care facilities. We are the region’s sole provider of a variety of quaternary services such as solid organ transplant, multiple trauma, pediatric care, cardiac subspecialties, and more.
The current space crunch creates special challenges for patient safety and quality as well as patient privacy and satisfaction. It also forces us to turn away patients from outlying areas; ironically, these are often the patients with complex conditions who are most likely to benefit from our care.
Space limitations have prevented us from expanding our imaging facilities and equipment, creating delays and inefficiency. More clinical space for pediatric and adult patients is critically needed if we are to provide the patient experience that our community expects.
The success of this Strategic Plan hinges on our ability to permit the clinical growth that both enables investment in the academic missions and leverages our translational research efforts. The highest priorities for capital investment in clinical facilities are:
- Pediatric Replacement and Imaging Sciences Modernization (PRISM)
- Ambulatory Surgery Center (ASC)
The centerpiece of our clinical strategy and our efforts to boost quality and safety is the Pediatric Replacement and Imaging Sciences Modernization (PRISM) project. URMC has filed an application with the New York State Department of Health seeking approval for a two-phase process that will initially involve construction of a 6-story clinical building to house the expansion of our adult and pediatric inpatient services. The PRISM also includes two floors dedicated to diagnostic and interventional imaging as well as materials management and other support services.
Once this new building is complete, the Medical Center would renovate its existing pediatrics floor, allowing us to open another 67 adult beds. In total, the PRISM project would add another 123 beds to Strong Memorial Hospital, expanding its licensed capacity to 862.
The $259 million PRISM, the most ambitious project undertaken in the Medical Center’s history, will enable URMC to emerge as a leader in translational medicine and provide optimal care for its community and the surrounding region. Without PRISM, patient access, quality, and our long-term financial vitality are threatened.
Given the urgency of our need, planning and design would begin immediately upon receiving State approval. Construction could begin as early as July of 2009. The full project, including the renovation of current pediatrics space, would not be completed until 2013.
Ambulatory Surgery Center
Outpatient surgery is the fastest-growing clinical activity and due to capacity constraints, URMC faculty members now perform more than 5,000 cases off-site at non-URMC facilities. The Medical Center currently has two Operating Room (OR) suites that offer a total of 33 operating rooms, half of which need to be upgraded and expanded. Yet, because of space and staffing limitations, cases are routinely scheduled throughout the day and into the evening, often at times inconvenient for patients, and leaving no opportunity for renovation.
The University of Rochester Medical Center has received State approval to construct an off-site, ambulatory surgery center. The 52,000-square-foot facility will accommodate ten operating rooms, two procedure rooms, pre- and post-operative care space, a materials processing unit to sterilize and prepare surgical instruments, and a family and patient waiting space.
The project will make it possible for future renovations of the Medical Center’s current ORs and pre- and post-anesthesia rooms, while improving all facilities to meet present-day size and technology standards.
URMC could begin construction as early as spring 2008, with completion slated for summer of 2009.
Read an overview document, listen to podcasts, review Strategic Plan Executive Summary, and more.