Current Initiatives: Putting Quality and Safety First Here at Strong Memorial Hospital, providing consistently high quality and exceptionally safe health care remains our number one priority. Every day, we challenge patient care teams throughout Strong Memorial and Highland hospitals to find ways we can do better. We’re not shy about taking long, critical looks at the care we provide, studying outcomes, rethinking processes, and then benchmarking our results against peer institutions. While we are understandably proud of efforts we’ve undertaken in recent years—a few of them highlighted below—we won’t rest until we consistently deliver the very best patient experience in the nation. High Quality Reliable Care To assess the quality of our care, we monitor both processes (the way we deliver your care) and outcomes (the results of your care). Our doctors and nurses strive to identify best practices related to each disease or condition and consistently implement them for all patients. For instance, one CMS-endorsed process measure focuses on how well we equip heart failure patients to continue their own care once they’ve returned home. In light of this, we’ve paid keen attention to ensuring more thorough in-hospital education about the importance of consistently monitoring symptoms. Additionally, we now provide these patients standardized, condition-specific printed instructions upon discharge, minimizing the risk that they’ll require readmission later on. As a member of the University HealthSystem Consortium (UHC), Strong Memorial Hospital has access to a robust, real-time database that compares its quality outcomes with those of more than 100 academic medical centers peers. Hospital leaders and board members carefully track mortality, readmission, and complication rates to paint a picture of how dependably we care for our patients. Rescuing Patients with Severe Sepsis/Septic Shock When a patient has an infection, sepsis may occur. Sepsis is an inflammatory response throughout the body caused by chemicals released into the bloodstream to fight the infection. Most patients with sepsis are treated for the infection and recover without further intervention. In some cases, however, this inflammation can trigger a cascade of changes that can damage organ systems, causing them to fail. This is referred to as severe sepsis. If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival. UR Medicine hospitals have joined New York State in working to prevent mortality from severe sepsis and septic shock. In 2013, best practice “bundles” to identify and treat adults and children with sepsis were developed by our teams of doctors and nurses. These bundles were implemented in 2014 and, since then, we have been collecting data to measure compliance with the best practices for each of our patients. These efforts have shown a reduction in mortality related to severe sepsis and septic shock. Reducing Avoidable Readmissions: Striving for Safe Transitions Readmissions place undue physical, emotional and financial burden on our most vulnerable patients, but national data shows that nearly one in five Medicare patients will wind up back in a hospital within just 30 days. Eager to provide our patients with more effective care—and safer, more seamless transitions back to their home or a skilled nursing facility—Strong Memorial Hospital continues an ambitious effort to improve the discharge experience. The effort to reduce avoidable readmissions extends beyond the walls of the hospital and includes partnership with our primary care physicians and visiting nurse services to ensure the transition from hospital to home is as safe as possible for each and every patient. A key component of this effort involves identifying patients who are particularly at risk for readmission (for instance, patients who’ve been readmitted in the past, or who have certain conditions like congestive heart failure or pneumonia), and then taking extra measures to support their discharges. The program empowers patients and families, providing more robust patient education about medicines (their unique purposes, potential side effects to watch for, etc.). The program also amplifies communication efforts, encourages post-discharge phone calls home to patients (to answer any lingering questions, make sure medications are being taken, etc.) and instituting a more consistent loop-back effort between hospital providers and primary care physicians (timely phone calls, e-mails, and data reports to relay what happened during a patient’s inpatient stay). Finally, the program emphasizes the importance of patients securing timely follow-up appointments with their PCPs; in some cases, a hospital nurse will go the extra mile, working to schedule this appointment on the patient’s behalf. Exceptionally Safe Care UR Medicine strives to provide exceptionally safe care by promoting a culture which emphasizes the role of all doctors, nurses, staff, patients, and families in being members of the care team who will speak up to address safety concerns. Teams throughout UR Medicine are now working diligently to prevent three specific types of infections through consistently practiced “bundles” of preventive measures. Central Line-Associated Blood Stream Infections (CLABSI) While central line catheters are life-saving lines that deliver medicine, hydration and nutrition to patients, historically, they have also been a prime target for bacteria. These dangerous bloodstream infections affect hospitals nationwide, putting patients at risk for potentially avoidable pain, distress, and even death. Because of our proven track record in creating best-practice care-bundles that dramatically reduced ventilator-associated pneumonias at Strong Memorial Hospital, another ICU team was tapped to help eliminate catheter-associated bloodstream infections. The team pored over research, working diligently to develop two simple, cost-effective best-practice checklists—one for catheter-insertion, and another for line maintenance. Called “Stop the Line,” this new push to retrain staff in a more careful, consistent approach to catheter insertion and care (the program also empowers every team member, from unit secretary to physician, to speak up if they think the sterile environment has been compromised) was rolled out to all staff via mandatory education sessions. The results were striking—in just 18 months, infections dropped nearly 50 percent, bringing Strong’s rates below the national average. Encouraged by these advances, teams implemented the same checklist strategies in non-ICU areas, reducing infection rates amongst those patients as well. However, efforts to continue to prevent CLABSI have not stopped there – our doctors and nurses routinely review, test, and implement new technologies that have been shown to be effective at preventing these serious infections. Catheter-Associated Urinary Tract Infections (CAUTI) Another type of indwelling catheter is often used to remove urine from the bladder when a patient undergoes surgery or is unable to move easily. These catheters may cause a urinary tract infection in the bladder or kidney if germs travel along the catheter. Preventing catheter-associated urinary tract infection is important to help our patients’ avoid unpleasant symptoms, excessive antibiotic use, more serious complications such as sepsis, and extended time in the hospital. Building on the previous successes with other types of infections related to medical devices used in the hospital, we currently have a team of doctors, nurses, and other caregivers identifying and implementing best practices regarding prevention throughout the hospital. This team has worked in a collaborative with other hospitals sponsored by the University HealthSystem Consortium (UHC) to obtain as current information as possible regarding effective strategies to address this complication. The team has focused on encouraging the use of alternatives to urinary catheters and educating doctors and nurses about the importance of removing the catheter as quickly as possible during the patient’s stay in the hospital. Improvements have been made to ensure that sterile technique is consistently adhered to in the placement and maintenance of the catheters. These efforts are beginning to show success as the number of catheter-associated urinary tract infections at Strong Memorial Hospital has been decreasing. Surgical Site Infections (SSI) Infections that follow surgery, in the part of the body where the surgery took place, can sometimes be superficial, involving the skin only. Other times, these surgical site infections (SSI) are more serious, harming tissues under the skin, organs, or even implanted materials. At Strong Memorial Hospital, the initial focus was on preventing surgical site infections among our cardiac surgery patients. Cardiac care leaders at Strong have been successfully reducing rates of SSI after coronary artery bypass graft surgery (CABG) patients through a comprehensive program to root out all potential infection sources since 2008. Similar safety efforts were next adopted to reduce SSI after colon surgery and now have been expanded to include many other types of surgical procedures that are performed at Strong every day. A team of surgeons, anesthesiologists, OR nurses, and quality improvement staff met for over a year to develop best practice checklists and bundles to ensure that preventative measures are not overlooked for any patient. These bundles differ by type of surgery but all have a common core that include a focus on the operating room environment and instrument sterility as well as peri-operative practices that reduce the risk of infection for each patient. As these bundles become routine practice, we expect to see a similar decrease in surgical site infections across the hospital as we observed for our cardiac surgery patients.