Current Initiatives: Putting Quality and Safety First

Here at the University of Rochester Medical Center, providing safe, top-quality 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.

Reliable Care: Measurably Better

As a member of the University HealthSystem Consortium (UHC), the Medical Center has access to a robust, real-time database that compares its safety and quality outcomes with those of more than 100 academic medical centers peers. URMC leaders and board members carefully track several UHC metrics (including mortality, readmission, and complication rates) together with core clinical care measures published by the Center for Medicare and Medicaid Services (CMS) to paint a picture of how dependably we care for our patients.

For instance, one CMS 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 that these patients receive a more thorough in-hospital education about the importance of consistently monitoring their symptoms. Additionally, we now provide these patients standardized, condition-specific printed instructions upon discharge, minimizing the risk that they’ll require readmission later on.

Chasing Zero

URMC stepped up its quality and safety initiatives in 2010 by announcing three areas in which it will endeavor to drive infection rates down to zero: Central line associated blood stream infections (CLABSI) in all intensive care units, and all adult non-ICU units; surgical site infections (SSI) among heart bypass and colon surgery patients; and ventilator-associated pneumonias (VAP) in all adult ICUs.

This “chasing zero” effort represents a seismic shift from traditional thinking, in which modest rates of infection are considered an inevitable cost of doing business. Teams throughout Strong Memorial and Highland are now working diligently to eliminate these three types of infections through consistently practiced “bundles” of preventive measures. Zero may be an audacious goal, but already units throughout the hospitals are seeing real improvement. Some areas are logging months without a single infection.

Ventilator-Associated Pneumonia (VAP)

Thanks to efforts that began back in October of 2002, Strong Memorial Hospital became one of the first hospitals in the nation to demonstrate the ability to virtually eradicate VAP in the intensive care unit setting. A deadly problem plaguing hospitals throughout the U.S., national studies at the time estimated that these pneumonias affected between 10 and 65 percent of patients on ventilators—stretching the amount of time patients must spend in the ICU, or in many cases, even leading to death.

Thanks to strict adherence to a specific bundle of practices that have been shown to improve patient outcomes—practices like elevating the head of a patient’s bed more than 30 degrees to reduce the chances that secretions will pool in the lungs—teams throughout Strong have seen dramatic results. The incidence of VAPs dropped 67 percent the first year after the initiative began, with one ICU remaining VAP-free for almost 18 months straight. What’s more, VAP rates since have remained low; in fact, in 2010, Strong’s ICU VAP incident rate was less than half the national average.

Central Line-Associated Blood Stream Infections (CLABSI)

While 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 infections curse 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 VAPs at URMC hospitals, another ICU team was tapped to help eliminate catheter-associated 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 thought the sterile environment had been compromised) was rolled out to all staff via mandatory education sessions. The results were striking—in just 18 months, infections dropped close to 50 percent, bringing Strong’s rates below the national average. Encouraged by these advances, teams have begun implementing the same checklist strategies in non-ICU areas, reducing infection rates amongst those inpatients as well.

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.

Cardiac care leaders at Strong have begun successfully reducing rates of SSI for coronary artery bypass graft surgery (CABG) patients. In March 2008, a multidisciplinary workgroup composed of cardiac surgeons, nurses and other ICU personnel, infection control and operating room staff, met to launch a comprehensive program to root out all potential infection sources.

After scouring the literature, the team implemented an evidence-based checklist, including steps like taking nasal cultures (to check for resistant organisms, and treat patients when necessary) and using post-operative dressings containing silver-impregnated technology (which kills bacteria). In just half a year, the team reduced SSI for CABG patients by more than 50 percent. Today, rates remain well below the national benchmark, and in the fourth quarter of 2010, Strong Memorial saw zero CABG infections.

Currently, similar safety efforts are underway to reduce SSI in colon surgery patients.

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 has launched an ambitious effort to improve the discharge experience and cut 30-day readmission rates by 15 percent. Called “Safe Transitions,” this initiative began on all adult medical and surgical units in January 2011.

A key piece of this “Safe Transitions” program involves identifying patients who are particularly disposed to readmission (for instance, patients who’ve been readmitted in the past, or who have certain high-risk 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, introducing a routine post-discharge phone call 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.