The Team Award for Quality Improvement recognizes outstanding accomplishments of teams working to improve quality and excellence at Barnes-Jewish Hospital. This program offers teams opportunities to apply for the award and showcase their improvement efforts. Awards are given in the business results, clinical quality and service excellence categories.
Custom Pack Management Team
Custom Operating Room (OR) Packs are collections of supplies used frequently for specific types of surgical cases. They account for more than $6 million in perioperative services’ annual supply expenses. With 72 custom packs for south campus ORs and 43 for north campus cases, this team realized there was a potential to reduce supply expenses. The goals of the project were to reduce waste of unused product left in packs and establish formal processes that included standard work for the newly developed in-house pack reviews, pack change requests, and pack approvals and denials. Random pack change requests have been eliminated which, coupled with the implementation of the internal pack review process and team, resulted in reducing waste and annual hospital savings of $51,000.
Pre-Lung Transplant Services
The goal of this project was to identify wastes and variances in the pre-lung transplant process, and to develop a more streamlined process. The team targeted areas that were identified by its customers — patients, transplant physicians, and referring physicians — as well as the transplant staff. One of the biggest areas of concern was communication between the lung transplant program and referring physicians. Research revealed that formal correspondence with the referring physician was delayed for weeks, or missed altogether. A redesigned process has resulted in a 30 percent reduction from the time of referral until the referring physician receives a post-evaluation letter. Furthermore, the number of missing referral letters was reduced to zero after a pilot program was completed.
Hyperacute Stroke MRI
There’s a saying among teams who evaluate and treat potential stroke victims: time lost is brain lost. The clot-busting drug, tPA, reduces long-term disability from stroke when given within 4.5 hours of stroke onset. In cases where the diagnosis is unclear, or when timing of stroke onset is unknown, an MRI is recommended. The stroke team set out to reduce the time it took for a patient who presented at the emergency department with stroke symptoms to receive a hyperacute stroke MRI. Previously, MRI was not a rapid response test, and the fastest response times achieved was 86 minutes, in a controlled research study. As of March 2014, 47 stroke patients followed the hyperacute stroke MRI pathway with a median "door to MRI begin time" of 57 minutes. The efficiency of this new protocol allowed many patients to be given tPA within the recommended 4.5 hour window who would have otherwise not been able to receive tPA. The protocol continues to be used today with continued success.
Preventing Surgical Site Infections – Hip & Knee Replacement Decolonization
This team partnered with patients to help reduce staph infections in elective hip and knee replacement procedures. Through research, the team determined that a patient’s compliance with procedures to reduce the presence of staph bacteria on their body prior to their surgery was key. Through better patient education and better screening of patients prior to surgery, the team was able to achieve a significant reduction in infections. Prior to this team taking action, there were 0.5 surgical site infections reported per 100 patients. Following implementation, the rate declined to .06 infections per 100 patients. Not satisfied with this result, the team strives toward a goal of zero surgical site infections by continuing to educate and empower patients to be compliant with their pre-procedure protocols.
CPC Point-of-Care Quality Initiative for Augmenting Outcomes in PCI Populations
Patients undergoing angioplasty or receiving coronary stents are at risk for bleeding complications and damage to their kidneys from their procedure. In order to ensure the safest experience for our patients and to excel as a Cardiovascular Procedure Center when compared to other hospitals, this team launched a series of safety and quality programs to improve patient care. A new protocol was developed to ensure that patients received enough hydration to protect their kidneys from the dye used in the procedure. The center also launched a bedside risk-management program that helped physicians make appropriate determinations about ways to reduce a patient's risk of bleeding and determine how much dye to use to avoid kidney damage. As a result, the incidence of acute kidney injury to the center’s patients was reduced by nearly 40 percent, risk-adjusted bleeding declined by almost half. In addition, the center was able to improve clinical documentation for its highest-risk patients concerning the appropriateness of their procedure.
Rapid Recovery: Increasing Mobility Among Hip Replacement Patients
Research has demonstrated that hip replacement patients who begin walking and physical therapy the day of their surgery experience less pain in recovery and a shorter length of stay. In 2012, data indicated that only 50 percent of hip replacement patients at Barnes-Jewish who were eligible for therapy on the day of their surgery were receiving it. The team identified and executed several process changes, one of which was to identify patients as “rapid recovery” so their cases could be scheduled earlier in the day. Following implementation, about 72 percent of patients were getting out of bed the day of their surgery by September of 2013, and that number increased to 90 percent in 2014. In addition, length of stay has decreased from 4.3 days to 2.8 days.
Discharge Communications Project Team
The Discharge Project was initiated due to concerns expressed by primary care and referring physicians who were unaware of their patients' discharges from the hospital and what occurred during the stay. The team improved this important communication network by revamping and streamlining the online tools used by attending physicians to discharge patients. As a result, the number of incomplete physician notes decreased by 85 percent in 2014. The improvements also complied with Barnes-Jewish’s Meaningful Use requirement by increasing the availability of electronic discharge summaries for referring physicians and by making a patient’s discharge instructions available nearly 100 percent of the time they request an electronic copy.