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 categories of business results, clinical quality and service excellence.
Living Donor Kidney Transplant Team
In 2014, the kidney transplant program at Barnes-Jewish Hospital increased its living donor volume by 25 percent, its highest volume since 2010. Efforts to streamline the donor evaluation process decreased the average time from referral to donation by 84 days. The program also experienced a 30 percent increase in volume of patients undergoing evaluation.
LVAD Equipment Management Team
The LVAD Equipment Management Team successfully standardized the ordering and billing process for inpatient and outpatient LVAD equipment, and ensured every piece of equipment is accurately billed within five days of the date of service. The team was able to improve charge capture on average by 19 percent to achieve its goal of 100 percent of equipment charges, and reduce late charges to 2.7 percent.
8400 CAUTI Reduction Team
Urinary tract infections are one of the most common hospital-acquired infections with the urinary catheter contributing up to 80 percent of those infections. The 2014 Barnes-Jewish Hospital strategic plan goal for safety and quality “to reduce potential hospital-acquired conditions” named catheter-associated urinary tract infections (CAUTI) as a specific concern. In an effort to improve patient care and safety, the hospital’s 8400 medical intensive care unit joined the University HealthSystem Consortium CAUTI Improvement Collaborative in August 2014 with the goal of decreasing CAUTI rates per the National Healthcare Safety Network (NHSN) definition from the baseline of 5.1 to 2.4. The initiative was a success with the unit experiencing a 68% decline in CAUTI rates. The unit went for eight consecutive months without a CAUTI (October 2014 through May 2015) using the 2015 NHSN CAUTI definition. The Standardized Infection Ratio decreased from 2.2 to 0.49 exceeding the target of 0.8.
Pharmacy and Respiratory Care collaborated to plan and institute a process for timely delivery of Colistimethate. This drug, once prepared, has a short life and timely administration is challenging. To eliminate delays and missed administration, the team decided to move the preparation of the drug from Pharmacy to Respiratory Therapy. Preparing the medication at the bedside resulted in timely administration, zero wait times and the elimination of remixing.
Readmission Prevention Team
- acute myocardial infarction
- chronic obstructive pulmonary disease
- congestive heart failure
Successful implementation of specific interventions required the support and collaboration of various members of the interdisciplinary team. With a targeted approach, the team has been successful in reducing the overall rate of 30-day hospital readmissions for these diagnoses since 2011. The greatest success to date was achieved in 2014. The 2014 BJH key performance indicator target for this population was 19.3%. Following implementation of this program, the overall BJH readmission rate for these diagnoses decreased from 24.39% in 2011 to 15.63% in 2014. The BJH Readmission Team continues to strive to reduce readmissions and has been collaborating in 2015 with the Readmission Prevention Teams for elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass grafting.
Epharmix – IDEA Labs Team
Epharmix?is a collaboration of?health care innovators including providers, Barnes-Jewish Hospital?team members, administrators, medical students, engineers, and?Washington University School of Medicine?faculty?that were brought?together?through the Washington University IDEA Labs incubator.?This team has developed solutions to the problem of inefficient patient-provider communication after discharge. As described by the?Joint?Commission, this?communication?inefficiency leads to?reduced effectiveness of medical interventions, decreased patient satisfaction and poor clinical outcomes.?To meet this challenge, the team developed a portfolio of condition-specific communication tools that not only increased the amount of patient communication with providers and hospital team members, without creating additional work.
The tools collect specific relevant information from the patient (such as blood sugars, breathing difficulties, etc.) using phones they already have, and use smart algorithms to ensure providers are contacted only when necessary. The Epharmix solution has already demonstrated a 54 percent reduction in hospitalization for dialysis patients and a 9/10 in patient satisfaction with patients commenting: “I look forward every morning to that phone call at 8:30. People are looking after me,” and that the system “keeps me on point with my health.”
CT Radiology Performance Improvement Team
The CT department significantly reduced patient wait times, and increased patient satisfaction and employee engagement, all while meeting volume demands for CT exams. This was accomplished through the involvement of the entire CT team using a daily continuous improvement system of lean tools and concepts, MDI (managing for daily improvement) boards, huddles, and an idea management system to collect, analyze and implement improvement ideas generated by the staff. The team has sustained the improvements.
Pulmonary Rehab Scheduling Accuracy for Transplant Patients Team
Respiratory therapists in the pulmonary rehabilitation department provide 6-minute walk tests for lung and kidney transplant outpatients. The appointments are scheduled by therapists when contacted by the transplant secretaries. The therapists noted that patients would frequently arrive only to learn they were not on the schedule and it wasn’t always possible to fit them in when this occurred, which was frustrating for both patients and therapists. The pulmonary rehab team set a goal to reduce scheduling errors to less than 3 percent as a 2015 strategic goal.
To understand the current state, they created a process improvement team and collected post-appointment error data to estimate the most likely causes. The main failure seemed to be a change in appointment that was not communicated successfully.
The team mapped the process, emphasizing steps involving changes, communication and confirmation. Key stakeholders with the lung and kidney transplant departments were engaged. Comparing three months of baseline information to the “after- intervention” period of May to August, the number of visits remains constant and the proportion of appointment errors plunged from 10-20 percent to 2-3 percent; with 0 percent for several successive weeks. The “after” state is now stable and virtually zero.