The Great Catch Awards recognize Barnes-Jewish Hospital team members who intervene to prevent harm, or potential harm, to patients. Annual awards are given in three categories: courageous catch, critical catch and overall best catch. The annual Great Catch Award recipients are chosen from the year’s monthly winners.
The Courageous Catch exemplifies an employee choosing to protect a patient from harm even though it requires them to step out of their normal role or comfort zone and may cause risk to their person, their job or relationships.
The winner of the Courageous Catch Award is Brittany Brandt, BSN, RN. Brittany was working on discharging a patient when she noticed the patient’s heart rate was elevated. Brittany checked the peripheral pulse and found it to be irregular. After recommending and completing an EKG, the patient was found to be in a dangerous, irregular heart rhythm (Afib with RVR). The patient was then transferred to a high-risk cardiology unit and later on to the ICU.
The Critical Catch is awarded to the employee that prevented serious harm from occurring to a patient.
The winner of the Critical Catch Award is Brittany Monken, RN. Brittany received a patient at 7 a.m. and learned that at 5 a.m. he was a new onset AFIB. During the morning discharge rounds, the team was ready to discharge the patient. Brittany insisted that he not be discharged due to the change in his status and relayed that he needed anticoagulation for home. Upon further investigation by the vascular nurse practitioner, his discharge was canceled. The patient was cardioverted back into normal sinus rhythm the next day and was discharged safely.
Overall Best Catch is a combination of a courageous and critical catch that honors the employee who courageously protects a patient from harm and catches a critical patient safety error from occurring.
Sarah Feeherty, BSN, RN, received the award for Overall Best Catch. Sarah was caring for a patient admitted from an outside hospital with concerns of acute myeloid leukemia. The patient was to receive a bone marrow biopsy and begin chemotherapy. However, the patient began complaining of abdominal pain, distention and increased shortness of breath. She also was experiencing pain in her left leg along with numbness and coolness in her left foot. Sarah was unable to doppler the patient’s left pedal pulse. The physician was notified immediately and the patient was taken to the OR within hours for life saving procedures unrelated to the leukemia.
Colorectal Enhanced After Recovery Surgery Team
Barnes-Jewish Hospital was identified as a high outlier of colorectal surgical site infections with a rate greater than 20 percent. This was the impetus to create an Enhanced Recovery After Surgery (ERAS) protocol. ERAS is a framework for how colorectal surgical patients are managed across the perioperative period, with the goal of improving patient outcomes. A multidisciplinary ERAS workgroup was created and practices were changed. The ERAS protocol has resulted in a dramatic reduction in surgical site infection rates – less than 10 percent – and a significant reduction in length of stay. ERAS principles from this project are now being shared with other surgical services to continue to improve patient outcomes.
Data Management and Performance Measurements Team
The Data Management and Performance Measurements team (DMPM) developed and enhanced technology solutions to facilitate data aggregation, analysis and performance improvement opportunities for throughput initiatives at Barnes-Jewish Hospital. Goals were to maximize availability of information assets, prioritize areas for business improvement and develop a feedback mechanism for process improvement.
The throughput team was charged with identifying goals to enhance throughput and capacity, plus standardize definitions of key metrics related to throughput. The team also determined the frequency and methods of data distribution.
One of the deliverables – the Flash report – is a highly accurate and timely report that pulls data from nine sources. It is automatically emailed to stakeholders three times a day to facilitate bed placement and inpatient throughput. The report provides a variety of information to assess current state and assist in planning for the future by displaying 80 measures including current census, bed availability, patients waiting and perioperative cases for the day. Since the roll-out of the 7 a.m. Flash report, blocked beds have decreased by an average of 20 per day. The report is updated and emailed again at noon and 7 p.m. The noon report provides a measure for physician discharge orders by 11 a.m.
In addition, in 2015 and early 2016, the team completed 53 projects (137 tasks), and emailed over 141,336 reports. DMPM manages email subscriptions for 33 different reports to over 450 customers. Eighteen of these reports are emailed daily to clinical directors, nurse managers, assistant nurse managers, charge nurses, physicians and other key stakeholders.
Division 6900 “Red” Zone Team
The fall rate on division 6900 had been on the rise for years and the unit was determined to make improvements. Through analysis of fall data, the team determined 40 percent of the patients who fell on division 6900 had five things in common, which became known as the 5 Ds. Any patient identified as having two or more of the 5 Ds is placed into the “Red Zone” and interventions are put into place.
Following extensive staff training, the project was launched. In the first six months, the “Red Zone” helped identify high fall-risk patients early in their care. In the second quarter of 2016, the division went 42 days without a patient fall, and had only 8 falls during the quarter for an average of 2.6 falls per month. During the third quarter, there were 6 falls. It is a continued effort of all 6900 staff to sustain the “Red Zone” process and decrease patient falls.
Since implementation, other units within the oncology departments began looking at their patient population and how they could implement a similar process.
Doctors’ Access Line
Case Management Services developed a new process for screening transfer patients from outside hospitals that better suits incoming patients in terms of care and insurance.
Previously, receiving services, contacted through the Doctor’s Access Line, accepted most transfers without considering insurance network coverage or the medical necessity for transfer. This led to a substantial number of patients being transferred great distances to receive care that, often could have been provided closer to home. The hospital also faced challenges with capacity and throughput, and patients faced potential financial liability from being transferred outside of their insurance network.
A process was developed that focused on patients with non-urgent medical diagnosis to ensure patients met criteria for admission and developed tools to ensure Barnes-Jewish was an in-network medical provider for the patients. For more complex situations, physician advisors reviewed the plan. For those patients who did not meet criteria, additional resources were developed to make recommendations for outpatient alternatives such as clinic appointments and consultations.
The hospital is now meeting its goals for:
• reducing out of network admissions
• reducing the number of patients transferred who do not specifically require resources at Barnes-Jewish
• directing our resources more effectively to those patients who truly need a tertiary setting
Cost savings for redirecting out-of-network patients to their proper in-network facility has exceeded two million dollars.
Increasing Joint Replacement Patients Discharging to Home Team
The Barnes-Jewish Hospital and Washington University Hip & Knee Center of Excellence signed up for CMS’ Bundled Payment for Care Improvement (BPCI) programs in order to re-design major joint replacement care. Financially responsible for patient care for 90 days after admission, the team identified and implemented a number of interventions intended to improve clinical outcomes and reduce variation in care. One intervention was to increase the number of patients discharging directly to home, instead of post-acute facilities, reducing the risk of admission. Through consistent messaging throughout the continuum of care and enhanced patient education and engagement, 80 – 90 percent of hip and knee replacements performed at Barnes-Jewish Hospital and Washington University in 2016 went directly home after surgery.
Influenza Inpatient Vaccine Compliance Team
For several years, Barnes-Jewish Hospital’s inpatient influenza vaccine compliance had been less than the goal of 95 percent. This led to the formation of a team focused on achieving 95 percent compliance for the flu season beginning in October 2015.
The team began by mapping the current process and identifying potential breakdowns. Possible solutions were gathered, along with ideas to improve the process. These were prioritized based on the amount of effort needed to complete the task versus the benefit to be gained. The team met every two weeks and established standard work to ensure influenza vaccination is appropriately addressed during a patient’s stay.
Technology was used to create automations in the electronic medical record, minimizing the risk for human error. When appropriate, administering the vaccine earlier in the patient’s stay was encouraged. An internal report was created in COMPASS to pull daily reports on discharged patients to assess performance, enabling us to immediately identify and investigate outliers and use these as learning opportunities. A limited supply of vaccines were stocked on the floors in Pyxis so nurses could quickly obtain and administer the vaccine. As a result, the hospital experienced five consecutive months of exceeding or achieving its goal of 95 percent compliance.
Low Acuity Throughput Team
The Low Acuity Throughput team identified a need for a parallel path of treatment for patients seeking care in the Barnes-Jewish Hospital emergency department for non-life threatening medical conditions. This change has had a positive impact on patient satisfaction, decreased length of stay and increased efficiency in treating these patients. The multidisciplinary team worked to implement and maintain a new process that has impacted patients in a positive manner, providing them with excellent care in a reasonable time frame. This has also had a positive impact on our more acute patients by freeing up resources that would have previously been allocated to these less sick patients.
OR to ICU Handover Process Improvement Team
Safety issues during patient handover from the OR to the ICU were identified in 44ICU and 56ICU, which led to the creation of a multidisciplinary process improvement team from the CTICU, SICU, anesthesia, respiratory and the operating room. To improve safety, standard work was developed for all roles involved in the handoff process:
1) ICU room set-up
2) Notification process from OR-ICU
3) Notification process on arrival to ICU
4) OR-ICU handoff script
This improved work flow was shared with anesthesia providers, surgeons from all surgical services, and RN, RT, PCT, secretarial and ICU staff in all areas. The new handoff process has been in effect since 2014. Significant improvements have been sustained in the quality of the handoff report with no interruptions, presence of all team members required for handover, necessary equipment present in the room and a more thorough report in a shorter time period.
Transplant Medicare Cost Report Team
The Transplant Medicare Cost Report Team successfully implemented a process to identify and flag transplant organ acquisition-related charges. The process will help ensure every charge is identified and captured as a part of Medicare Cost Reporting. The team also developed a Soarian interface that will help capture approximately 95 percent of transplant-related organ acquisition charges.
Workload Assignment - 100 percent Consistent, 50+ percent faster
In December 2015, Clinivision, the system respiratory care services had relied on since the 1980s to pull inpatient order sets and assign scheduled services was about to become obsolete. IT, Compass and outside vendors were unable to offer a workable successor, and the benchmarking of other respiratory care departments both within BJC and across the country provided no suitable alternatives.
In the absence of a solution, respiratory care services would have to manually find and organize orders, which is an extremely time-consuming and error-prone option.
In just four months, a committed, cross-departmental team developed a new way to execute the process internally resulting in a process more than 50 percent faster and completely eliminating all consistency and reliability issues inherent in the original process.