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Welcome


Welcome to the Barnes-Jewish Hospital 2018 Report that shares a year full of challenges and successes. From day one, we rallied our team members to pull together for four milestone events including the opening of our new 12-story Parkview Tower and the implementation of a single electronic medical record platform across our academic campus.

These milestone events would not have been possible without the unwavering dedication of our clinical and non-clinical teams who worked through rapidly changing priorities.

However, most importantly our entire team maintained their focus and commitment to providing safe, quality care to the communities we serve. Our mission of taking exceptional care of people was never more apparent than this year when our teams lived, breathed and delivered excellent care to every patient, every person, every moment.


 

By the Numbers


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Highlights


A year of milestones

Parkview Tower connects with the new 12-story expansion at St. Louis Children’s Hospital by a fifth-floor bridge over Parkview Place, connecting labor and delivery and the level-four neonatal intensive care unit (NICU).

Barnes-Jewish Hospital entered 2018 facing four milestone events while fulfilling our mission of taking exceptional care of people.

Parkview Tower

In February, Barnes-Jewish Hospital officially welcomed patients into Parkview Tower. The new 12-story inpatient tower was designed to enhance the care and comfort of patients at Barnes-Jewish and Siteman Cancer Center.

The distinct design of the tower will shape the lives of countless patients, team members, physicians and the greater community as it expands clinical care at the Siteman Cancer Center, grows the hospital’s surgical programs, and launches St. Louis’ most advanced, integrated center dedicated to women’s health.

By the numbers


  • Square feet: 558,000
  • Stories: 12

Siteman Cancer Center space


  • 160 private rooms
  • 10 bone marrow transplant intensive care unit (ICU) beds

Women & Infants Center space


  • 52 obstetrics inpatient beds
  • 18 labor and delivery rooms
  • 12 women’s assessment rooms
  • 3 C-section rooms
  • 1 fetal surgery operating room

Other space for adult patients


  • 15 inpatient ICU beds
  • 12 operating rooms
  • 5 interventional rooms

Magnet

In 2018, Barnes-Jewish Hospital once again achieved the highest acknowledgment of nursing excellence — Magnet recognition by the American Nurses Credentialing Center (ANCC). To confer Magnet designation, the ANCC looks for evidence of excellence in the following areas: transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvements, and empirical outcomes. Barnes-Jewish submitted more than 1,000 pages of documentation and then participated in a four-day on-site review by an ANCC appraisal team in January.

In 2003, Barnes-Jewish was the first adult hospital in Missouri to receive Magnet designation. Hospitals must apply for Magnet program re-designation every four years, and Barnes-Jewish is among less than 1 percent of hospitals in the U.S. that have maintained this status since the program was launched in 2003.

Research cited by the ANCC indicates that hospitals embracing Magnet standards achieve better nurse satisfaction and an improved patient experience. Barnes-Jewish has a staff of 3,738 nurses, and 82 percent of them hold a bachelor’s degree or higher.


Epic

In June, Barnes-Jewish Hospital, along with Washington University School of Medicine, St. Louis Children’s Hospital and Barnes-Jewish West County Hospital, successfully implemented Epic, a new electronic health record system. The implementation on our campus added about 40,000 enterprise Epic users, making it one of the largest go-live events in Epic’s history.

The official go-live date followed months of planning and training. During the first days of using the new system, issues arose and were quickly addressed and resolved. Epic support personnel reported they have never seen an organization so prepared at go-live. Team members throughout the organization continue to provide feedback on ways to further optimize Epic to improve daily work.

The implementation of one electronic medical record platform throughout BJC facilities and the Washington University Faculty Practice Plan is a significant and important step for our patients. This standardization has resulted in improved accuracy, timeliness and increased satisfaction among both patients and clinicians.


The Joint Commission

To participate in government payment programs, U.S. hospitals must undergo review by The Joint Commission every three years. In December 2018, a team of surveyors from The Joint Commission arrived to conduct the hospital’s triennial review. Six surveyors logged more than 150 hours of direct observation as they visited every part of the hospital – surgical and medicine floors, ORs, ICUs, along with off-site locations such as the Psychiatric Support Center, Chesterfield Orthopedics and our South County facilities.

Barnes-Jewish team members were eager to showcase their work and commitment to excellence. The surveyors noted many best practices and the unique ways Barnes-Jewish team members support each other. By the end of the week, The Joint Commission validated what hospital staff already knew: that Barnes-Jewish is among the very best places to receive the highest quality care, delivered by the very best people.


Safety & Quality


Enhancing recovery after surgery sends patients home healthier, sooner

Barnes-Jewish Hospital’s Enhanced Surgical Recovery program that began in 2017 is steadily making its way through the hospital’s services lines of care. The program targets 48 elective surgeries impacting more than 12,000 surgical cases annually across five departments and 18 sections. To date, 13 teams have developed 18 pathways. Two pathways, living donor for kidney and bariatric surgery, made significant strides in 2018 to improve recovery time for patients and reduce length of stay.

Chris Eagon, MD, and Shaina Eckhouse, MD, Washington University physicians, are two of the bariatric surgeons instrumental in the Enhanced Surgical Recovery Program for bariatric patients.

Liz Pratt, DNP, ACNS-BC, RN, director of Enhanced Surgical Recovery at Barnes-Jewish, explains the focus on living kidney donors. “In 2017, the hospital reached a milestone for living kidney donation with 5,000 donations. These are healthy people who are coming into the hospital for the altruistic act of donating an organ. We want to make sure that, after the surgery, they recovery quickly and have the shortest hospital stay possible.”

The transplant team implemented a multi-modal pain therapy to treat patients’ pain and reduce opioid use, which includes:

  • A long-acting numbing medicine near the surgery area in the operating room that helps them upon wakening.
  • Administering acetaminophen around the clock after surgery.
  • Administering opioids if the pain becomes worse.

A significant amount of time is spent partnering with the patient to set expectations. Patient education around types of pain – surgical pain and referred pain, and the importance of ambulating as soon as possible after surgery to help relieve pain – is stressed. Before discharge, nurse practitioners review medications the patient has taken and agree what the patient will go home with, including when they should call if their pain is not improving.

The team’s work has paid off with a 70 percent reduction of opioids taken home by patients, a decrease in length of stay by more than a half day, and zero readmissions for pain and bowel obstruction.

Says Pratt, “The benefit of the enhanced surgical recovery program is that steps taken to improve are unique and specific to the type of surgery.” For bariatrics, the team focused on:

  • Expanding perioperative education including patient panels that share successful strategies and offer support.
  • Improving postoperative complications including infections and nausea, with preventative strategies.
  • When necessary, patients are now seen postoperatively with same-day appointments or an infusion clinic to avoid the emergency department.

As a result, readmissions for bariatric patients has decreased by 43 percent.

 

From left, Courtney Hosto, PA-C, physician assistant; Jason Wellen, MD, MBA, surgical director of Washington University and Barnes-Jewish Transplant Center’s kidney program; and nurse practitioner Julie Colicchio, MSN, RN, NP-C, check on Ryan Armistead, a kidney transplant patient.

 

2018 Strategic Priorities

Objective 2018 Improvement Priorities
Improve Vizient ranking from 3 stars to 4 stars
  • Improve the patient experience and equity of care with a focus on HCAHPS as a measure of improvement.
  • Initiate a study of High Risk Patient (HRP) access pathways and how they can all integrate for more efficient and effective care. The focus for 2018 is to redesign patient-care pathways for HRPs that access care through the ED.
  • Continue to develop and implement the ED Operating System with a focus on employee development and retention.
Achieve the 2019 budget of 11.8% margin
  • Implement EPIC successfully.
  • Plan and grow volume to fill additional capacity.

2018 Vizient Quality and Accountability Performance Scorecard

This scorecard provides a comparison of Barnes-Jewish Hospital’s performance with that of other comprehensive academic medical centers. In 2018, Barnes-Jewish Hospital improved its ranking among the 99 hospitals from 42 with a three-star rating to 26 with a four-star rating. The data is provided by Vizient, the Hospital Compare Web site and the National Healthcare Safety Network.

Star rating

 

Overall rank

26

Overall score

60.06%

Domain performance

Color based on domain rank

1-10
11-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91-100

Barnes-Jewish Hospital 2018 Year-End Best-In-Class Clinical Quality Scorecard

Barnes-Jewish Hospital achieved an overall Best-In-Class score of 0.92 in 2018. The Clinical Quality Performance Scorecard outlines performance in patient care or treatment delivery. Performance improvement teams are assigned to each quality indicator to evaluate processes, systems, clinical practice and healthcare worker behaviors, make recommendations for improvement, and share information on best practices.

  Maximum   Target   Threshold   Minimum   Below Minimum
Indicator   2018 Target     2018 YTD   YTD Performance
Safe
Falls with injury per 1,000 patient days (excludes gero-psych units) 0.60 0.76  
Standardized infection ratio for lab Catheter-associated Urinary Tract Infection (CAUTI) ICU (NSHN) 0.60 0.57  
Standardized infection ratio for lab idenftified Clostridium Difficile infection (NHSN) 0.60 0.98  
PSI Roll-up (Composite) (BJH) 118 123  
PSI-6 Iatrogenic Pneumothorax   13  
PSI-9: Postoperative Hemorrhage or Hematoma   12  
PSI-11: Postoperative Respirator Failure   32  
PSI-13: Postoperative Sepsis   66  
Standardized infection ratio for Central Line-associated Bloodstream infection (CLABSI) ICU (NHSN) 0.86 0.62  
Standardized infection ratio for hysterectomy surgical site infection (NHSN) 0.60 0.92  
Inpatient Vizient Mortality Index (Vizient) 0.86 0.78  
Effective
Hospital-wide All-Cause Unplanned 30-Day Readmissions (Vizient) 11.54% 11.99%  
VTE-6: Hosptial acquired potentially preventable venous thromboembolism (CMS-IP) 1.00% 4.28%  
Efficient
Median Time from ED Arrival to ED Departure in HMED for Admitted ED patients (BJH) 427 462  
Vizient LOS (Length of stay) index (Vizient) 0.96 0.93  
Patient Centered
HCAHPS - Overall Patient Experience: Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) (HCAHPS) 76.12% 76.06%  
Safety Structural Measures
Just Culture (BJC) 97.0% 100%  
Operating System (BJC) 130 140  
Epic BCMA (BJC) 94% 94%  

Barnes-Jewish Hospital 2018 National Patient Safety Goals

An independent, not-for-profit organization, The Joint Commission, accredits and certifies more than 20,000 health care organizations and programs in the United States. The Joint Commission is committed to improving health care safety. This commitment is inherent in its mission to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. At its heart, accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes.

Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Its National Patient Safety Goals (NPSGs) program was established to help accredited organizations address specific areas of concern in regard to patient safety.

The chart below provides a review of Barnes-Jewish Hospital’s NPSG measures comparing 2018 targets to year-to-date metrics.

  Maximum (BIC) Top 10%   Target   Threshold (Top 25%)   Minimum
 
  2018 TARGET 2018 YTD YTD vs Goals
Medication Safety
Medication reconciled at discharge 90% 97%  
Medication reconciled at admission 90% 98%  
Medication Labeling 90% 100%  
Improve the effectiveness of communication among caregivers.
Use 2 patient identifiers when taking specimens, administering medications, treatments or blood and blood products. 95% 100%  
"Read back" performed for received telephone/verbal orders or critical test results - Nursing 95% 100%  
"Read back” obtained for reported critical test results and values-Lab 95% 100%  
Critical results/values reported by Lab within 30 minutes of availability of results. 95% 100%  
Critical results/values reported to licensed person who can act, within 60 minutes of notification of results. 95% 97%  
Universal Protocol: Eliminate wrong site, wrong patient and wrong procedure surgery.
Pre-procedure verification process completed:
        Operating Room: Checklist completed. 95% 100%  
        Procedure Areas: Checklist and/or area-specific elements documented. 95% 96%  
Surgical or procedure site marking completed prior to procedure:
        Operating Room 95% 100%  
        Procedure Areas 95% 94%  
Time out (final verification process) conducted prior to the start of procedures:
        Operating Room 95% 100%  
        Procedure Areas 95% 99%  

2019 National Patient Safety Goals

Barnes-Jewish Hospital works to ensure processes that address the following National Patient Safety Goals established annually by The Joint Commission.

Improve the Accuracy of Patient Identification


  • Use two patient identifiers when providing care, treatment and services.
  • Eliminate transfusion errors related to patient identification.

Improve Effectiveness of Communication Among Caregivers


  • Report critical results of diagnostic tests and procedures in a timely manner to the provider/staff authorized to respond to the results.

Improve Safety of Using Medications


  • Label medications and solutions when transferred from original packaging into another container (for example, a syringe or basin) even when only one medication/solution is being used.
  • Follow established procedures to reduce likelihood of harm to patients on blood thinners.
  • Compare patient home medications to those ordered in the hospital to identify discrepancies or duplicates; provide the patient with a new medication list at discharge.

Reduce Health Care-Associated Infections


  • Follow hand-hygiene guidelines and set goals to improve hand-cleaning rates.
  • Use proven guidelines to prevent health care-associated infections related to the use of certain devices and surgical procedures.

Improve Safety of Clinical Alarms


  • Establish alarm safety as a priority and identify the most important alarm signals to manage.
  • Ensure alarm management procedures address key aspects such as alarm settings, changing or turning off alarms, response to alarms and checking equipment for proper operation of alarms.
  • Educate staff and providers about the purpose and proper operation of alarm systems for which they are responsible.

Reduce the Risk for Suicide


  • For designated behavioral health patient space, conduct an environmental risk assessment to identify and eliminate features that could be used to attempt suicide.
  • For non-designated spaces where patients at risk for suicide may be treated, implement procedures to mitigate or remove environmental risks that may pose a risk for self-harm.
  • Screen patients for suicide risk who are being evaluated or treated for behavioral health conditions as their primary reason for care. If screening is positive, conduct a focused suicide assessment.
  • Trained and competent staff care for, monitor and reassess patients at risk for suicide.
  • At discharge, provide follow up care and counseling, as appropriate.

Universal Protocol


  • Prevent wrong-site, wrong-procedure and wrong-person surgery
    • Use a pre-procedure checklist to verify correct medical record documents, test results, and/or required equipment/supplies are available and match to the correct patient.
    • Mark the procedure site which should be visible after skin preparation and draping.
    • Just prior to the start of the procedure, a “time out” is performed to verbally verify the correct patient, procedure and site.

Patient Experience


Creating a diverse team to serve a diverse patient population

As an urban, academic medical center, Barnes-Jewish Hospital serves an ethnically and socioeconomically diverse patient population. In 2018, about 16,000 of our patients indicated that their primary language was something other than English.

We strive to provide an excellent experience that is also equitable to every patient, every person, every moment. To achieve this, we:

  • Provide cultural competency, equity, and inclusion training for staff.
  • Offer resources for limited English proficient (LEP) and deaf/hard of hearing patients.
  • Reach beyond our walls to learn about the needs of our most vulnerable communities.

Why do we think this way?

Whether we’re aware of it or not, we all possess biases that affect how we see, experience and engage in the world. This is important to recognize because biases, particularly our unconscious ones, can also affect the delivery of health care.

For the past two years, Barnes-Jewish Hospital, along with our parent organization, BJC HealthCare, has been training our staff to be aware of their unconscious biases. The training, called “Everyday Bias for the Health Professions,” teaches caregivers how unconscious biases can affect important health care decisions and outcomes.

By the end of 2018, 90 percent of all BJH leaders and 50 percent of all BJH staff had completed this training.

Do you speak my language?

Communication is key to effective healthcare, and consistently ranks among the top contributors to medical errors. Language services at Barnes-Jewish Hospital provides round-the-clock medical interpretation services and language support for patients in more than 85 languages and dialects.

Adam Brouillard, MD, uses the new Cyracom two-way phone set to communicate with a clinic patient whose primary language is Nepalese.

These services are provided free of charge to our patients in multiple ways: on-site interpreters, over-the-phone interpretation, video remote interpretation and written translation services. In 2018, Barnes-Jewish joined with BJC HealthCare in upgrading to Cyracom interpreter devices, which provides coverage for additional languages and increased privacy.

The new Cyracom phones improve patient/caregiver confidentiality through the use of a two-way handset.

Are you listening?

Many leading hospitals have a vision for improving the care they provide while aspiring to improve the health of the communities they serve. To refine that vision, Barnes-Jewish solicited feedback from surrounding communities through a series of listening sessions in 2018.

The sessions, held at places of worship and community centers, were an opportunity for community members to share their views about Barnes-Jewish and to tell hospital leaders about their visions for better quality care. The information gained from these sessions is being used to improve overall patient experience and to bolster programs aiming to reduce health disparities that exist within our patient population. Community representation also has been added to our existing Patient Advisory Council, transforming it into a Patient, Family and Community Advisory Council.


Awards & Achievements


Barnes-Jewish Hospital’s exceptional quality and unmatched experience has earned regional and national recognition. We also recognize our team members annually for their contributions to patient safety and quality, and for initiating process improvements in specific areas and across the hospital.

Great Catch Awards


Anna Mosby

Courtney Rodriguez

Penny Brasfield

Overall Best Catch Award – Anna Mosby, MOTR/L

On her way to the hospital, Anna Mosby helped a visitor who was having serious difficulty getting up the stairs with several bags. Shortly after getting him settled inside, she enlisted the assistance of a public safety officer and a code was called. Mosby’s willingness to offer assistance may have ultimately saved the visitor’s life.

Courageous Catch – Courtney Rodriquez, RN

Courtney Rodriquez noticed one of her patients was not responding normally. A head CT scan was ordered and the results were normal but Rodriquez persisted in verbalizing her concerns. When an angiocath was ordered, it showed the patient had an emerging stroke.

Critical Catch Award – Penny Brasfield

Penny Brasfield was stocking supplies when she heard a patient struggling to breathe. When she checked on him, she noticed his tracheostomy tube had become dislodged. Brasfield alerted the staff and a code was called, ensuring the patient received timely intervention to secure his airway.

Team Awards for Quality Improvement


Sepsis Mortality Reduction

Sepsis is a potentially life-threatening condition caused by the body’s response to infection. By assembling a team that crossed many areas of the hospital and creating better screening and data display tools, the team succeeded in improving the hospital’s performance on this metric to 52nd in the country among 150 medical centers last year.

Stroke Imaging Implementation and Workflow Team

For patients suffering a stroke due to blockage of a brain artery, time to treatment is critical. By redesigning this critical flow of work, the team was able to decrease arrival time for treatment by five-and-a-half minutes from previous levels.

Cardiac Surgery Prolonged Ventilation Taskforce

Through our telemedicine ICU service, reminders to evaluate the patient for removal of ventilators are posted for the treatment team every six hours following the patient’s surgery. As a result, average time on ventilators decreased by 11 hours last year, and the number of coronary artery bypass patients on a ventilator more than 24 hours decreased by 78 percent.

BJH Patient Transportation

The team focused on one of its highest volume areas – transports to south radiology – and sought to better understand the department’s needs and causes of delays. To achieve sustained improvement, patient transport managers now engage in a daily huddle to review radiology transport times and evaluate changes that have been made.

Reducing Patient Meal Turnaround Times

With the growth in patient census in Parkview Tower, tray volumes for north campus have increased about 46 percent. Following a rapid improvement event, meal delivery times decreased by 28 percent. North campus patients now receive meal trays an average of 29 minutes after the order has been placed.

MRI CED Workflow Improvement Team

The presence of any metal during an MRI presents a serious safety risk. By improving communication and standards between the department and nursing units, the MRI department was able to reduce safety events in the MRI area related to cardiac implantable electronic device (CIEDs) to zero last year.

Outpatient Radiology Team

When patients present at radiology with an incorrect order, it causes delays, impacts patient safety and decreases patient satisfaction. In December 2017, the team established a new exam ordering guide for all orthopedic patients. As a result, radiology decreased incorrect orders by 59 percent for the first half of 2018.

Strategic Data and BJC Decision Support Team

The data management and performance measure team utilized innovative technology to integrate more than 16 billion rows and 576 columns of data, into a high-performance database. Users in all 13 BJC entities can now instantly query Business Decision Support data to perform self-service analytics.

Surgical Hip and Fracture Treatment (SHFT) Care Redesign

When patients fall and break a bone, or when a bone needs to be surgically broken as part of cancer treatment, there is little to no time to prepare for the difficult recovery ahead. The SHFT workgroup standardized care for these patients, reduced readmissions and identified processes that allow them to return home sooner.

SEMS Quick Submit

In order to encourage staff to speak up and use the safety event management system to report safety issues or concerns, this team developed a quick submit form in the hospital’s Safety Event Management System (SEMS), which reduced the time it takes to enter a report by nearly 57 percent, and reduced operating costs.

CT Error Reduction and Prevention

The Barnes-Jewish CT department performs more than 100,000 exams per year. Through the Error Reduction and Improvement project, the CT department made a strong commitment to excellent care and patient safety. Exams performed without an avoidable error has reached a success rate of 99.7 percent, improving from 99.4 percent at the beginning of the year.

View more hospital awards and achievements.


Community Outreach


With 10,000-plus team members at Barnes-Jewish Hospital and more than 30,000 across BJC HealthCare, we’re invested in our communities and committed to reaching across the St. Louis Metropolitan Region. View the details of our outreach.

Each October, Barnes-Jewish Hospital provides 20,000 free flu shots for the community across the St. Louis region.


Leadership


Barnes-Jewish Hospital leadership includes many people throughout a variety of disciplines that plan for daily operations, long-term success and a continued commitment to patient safety and quality

Barnes-Jewish Hospital administration includes:

Robert Cannon, President


Sam Darweesh, Vice President, Women & Infants Center


Susan Ell, Executive Director and Vice President, The Foundation for Barnes-Jewish Hospital


Mark Krieger, Vice President and Chief Financial Officer


Christina Longnecker, Vice President, Oncology Services


John Lynch, MD, Vice President, Chief Medical Officer and Chief of Clinical Operations


Jackie Martin, Jr., MD, MBA, Vice President of Perioperative Services


Gregory A. Patterson, Vice President, Facilities and Support Services


Angelleen Peters-Lewis, Vice President of Patient Care Services and Chief Nurse Executive


View our board of directors and governing councils.


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