Corridor hospitals part of statewide initiative to boost quality of care

Bad things can happen at hospitals, admits Tom Evans, chief executive officer of the Iowa Healthcare Collaborative.

'This is a complex industry,' Evans said. 'It's easy to say bad things happen sometimes — but sometimes things are preventable. We need to have a common understanding of where we are and what we can do better.'

In fact, hospitals in Iowa and across the country are working to improve the quality of care patients receive, cutting down on hospital-associated conditions, such as surgical-site infections, and improving readmission rates.

About 50,000 fewer patients nationwide died in hospitals and about $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013, according to a U.S. Department of Health and Human Services report released last week.

In 2013 alone, almost 35,000 fewer patients died in hospitals, and there were about 800,000 fewer incidents of harm having occurred — saving $8 billion — the report found.

Hospital-acquired conditions can include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical-site infections, among others.

Hospitals throughout the country are working to reduce these adverse events, in part due the Affordable Care Act, which created Medicare payment incentives to improve the quality of care, and through the Partnership for Patients initiative.

The Health Department began the Partnership for Patients initiative in 2012 to make health care safer and less costly through reducing preventable injuries and complications. It set a goal of reducing readmissions by 20 percent and bringing down preventable harm by 40 percent by 2014.

The Centers for Medicare and Medicaid Services then created a nationwide public-private collaboration, awarding 27 contracts to these partnerships — called Hospital Engagement Networks — to identify improvements and solutions.

Best practices in Iowa

Iowa's Hospital Engagement Network, the Iowa Healthcare Collaborative, has 100 percent hospitals participation.

The 128 participating Iowa hospitals prevented harm to more than 4,300 patients in 2013 and reduced health care costs by more than $51 million, according to health care collaborative.

'We asked every hospital to build a work plan and develop their own strategy,' said Evans, its CEO. 'They then had to measure how they're doing on a monthly basis.'

Evans said the state's hospitals have worked to reduce adverse drug events by 99.9 percent, early elective baby deliveries by 95 percent, and pressure ulcers by 85 percent.

Corridor hospitals have worked diligently over the past few years to improve metrics, administrators said, mainly by studying and implementing best practices.

'We look at what's been tried and what's been successful,' said Dr. Mark Valliere, Mercy Medical Center's chief medical officer. 'Then we see what's doable and what has a favorable outcome.'

Ventilator-associated pneumonia rates have dropped over the years at both Mercy and UnityPoint Health-St. Luke's Hospital. Ventilator-associated pneumonia, a lung infection, develops in someone who is on a ventilator for breathing assistance.

Mercy's rate has fallen from 6.51 per 1,000 ventilator days in 2010 to 1.250 per 1,000 days in 2012. It had a rate of zero through September 2013. St. Luke's has had a rate of zero for the past three years.

Mary Ann Osborn, St. Luke's regional senior vice president chief care coordination officer said the hospital has implemented strategies from the Institute of Healthcare Improvement, which include elevating patients' heads, improving their oral care, and making sure they are digesting food properly.

Osborn said while these tasks seem simple, they are easily missed because health care professionals caring for a patient have 'multiple priorities' at once.

To deal with this, the hospital has built these practices into order sets and established multidisciplinary rounds, which are physician led but include the patient's health care team — nurses, social workers, pharmacists, and therapists.

'They do their rounds every morning, a lot of times the family is present,' Osborn said. 'They find it hugely satisfying because they can ask questions and know what the plan is.'

Both hospitals also have worked to improve readmissions rates. Mercy met national benchmarks for readmissions in all categories, and performed better than the national average of readmissions after hip or knee surgery, according to the hospital's 2014 quality report.

Meanwhile, St. Luke's has a readmissions rate of 10.1 percent, compared with a national rate of 17.7 percent, Osborne said.

'There's not one silver bullet to improve readmissions rates,' she said, attributing its success to post-acute care, the hospital's home-care team, and new intervention practices put into place, including its teach-back program that involves patients repeating treatment and information back to their physicians.

Mercy's Valliere agreed, saying the hospital continues to implement new practices over time.

'We keep scanning the literature,' he said, 'and we keep driving it down, getting it lower and lower and lower.'

This helps the hospital save but more importantly, it ensures that patients don't leave sicker than when they arrived.

'If you're coming into the hospital for a knee or hip replacement, you're not planning of getting an infection and being in the hospital for 10 days instead of two days,' Valliere said.