Do basics and beyond
Dr. William Bornstein, Emory Healthcare’s chief quality officer, said performance statistics like Medicare’s have forced the basics of care back to the top of the agenda, even at teaching hospitals where the focus has been training new doctors and developing ground breaking treatments and technologies.
“We’ve got to continue to be on the leading edge of the brilliant type of things,” Bornstein said, “but we also have to do the basic blocking and tackling of making sure all the patients who should get flu shots get flu shots and all these medications are delivered to patients on time.”
Achieving a strong record isn’t as simple as putting a memo out to the staff on one day and getting full compliance on the next.
St. Joseph’s Hospital in Atlanta stands out for its low rate of readmissions among heart failure patients. Before patients leave the hospital, they must graduate from Heart Failure University, a six-session program that covers everything from when to call the doctor to the sodium content in a can of soup. “It’s been tremendous in the compliance we have seen,” said Dr. John O’Connell, director of St. Joseph’s heart failure program.
But O’Connell isn’t satisfied. He’s in the midst of devising a new program that will send heart failure patients home with blood pressure cuffs and scales and a means to transmit results so that the hospital can closely track patient progress during the first 30 days of recovery at home.
Many hospitals have been reluctant to take on such preventive care programs, O’Connell said, because of the expense. That attitude is changing, he said, as Medicare contemplates a pay-for-performance model.
Atlanta’s Piedmont Hospital is the only hospital in Georgia to post a better-than-average pneumonia death rate in the Medicare report.
To get there, the hospital assembled a team of nurses, doctors, pharmacists, respiratory therapists and specialists in information technology, radiology and infection control.
The team developed a system under which a “red bar” would fire in the emergency room if a probable pneumonia patient came in. The system allowed for a variety of short cuts with one goal in mind: quickly administering an antibiotic.
“That’s what prevents it from getting so bad that you end up on a ventilator,” said Connie Whittington, Piedmont’s vice president of nursing services.
The time-saving changes involved such steps as locating a stock of antibiotics in the ER instead of the pharmacy. The results for patients are powerful.
“It really helps us to save lives every day,” Whittington said.
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