About Triumph Healthcare • Triumph Healthcare consists of 29 long term acute care hospitals in 12 states. Each hospital provides specialized care to medically complex patients who require prolonged hospital stays. The care is provided utilizing an interdisciplinary team of physicians, nurses, therapists and the patient and family. The interdisciplinary team establish mutually agreed upon goals and treatment plans in order for the patient to obtain his/her maximal potential.
Quality Improvement Program • Triumph Healthcare is committed to the principles of continuous performance improvement, in an effort to improve quality of care and patient safety. The goal of the program is to exceed our customers expectations.
What our patients say…… Information obtained from patient satisfaction surveys; 2007, 2008 & 2009
2008-2009 Clinical Initiatives • During 2008, Triumph Healthcare fully embraced and implemented the Institute for Healthcare Improvement’s clinical initiatives. • These included prevention of: • Ventilator Associated Pneumonia • Bloodstream Infections • Management of Pressure Wounds • Preventing Patient Falls
Improved Quality Of Care • Through the use of “bundles” and other evidence based initiatives, Triumph Healthcare was able to prevent a number of adverse events and improve the overall quality of care that was provided to our patients.
BUNDLES • Bundle: is a set of 3-5 evidence-based practices that are proven to be necessary for the best care and will result in improved patient care. • Triumph Healthcare incorporated bundles into its daily practices. It includes, but not limited to, the following: 1. VAP Bundle 2. Central Line Bundle
The VAP Bundle implemented at Triumph Healthcare has a set of 5 evidence-based practices: • Elevation of the head to 30-45 degrees • Peptic Ulcer disease (PUD) prophylaxis • Deep vein thrombosis (DVT) prophylaxis • Oral hygiene/ care every 2 hours • Daily “sedation vacations” and assessment of readiness to extubate
Clinical OutcomesVentilator Associated Pneumonia(VAP) 2007 Rate - 2.10 2008 Rate - .85 2009 Rate - .80 The mean national VAP rate for medical-surgical ICUs is 2.7 according to the IHI
The Central Line Bundle has a set of5 evidence-based practices • Hand hygiene • Maximum barrier precautions • Chlorhexidine skin antisepsis • Optimal catheter site selection (avoid the femoral site) • Daily review of line necessity, with prompt removal of unnecessary lines.
Clinical OutcomesBloodstream Infections 2007 Rate - 2.47 2008 Rate – 1.74 2009 Rate – 1.76 According to the 5 Million Lives Campaign approximately 5.3 central line infections (often termed catheter-related bloodstream infections) occur per 1,000 catheter days in ICUs.
Management of Pressure Wounds • Triumph standardized their wound care program in 2007 and instituted a new electronic documentation system in 2008. • IHI’s recommendation of completing a Braden daily (risk assessment) daily was instituted in the Spring of 2008. • Triumph continues to share best practices throughout the system in an effort to improve overall care. • The goal for 2010 is to standardize wound care products
Management of Pressure Wounds- Improvement in Wounds Consistency in practice and data collection through the Wound Trakker system assisted in improving this process.
Prevention of Falls • According to Agency for Healthcare Research and Quality, 2.3 to 7 falls occur in U.S. hospitals every 1,000 patient days. • Because of this, fall prevention has been a major focus for Triumph Healthcare. • Triumph has embraced the national Patient Safety Goal related to fall prevention as published by the Joint Commission. • Triumph has maintained a low rate below 4.0 for 3 years. • Major focus will be given to this process by utilizing IHI initiatives during 2010 to assure further improvement.
Clinical OutcomesPreventing Patient Falls 2007 Rate – 3.5 2008 Rate – 3.5 2009 Rate – 3.8 National benchmark 2.3 - 7.0 per 1000 patient days
Case Mix Index (CMI) • The average DRG weight for all of a hospitals Medicare volume is called the case mix index (CMI). This index is very useful in analysis since it indicates the relative severity of a patient population and is directly proportional to DRG payments. • It is a metric addressing the question “How sick (resource intensive) are my patients?”
Where did our patients go….. • Even with our higher CMI, our discharges to home improved while our unplanned Discharges to Short Term Hospitals decreased. • This was accomplished by improving our clinical product through increasing clinical competency.
We Believe….. Triumph’s commitment to continually improving the care, services and safety we provide, has ensured that we have been able to fulfill our guiding principle of EVERY LIFE improved