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Rural WI Hospitals Improving Together. Overview of the surgical care improvement and stroke collaboratives. Dana Richardson, RN, MHA Vice President, Quality 608-274-1820 [email protected] Collaborative Method.

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rural wi hospitals improving together

Rural WI Hospitals Improving Together

Overview of the surgical care improvement and stroke collaboratives

Dana Richardson, RN, MHA

Vice President, Quality


[email protected]

collaborative method
Collaborative Method
  • Multi-professional teams commit to improve services within a specific subject and to share how they made their improvement with others
  • Focused on a clinical or administrative subject
  • Gap between best and current practice
  • Learn from experts about the evidence for improvement, change concepts and practical changes
  • Use small changes in quick succession
  • Set measureable targets and collect data to track performance
  • Meet at least twice to share experiences
  • Participate in a continuous exchange of ideas via visits, e-mail or conference calls
The SCIP project national goal is to “reduce preventable surgical morbidity and mortality by 25% by 2010”
  • National leadership provided by CMS and IHI
    • Evidence based guidelines
    • Consensus measures
  • Funding provided by WI Office of Rural Health, Flex Grant Program
  • Lead by Wisconsin Hospital Association
why surgical care improvement
Why Surgical Care Improvement?
  • National and state interest
  • 30 million major operations per year in the U.S.
  • Known variation in perioperative care, despite major advances in surgical and anesthesia technique
  • Evidence based interventions are available to prevent complications
  • Surgical site infection (SSI) is one of the more common HAI
  • Patients with post-op complications have:
    • Increased length of stay
    • Increased mortality
    • Increased costs
  • CMS includes SSI in list of non-payment DRG’s
hospital profits
Hospital Profits

Source: IHI Clinical Advisory Board interview & analysis

4 target areas
4 Target Areas
  • Surgical infection prevention **
    • Appropriate timing and use of antibiotics
    • Appropriate hair removal
    • Postoperative glucose control
    • Postoperative normothermia
  • Cardiovascular complication prevention **
    • Beta blockers for patients on beta blockers prior to admission
  • Venous thromboembolism prevention **
    • Venous prophylaxis ordered
    • Venous prophylaxis received
  • Respiratory complication prevention (ventilator pts.)
    • HOB elevated
    • Stress ulcer prophylaxis
    • Ventilator weaning protocol

** Target area included in Rural SCIP Project

project goals
Project Goals
  • Engage rural hospitals in:
    • a structured shared learning project
    • objective decision making
    • team development
  • Support process change implementation related to surgical care
  • Educate rural hospitals regarding the connection between nationally recognized quality indicators and process improvement within the hospital setting
participating hospitals
Participating Hospitals
  • Amery Regional Medical Center, Amery
  • Baldwin Area Medical Center, Baldwin
  • Boscobel Area Health Care, Boscobel
  • Columbus Community Hospital, Columbus
  • Good Samaritan Health Center, Merrill
  • Grant Regional Health Center, Lancaster
  • Hayward Area Memorial Hospital, Hayward
  • Hudson Hospital, Hudson
  • Langlade Memorial Hospital, Antigo
  • Memorial Hospital of Lafayette Co., Darlington
  • Memorial Medical Center, Ashland
  • Memorial Medical Center, Neillsville
  • Reedsburg Area Medical Center, Reedsburg
  • Ripon Medical Center, Ripon
  • Sacred Heart-St. Mary’s Hospital, Rhinelander
  • Sauk Prairie Memorial Hospital, Prairie du Sac
  • Southwest Health Center, Platteville
  • Spooner Health System, Spooner
  • Tomah Memorial Hospital, Tomah
  • Waupun Memorial Hospital, Waupun
  • Westfields Hospital, New Richmond
  • Monthly data collection
    • Excel data collection tool
    • Monthly data aggregation by WHA
  • Planning conference call with participating hospitals
  • 3 full day learning sessions (February, April, June)
  • Conference calls
  • Provided research and best practices
  • Respond to questions
National leadership through American Heart/Stroke Association
    • Evidence based guidelines
    • Data collection tool
    • Consensus measures
  • State leadership through WI Stroke Committee & the WI Heart Disease & Stroke Prevention Program
    • Approx. 25 TJC Certified Primary Stroke Centers in WI
  • Funding provided by WI Office of Rural Health, Flex Grant Program
  • Co-lead by American Heart Association & Wisconsin Hospital Association
  • Engage rural hospitals in:
    • a structured shared learning project
    • objective decision making
    • team development
  • Support process improvement change using evidence-based guidelines
  • Engage rural/critical access hospitals to use the quality data collected to monitor the progress of process improvement activities
participating hospitals1
Participating Hospitals
  • Agnesian HealthCare – Fond du Lac
  • Black River Memorial Hospital – Black River Falls
  • Bond Health Center – Oconto
  • Community Memorial Hospital Inc. – Oconto Falls
  • Divine Savior Healthcare – Portage
  • Fort HealthCare – Fort Atkinson
  • Good Samaritan Health Center – Merrill
  • Grant Regional Health Center – Lancaster
  • Langlade Memorial Hospital – Antigo
  • Memorial Hospital of Lafayette County – Darlington
  • Memorial Medical Center – Neillsville
  • Moundview Memorial Hospital & Clinic Inc. – Friendship
  • Riverview Hospital Association – Wisconsin Rapids
  • Sacred Heart-St. Mary’s Hospital – Rhinelander
  • Spooner Health System – Spooner
  • St. Joseph’s Hospital – Hillsboro
  • Stoughton Hospital – Stoughton
  • Waupon Hospital – Waupon
  • Westfields Hospital – New Richmond
Train on GWTG patient management tool
    • 1 year GWTG patient management tool fee paid by grant for participating hospitals
  • Two full day learning session (Jan., June)
  • Conference calls (Dec., Feb., May)
  • 7 additional Webinars during the project hosted by GWTG
key learning areas
Key Learning Areas
  • Overview of Brain Attack Coalition Recommendations
  • Overview of Stroke Systems of Care
  • Understanding of Stroke Consensus Measures
  • Understanding of ASA Guidelines
  • Understanding of NIH Stroke Scale
  • Focus on stroke education
  • Focus on transfer protocols
  • Focus on strategies to overcome barriers
lessons learned
Lessons Learned
  • Barriers to Improvement
    • Data collection
      • Infrastructure
      • Low volume
    • Reduced access to time or expertise in identifying evidence and tools available
    • One key “nay sayer” can be a huge stumbling block
  • Advantages with Improvement
    • Issues are similar to other rural (and urban) hospitals
    • Less structure so they can make changes quicker
    • A good champion can move mountains
  • Rural hospitals want and can provide “state of the science” care in their communities
Is there a role for practice based research in collaborative improvement projects?