Executive Summary:
A New Jersey initiative to reduce complications for hospitalized patients is reporting significant success. Over three years the program averted almost 14,000 incidents of patient harm and saved $120 million in healthcare costs.
- New Jersey hospitals achieved a 7.7% decrease in the rate of patients readmitted to the hospital within 30 days of a prior hospital stay.
- Reduced readmissions account for about $84 million of the projected savings.
- New Jersey has traditionally had one of the nation’s highest rates of readmission.
A three-year initiative by New Jersey hospitals to confront and reduce the incidence of complications for hospitalized patients is reporting positive results: more than 13,730 cases of patient harm averted and $120 million in healthcare cost savings. Other hospitals across the country could replicate the same results, participants say.
The initiative, Partnership for Patients-New Jersey, was part of the national Partnership for Patients project, spearheaded by the U.S. Centers for Medicare & Medicaid Services and involving hospitals across the country. In New Jersey, the effort was led by the New Jersey Hospital Association’s (NJHA) Institute for Quality and Patient Safety, which was designated as one of 27 “hospital engagement networks” nationwide.
NJHA has been selected as one of 17 national, regional or state hospital associations and health system organizations to continue efforts in reducing preventable hospital-acquired conditions and readmissions. Through the Partnership for Patients nationwide public-private collaboration, which began in 2011 to reduce preventable hospital-acquired conditions by 40% and 30-day readmissions by 20%, NJHA will participate in a second round of hospital engagement networks to continue working to improve patient care in the hospital setting.
Since the launch of the Partnership for Patients, the vast majority of U.S. hospitals and many other stakeholders have joined the collaborative effort and delivered results. The Department of Health and Human Services has estimated that 50,000 fewer patients died in hospitals and approximately $12 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. Nationally, patient safety is improving, resulting in 1.3 million adverse events and infections avoided in hospitals since in that time period. This translates to a 17% decline in hospital-acquired conditions over the three-year period.
In New Jersey, NJHA worked with the state’s hospitals from 2012 through 2014 in a program that focused on education from national experts, sharing of best practices, and detailed data reporting to achieve better, safer healthcare services for patients.
The hospitals focused on reducing adverse events in 10 areas, explains Aline Holmes, RN, DNP, NJHAs senior vice president of clinical affairs and director of NJHA’s Quality Institute. Those areas were four different kinds of infections plus surgical infections, falls, pressure ulcers, adverse drug events, adverse obstetric events, and readmissions.
New Jersey hospitals had been addressing some of those issues in smaller projects before the Partnership for Patients project, so they were able to build on that success, Holmes notes. Hospitals in the state had previously addressed cesarean section rates and early elective deliveries, for instance. The early elective rate dropped from 6% to 1% over the course of the current project, Holmes notes.
Holmes explains that the New Jersey results are attributable mostly to reduced rates in post-surgical infections, pressure ulcers or medication errors. New Jersey hospitals posted a 27.1% average reduction in these conditions in 2014. They also achieved a 7.7% decrease in the rate of patients readmitted to the hospital within 30 days of a prior hospital stay. (For detailed results in New Jersey, see the story in this issue.)
By comparing those new rates against the industry’s standard expected rates, this work has averted a case of medical harm for 13,730 New Jersey patients by the end of the three-year initiative, Ryan says. Those averted complications saved the healthcare system about $120 million in added costs, according to cost data from the U.S. Agency for Healthcare Research and Quality (AHRQ). The largest cost savings come from the reduction in hospital readmissions, which accounts for about $84 million of the projected savings.
Reduced cost for the healthcare system is “icing on the cake,” says NJHA President and CEO Betsy Ryan, Esq. Improving patient care is the always the primary goal, she says, with the added bonus that avoiding adverse events almost always means avoiding extra expenses.
NJHA used a variety of methods to help hospitals address the targeted adverse events, Holmes says. Speakers were brought in to hospitals for seminars, and the association also hosted monthly webinars and conference calls. The webinars and conference calls were useful in presenting new content, coaching, and hearing updates on the hospitals’ progress, as well as reports of problems or challenges encountered.
Those virtual meetings also allowed hospitals to share information and develop best practices.
“When we started out, everyone had a different process for pressure ulcers and that was problematic, but over the course of a couple years they came to consensus on standardizing the process. They could see how important it was to be consistent, with these patients going back and forth across care settings,” Holmes says. “One of the best things was that even when the hospitals were very competitive, the physicians weren’t and they were willing to cooperate and exchange information.”
NJHA also set up listservs so that a nurse, for example, could post a question about the project’s goals and receive multiple responses within an hour. That was a more attractive option to many participants than contacting NJHA or hospital administration, Holmes notes, and in many cases the project’s experts in a particular topic participated on the listservs.
Ryan points out that physician engagement is critical for making a project like this successful. Also, she says it is important not to alienate clinicians by making dramatic changes in policies and procedures overnight. The better approach is to determine what changes need to be made to get to the goal, but then implement them incrementally.
“We learned early that making wholesale changes created a lot resistance from physicians, who all thought that you were saying that what they had been doing along was wrong,” Ryan says. “Try small things rapidly, measure the effects, and then spread those.”
The initiative is not just about statistics and dollars, Holmes notes. “This work has a very real impact on patients,” she says. “It means better care, shorter hospital stays, and better patient outcomes. I’m especially proud of the areas like surgical site infection rates and birth issues like early elective deliveries, where New Jersey hospitals not only have improved their results over time, but have also performed much better than the national average.”
Thirty-day readmission rates are another key issue for New Jersey, Holmes says. The state has traditionally had one of the nation’s highest rates of readmission, and now research has shown that socioeconomic factors make it more difficult for states like New Jersey, with many urban communities, to reduce hospital readmissions.
“There are numerous personal economic factors that affect whether a patient may return to the hospital after an initial stay, such as whether a patient can afford prescriptions or whether transportation is available for follow-up appointments,” Holmes says. “But the good news is that New Jersey hospitals are making progress, and our work on readmissions alone has resulted in $84 million in reduced healthcare costs in our state.”
- Aline Holmes, DNP, RN, Senior Vice President of Clinical Affairs. Email: [email protected]. Telephone: (609) 275-4157.
- Betsy Ryan, President and CEO, New Jersey Hospital Association. Email: [email protected]. Telephone: (609) 275-4241.
