Quick Wins: Blood Draws, Infection Rates, Sepsis
University of Pittsburgh Medical Center (UPMC) has had success with several quick wins through the kind of quality improvement effort that yields meaningful change without requiring a lot of time, money, or effort.
Quick wins are a favorite strategy for Tamra Minnier, BSN, MSN, chief quality officer at UPMC and executive director of the Beckwith Institute, a foundation that supports healthcare innovation. She says the following are some of her favorite quick wins at UPMC:
• Blood draws. Responding to concerns that certain patients were put at risk of needing blood transfusions when too much was taken for lab work, UPMC decreased the amount of blood taken in each draw.
“We changed our tube sizes so that we gathered 1 cc less of blood per patient, and that saved us 3,000 units of blood in one year,” Minnier says. “All we did was buy tube A instead of tube B from the supplier, and that meant we gathered 1 cc less than before. Not having that 1 cc didn’t change anything we did with labs or keep us from doing any tests.”
Fewer patients needed blood transfusions, and so the hospital did not have to buy as much for its blood bank. With a unit of blood typically costing at least $200, that was a savings for UPMC of at least $600,000 in one year.
• Infection rates. One of the best ways to reduce surgical infections is to provide each individual surgeon his or her own infections rate, Minnier notes. That is a well-known strategy for reducing infections, yet it does not happen as much as many quality professionals assume, she says.
“Through the years of bigger data, bigger systems, and more reporting, we see a lot of aggregated data and we lose sight of the individual surgeon and their own number of surgical site infections,” Minnier says. “People had gotten used to seeing CMS data at the hospital level, and maybe they thought it was too difficult to share individually or wouldn’t work.”
The chairman of neurosurgery decided two years ago to start sending out those rates to all the surgeons, without making it a big deal and saying it was just interesting information and maybe there was room for improvement, Minnier explains.
Neurosurgery cut their infection rate in half just by sharing data, so Minnier expanded the data-sharing to all surgical departments and is about to take it systemwide. It is a very simple strategy, but it works because all physicians are scientists and like to see information — and they are competitive, she says.
“We have found this to be so easy and so effective. People could start doing this tomorrow. If you’re not doing it, you should,” she says. “In quality improvement, never underestimate the value of being transparent.”
• Blood platelets. Because they last only a couple of hours before going bad, platelets can be a significant cost when they are ordered and not used. For years, the process at UPMC was that the doctor would order platelets and the lab would immediately start the defrosting process, get the platelets ready, and send them up to the unit for transfusion.
But when nurses are busy, the platelets may not be used right away, and they sit past their use-by time, Minnier explains. To avoid that kind of waste, UPMC changed from its old system — what the manufacturing industry calls a push system — to a pull system.
“When the nurse is ready for the platelets, that’s when she calls down and tells them to go ahead and start defrosting. It doesn’t take long for them to do that, so the turnaround is still pretty fast,” Minnier says. “You can imagine how much waste there was in platelets that were defrosted and not administered in time because the nurse was tied up with another critical patient. It was just a procedure change that made the nurse happier and avoided the waste.”
• Sepsis education. In the aftermath of the tragic death of a 12-year-old boy from sepsis after scraping his arm, concerns were raised that the parents had not been alerted to the possibility of sepsis and missed warning signs. A foundation was established to raise awareness about sepsis, and leaders at UPMC wanted to improve its education of parents and others about this risk. (More information about the Rory Staunton Foundation is available online at: https://bit.ly/1l3kgA3.)
“We created small magnets that say ‘Think Sepsis,’ and now they’re all over the place at the hospital, encouraging parents and others to become advocates for thinking about sepsis,” Minnier says.
“While it was part of a multipronged strategy at UPMC, the magnets have played a big part in getting people to just know what sepsis is and consider it when they see an unexplained fever or other sign,” she adds. “We’ve had several instances in just the past six months where a family member raised the possibility that it might be sepsis, and the caregivers said yes, maybe so, and initiated treatment.”
University of Pittsburgh Medical Center has had success with several quick wins through the kind of quality improvement effort that yields meaningful change without requiring a lot of time, money, or effort.
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