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St. Joseph’s Hospital, an 850-bed nonprofit facility in Tampa, FL, has no practice guidelines or patient care pathways. Instead, best practices for common DRGs are listed as findings and recommendations on goldenrod sheets posted on patients’ charts. Findings and recommendations originate with process improvement teams (PIT). "The goldenrod sheets act as a trigger to remind people of key clinical processes," observes teams manager Debbie McElroy, LCSW, CCM. Compliance is voluntary.
4 IMPROVEMENT OPPORTUNITY
Joel Mattison, MD, physician advisor in clinical resource management and medical director, notes that while physicians eschew practice guidelines, "they’ll follow them or come close to them — if we call them findings and recommendations."
A PIT steering committee chooses topics from staff suggestions and assembles five- to 30-member interdisciplinary teams. Since January 1999, 18 PITs have completed work. Current topics include strokes, small and large bowel disorders, and timely physician consultations.
Findings and recommendations often reflect known rather than new treatment processes. They meet three quality standards:
1. Service: Patient, physician, and staff satisfaction.
2. Outcomes: Including readmission and mortality rates.
3. Cost: Total charges or length of stay (LOS).
The first PIT targeted pneumonia treatment. Within 12 months, mortality rates dropped from 6% to 1%. McElroy says, "When we focus on quality, LOS takes care of itself." With pneumonia, for example, the baseline of 6.5 days dropped to 5.1 at six months and 1.4 days at 12 months.
Findings and recommendations, followed by baseline, six-, and 12-month compliance rates:
• Four-hour door-to-antibiotic cycles, baseline, 40.9%; six months, 71.9%; 12 months, 86%.
• Daily oximetry (monitoring blood oxygen levels), baseline, 20%; six months, 79%; 12 months, 93%.
4 Keys to success
• Accountability: Close communication ensures completion of assignments, sustains motivation.
• Three-month implementation cycles: "Worker bees" — McElroy and clinical staff — supply benchmarks, background, and chart review data. Attending physicians go to one or two action-packed meetings, physician leaders, two to four.
• Strong physician leadership: Sustained by constant feedback of results.
• Positive feedback for PITs: Includes celebrations of success and showcasing results for management. Published results in the hospital newsletter and employee bulletin boards "make the teams shine," McElroy says.
Debbie McElroy Telephone: (813) 870-4973. E-mail: firstname.lastname@example.org.