Submitted by James R Gengaro, DO, Campus Chief HMS, Chair of Quality, Riddle Hospital
With the ever changing tide from volume-based reimbursement towards value-based reimbursement, it has never been more important to understand how consistently we are providing safe, high quality and cost-effective care to our patients. The Hospitalist Medicine Service (HMS) has been working closely with the Quality and Patient Safety departments at each campus on many initiatives towards these goals.
The first step to understanding how well we are providing care is by reviewing the data. One of the most important measured outcomes is mortality. Recently, an HMS physician has been selected to lead a team to review all mortalities in the health system. A standardized approach is taken to review these charts in order to discover identifiable trends in Quality and Patient Safety and opportunities for improvement.
Previously, such a trend was identified and an action plan was initiated. With a focus on the disease state of sepsis, MLH has seen a decline in overall mortality and in sepsis-related mortality at each campus. The first step was accurate documentation. The second step was an ER-focused sepsis alert system. This has increased the chances of identifying septic patients earlier at time of presentation when initiation of treatment has its best outcomes. The next step was continuing that level of attention to detail on admission. This has been accomplished with increased utilization of bundled order sets. The literature has previously shown that bundled order sets decrease the chances of letting any orders slip through the cracks, provides standardized care reflecting best practices and can improve outcomes including mortality. HMS physicians regularly use order sets as guidelines to assist in placing complete orders for many diagnoses, including sepsis, stroke, and acute myocardial infarction, to name a few.
Another important area of focus is transitions of care. The ultimate goal is to ensure the safest discharge for our patients by developing a follow up plan while simultaneously reducing the risk of readmission. This requires intensive coordination between the attending of record, the care management team, and any outpatient physicians with whom the patient should follow up. For HMS patients, the Primary Care Physician (PCP) is the focus of our communication at time of discharge. This includes key documents, work up results and communicating the follow up plan to the PCP without delay. HMS physicians typically utilize the EMR to create discharge summaries on the day of discharge, reconcile medication lists at time of admission and discharge, and prescribe new discharge medications electronically which allows these medications to be available immediately.
Finally, as a system-wide group, HMS drives home accountability on all of these fronts. Through physician leadership at the system and campus levels, each HMS physician is given the opportunity several times per year to review their personal quality and patient safety data, the HMS campus data and the HMS system wide data. This transparency allows us all to know what specifically we are doing well and where we have room for improvement. Ultimately, the overall goal is to exact change that can lead to reproducible, high quality and safe care for MLH patients.