As you all know, we experienced a fire in John Sealy Hospital last week. Although some of our teams are now working in temporary locations until the hospital can be restored, we have resumed normal operations. So this week, I am again looking ahead to Best Care and what we need to do to assure that we will rank in the highest quartile of performance as measured by the Vizient Quality & Accountability Study.
We have done much work since June when we began working in earnest to improve outcomes of care for our patients. As a result of that work, we are starting to see improvements in our performance. We all remember that when we began the Best Care initiative, we ranked in the top 20 out of 102 academic medical centers in both equity of patient care (this means that our patients get the same care, regardless of their race, ethnicity, sexual orientation, economic status, etc.) and in patient-centered care.
Moving forward, we needed to remain a top performer in both of these categories, and to date, we have accomplished this. For example, our goal in patient-centeredness for the first quarter of the fiscal year was to have 76.4 percent of our patients rate us on the patient satisfaction survey as a nine or ten (on a scale of one to ten) for their overall experience of care. And there’s good news—for the first quarter of FY17, 81.6 percent of our patients rated us at the top of the scale! This is excellent work, and we need to keep it up!
Our work to increase patient safety has also been exceptional. For this measure, we use a rating called the Patient Safety for Selected Procedures Composite Score (a measure developed by the Agency for Healthcare Research and Quality), otherwise known simply as PSI-90. Patient Safety Indicators (PSIs) reflect the quality of care inside hospitals, but focus on potentially avoidable complications and adverse events following surgeries, procedures and childbirth. These types of events include, but are not limited to, the rate of pressure ulcers, falls in the hospital resulting in hip fracture, the rate of hemorrhage or hematoma after surgery, and the rate of postoperative sepsis (a severe bloodstream infection resulting in decreased organ function). We are doing exceptionally well with this measure. Our target score for the first quarter was 0.91 and we scored 0.65 (lower numbers are better, in this case). Our target for next quarter is 0.80, so we need to keep up this excellent work and do all we can to do even better!
For preventable readmissions within 30 days of discharge, we exceeded our first quarter target of 13.6 percent—our performance was 12.5 percent (again, lower numbers are better). This means that we did a good job of managing our patients once they left the hospital, we followed up with them to make sure they were following their care plan, and/or we managed their health in our clinics so they did not come back to the hospital within the 30-day time frame. While this is excellent work, we increase the challenge to meet our targets each quarter so that we have to continually improve. For the next quarter, our goal for the 30-day all-cause readmission rate is set at 12.58 percent or less, so we have to keep improving!
We also met our goal to reduce our mortality rate, which is described as a ratio that compares how many patients passed away, in total, compared to how many were expected to pass away while in the hospital based on how sick they were. A significant part of the effort to improve our rate has been rooted in clinical documentation improvement, because the more specific the documentation is, the more accurately the patient’s severity of illness is reflected. Additionally, if we do not document the care we deliver to our patients well enough, our performance appears worse than it actually is—even if the care was excellent and the patient had a good outcome. To help support our providers in this endeavor, we have been working to optimize our electronic medical record (Epic), and we are also offering documentation training to physicians on our inpatient units—for example, providers should not use symbols when documenting, and it is important to use special and specific wording when describing the patient’s condition.
For the mortality score, a score of less than 1 means that more patients survived than were predicted to. A score of more than 1 means that more patients passed away than were predicted to. So, a lower score is better. This quarter, our mortality observed/expected rate was 0.91, where our target was 0.99. Since lower numbers are better, this means we met our goal. For the next quarter, however, our target is 0.90, so we have some more work ahead of us.
The last major measure we are tracking is length of stay (LOS). This falls under the Vizient Quality & Accountability Study’s category of Efficiency, which measures how well we are using our resources compared to how ill the patient is. This measure is case mix index adjusted, which essentially means that it takes into consideration the diversity, clinical complexity and resources needed to care for our total hospital patient population. Our goal for this first quarter’s LOS at the Galveston campus was 2.85 days. At 2.96 days, we missed our goal. We have a significant amount of work to do, because for next quarter, our goal will be 2.81 days.
I know many of you have asked me how we are doing when it comes to achieving Best Care. If I were to summarize, I’d say we are on the right track and moving in the right direction. But to meet the goals we have for the end of this fiscal year, we have stay focused and maintain our absolute resolve to meet our Best Care goals.
I want to thank each of you for our improvements made since June. I know this requires a lot of work, but if we can make these improvements stick, ultimately, our work will become easier. And even more importantly, our patients will receive the Best Care.
*Lower numbers are better