Dignity Health: Improving Patient Care

By launching a systemwide effort that included evidence-based practices, specialized nurse training, and bedside interventions, Dignity Health was able to reduce hospital-acquired infections (HAIs), lower its readmissions rate, and reduce patient falls among other measures. The net effect: cost savings of $30 million over a two-year period from January 2012 through December 2013 and improved outcomes that will potentially affect more than 10,000 patients—ultimately changing the quality of patient care throughout the health system.

Dignity Health, headquartered in San Francisco, is one of the five largest health care systems in the U.S. The health system operates in 21 states and is dedicated to providing affordable patient-centered care, particularly for the poor and underserved. Because of Dignity Health’s track record for success, the health system was selected to participate in the Partnership for Patients (PFP) Hospital Engagement Network for the third consecutive year. PFP is an initiative spearheaded by the Centers for Medicare and Medicaid Innovation (CMMI) under the Department of Health and Human Services. It is charged with identifying solutions that improve care and then sharing these solutions with other hospitals and providers. The network was made possible by the Affordable Care Act. “The goals of PFP align with Dignity Health’s mission and longstanding commitment to making hospital care safer, more reliable, and less costly,” says Barbara Pelletreau, senior vice president of patient safety. Dignity Health is one of 26 hospital organizations in the network.

The Hospital Engagement Network is the largest federal hospital initiative and is setting its sights on improving patient safety and quality of care. It has identified 10 patient safety areas and charged participating hospitals with improving care in these areas. By reducing these 10 hospital-acquired conditions by 40% and cutting hospital readmissions by 20%, the project expects to save an estimated 60,000 lives and conserve $50 billion in Medicare funding over 10 years.

Because of its efforts, Dignity Health was able to improve performance in several of these patient safety areas ahead of the three-year time frame. To achieve these improved outcomes, the hospital system introduced targeted evidence-based practices, which were deployed systemwide to ensure that specific procedures were conducted routinely and safely. For example, catheters were used only when necessary, which resulted in a 45% decrease in urinary tract infections. Insulin was administered at specific times, based on when patients ate their meals, which lowered the hypoglycemic rate by 65%. Central line-associated bloodstream infections dropped 34% after nurses began using alcohol-impregnated disinfection caps and new insertion practices. Hospital-acquired pressure ulcers were reduced by half through enhanced wound assessments and improved equipment and documentation methods.

Intervention at the Bedside

Dignity Health also employed a method called MeasureVention, a process of monitoring and follow-up in high-risk conditions used to evaluate whether new practices are being fully adopted and to ensure coordination of care at the bedside among clinicians, including physicians. MeasureVentionists—nurses that completed specialized training to assess patients’ conditions and measure their risk for infection and readmission—assessed and documented when protocols were being followed, which helped to ensure that hospital staff followed new protocols.

Thus far, Dignity Health’s improved outcomes include:

• a 65 % reduction in the hypoglycemic rate by standardizing insulin protocols.
• a 45% reduction in catheter-associated urinary tract Infections by requiring strict justification for catheter insertion coupled with education efforts.
• a 34% reduction in central line-associated bloodstream infections, resulting from new insertion practices, the use of alcohol-impregnated disinfection caps, and close monitoring by MeasureVentionists.
• a 35% reduction in patient falls by generating fall assessment scores and providing enhanced bedside protection.
• a 96% reduction in early elective deliveries by instituting “hard stop” policies and education for patients, nurses, and physicians.
• a 50% reduction in hospital-acquired pressure ulcers attributable to enhanced wound assessments, risk assessments, and improved equipment and documentation.
• a 35-percent reduction in surgical site infections through Surgical Care Improvement Project (SCIP) practices, proper skin prep, antibiotic dosing, environmental controls, wound dressing, and education.
• a 6% reduction in venous thromboembolism and pulmonary embolism through standardized risk assessments, staff education, daily huddles, and documentation monitoring by MeasureVentionists.
• a 60% reduction in ventilator-associated pneumonia attributed to best practices that included bed elevation and advanced sedation practices.
• a 9% reduction in hospital readmissions within 30 days, resulting in an estimated positive impact for more than 2,000 patients.

“Through enhanced collaboration and coordination among our staff, we’re seeing great results, and even more importantly, we’ve improved how care is delivered at Dignity Health hospitals,” says Barbara Pelletreau.

Dignity Health launched seven new measures in January, continuing its push to deliver improved patient care while lowering health care costs.

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