2012 annual report on to ey n journe our quality and...

2012 ANNUAL REPORT ON

Quality and Safety

27635_Cover_Layout 1 6/26/12 7:24 AM Page 3

Christiana Care Health System

In all that we do, Christiana Care strives to serve everyone as respectful, expert caring partners in their health. This is the Christiana Care Way, and it is our promise to each person who trusts us to care for

them. Embedded in this promise is a commitment to transform how we deliver that care.

This report tells the story of our journey to transform care, quality and safety. Our physicians, nurses and staff are collaborating on new and better ways to enhance safety; to achieve high reliability in consistently delivering safe, effective care through evidence-based practices and outcomes research; and to leverage technology to advance our quality and safety goals. It highlights improvements that

signifi cantly reduce the risk of infection and harm. Our Value Improvement Teams set the standard for the more effi cient use of available resources and adherence to national guidelines. Our journey is not only creating value for Christiana Care; other health systems throughout the nation are learning from our journey.

Our commitment to transformation and innovation is showing dramatic results in operational effi ciencies, including shortened length of stay, fewer readmissions and improved outcomes. Most importantly, we are increasing the value of care for our patients because we work with them and not merely for them. This is a testament to the power of the Christiana Care Way.

Robert J. Laskowski, M.D., MBAPresident and Chief Executive Offi cer

A message from the President and CEO

Creating a Safe Culture .................................................................................................................................................. 1

Achieving High Reliability .......................................................................................................................................... 16

Leveraging Technology ............................................................................................................................................... 32

Awards, Recognition & Achievements .................................................................................................................... 39

PO Box 1668Wilmington, Delaware 19899-1668www.christianacare.org

Christiana Care is a private, not-for-profit regional health care provider and relies in part onthe generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit christianacare.org/donors.

12PERF2

Synchronized Admissions Teams collaborate on interdisciplinary assessment. See pages 21-22.


The Christiana Care Quality and Safety Program

The Christiana Care Quality and Safety Program strives to achieve care that is safe, effective, patient-centered, timely, effi cient and equitable.

To achieve these goals, the program targets three strategic areas: creating a safe culture, achieving high reliability and leveraging technology.

2007

Safety First Learning Report

Enhancements for Follow Up

Just Culture Concepts (Planning)

Human Factor Analysis for Flex

Monitoring

Team Training

Transparency Concepts

Focus on “No Harm, Any is Too Many”

DVT Prophylaxis Development

(Planning)

Institute for Safe Medication

Practices (ISMP)

Assessment of CCHS Medication

Safety (Planning)

Medication Safety Offi cer (Planning)

5 Million Lives Campaign:

• System Wide Skin Team to Prevent

Pressure Ulcers

• Reduce MRSA

• High Alert Medications;

Anticoagulation Team

• Surgical Care Improvement

Program (SCIP)

• Heart Failure, Heart Disease and

Stroke: “Get with the Guidelines”

• Board Report of Key Measures

EMAR Implementation

Barcoding (Bedside

Specimen Labeling)

Sentinel Event Database

Bed Management System

Perioperative Documentation

Pharmacy Order Management

System (POMS)

Delaware Health Information

Network (DHIN)

CPOE: Zynx Implementation (Order

Sets/Standards Development) Phase I

Electronic Signatures

ThChiiCQlliddSffPi

CREAT

ING

A S

AFE C

ULT

URE

ACHIEVIN

G H

IGH

RELIABILITY

LEVERAGING TECHNOLOGY

QUALITYAND

SAFETY

CREATING A SAFE CULTURE

Every individual shares a deep commitment to make

safety a priority. Christiana Care’s culture of safety

is characterized by our patient-centered care, open

communication, a blame-free environment and

collective responsibility for safety.

ACHIEVING HIGH RELIABILITY

Health care organizations are complex entities

where the risk for accidents and injury runs

extremely high. High Reliability Organizations

(HROs) avoid catastrophes and accidents despite

the dangers inherent in their businesses.

Christiana Care employs best practices of other

high-risk industries in order to achieve the

defi ning characteristics of HROs.


Our commitment to invest heavily, yet prudently, in

technology—whether for patient care equipment,

electronic medical records or operational software to

streamline our effi ciencies—leads to safer, better

care and ultimately greater value for our patients.

Our Journe

27635_Cover_Layout 1 6/26/12 7:23 AM

20082009201020112012

ney — PROGRAM INITIATIVES 2007 to 2012

Partners in Learning for Safety/ Just

Culture Council

Human Resources and Safety Standards

for Event Follow Up

‘Good Catch’ Recognition

Safety Mentor Education

and Development

No Harm Intended Sessions

Speak Up Patient Safety Guide

Safety First Advisory Council

Safety in New Employee

Orientation/ On Boarding

Enhanced Focus on Excellence

(FOE) Awards

Powered Industrial Truck Policy,

Education and Inspection Program

Culture Survey (October)

Culture of Responsibility Phase I (June)

SAFE Weekly Huddles

Human Factors Analysis for

Radiation Oncology

Disclosure Policy & Process

Interdisciplinary Rounds

Cultural Diversity & Inclusion

Quarterly Environment of Care

Consultant Assessments

Specialized Training on Compressed

Gas Safety

Culture of Responsibility Phase II (Oct.)

Standarized Hand Off s for Transitions of

Care in Women’s Health

Embracing Patient Centered Care

through Implementation of AIDET

Unit Based Clinical Leadership Teams

5C Nursing Home Project

Bedside Shift Report

Employee Wellness

TRP Safety Education Module

Facilities and Services Safety

Committee Established

Slip, Trip Fall Workgroup Established

Department Level Focused Safety Training

Culture Survey (January)

Culture of Responsibility (Planning)

Patient and Community Involvement

Post Event Debriefs Partners in

Safety Updates

Enhanced Disclosure Process

Patient/Family Centered Care

Worker Fall Protection Policy

Skylight Safety Assessment

BEAT Training Classes

Arc Flash Policy and Program

Safe Work Permit Improvements

Culture Survey (April)

Culture of Responsibility

Phase III (October)

Employee Safety Handbook

Workplace Violence


VP Level Monthly Injury

Summary Reports

Contractor Safety Training

Video Updated

Workplace Safety Risk Review

Evaluation Completed by

Conner Strong

Formalized Systemwide “Good Catch”

Program (March)

Clinical Documentation Project

MRSA

National Patient Safety Goals:

• Management of Anticoagulation

• Improving Recognition and Response

to Changes in Patient Condition

“Never Events” Present on Admission

Hospital Consumer and Assessment

Provider Survey (HCAPS)

Medication Safety

Medical bariatric FMEA

Disease Specifi c Certifi cation

• Stroke Program

Comprehensive Unit-Based Safety

Program (CUSP)

Magnet Recognition

Flu Vaccine Program

Surgical Safety Team Checklist

Pregnancy Screening in

Non-OB Locations

SWAT (Synchronized Wilmington

Admission Team)

Obstetrical Emergency Response

Team (OBERT)

ED SPEED

Pharmaceutical Waste Management

Program Implemented

Disease Specifi c Certifi cation (May):

• Heart Failure

• Hip

• Knee

Recertifi cation Disease Specifi c

Stroke Program

Best Practices for Better Care

Partnership for Patients

Christiana Rapid Transfer Initiative

Proactive Assessment of Communicating

Patient Preferences/ Goals of Care

ED SHARP

Heart Failure Transformation Team

ED Triage Redesign

National Patient Safety Goal:

Reduce Risk of Healthcare

Associated Infections:

• Central Line Associated

Blood Infections

• Multiple Drug Resistant Organisms

• Prevention of Surgical Site Infection

Prevent Harm from High Alert

Medications (Hydromorphone)

Disease Specifi c Certifi cation Planning

• Primary Stroke Center

Hand Hygiene Campaign

ED Super Track

Pilot Early Warning System (EWS)

Patient Identifi cation Best Practice

Leadership Forum to Reinforce Culture

of Responsibility Concepts

SWAT launches at Christiana

Human Factors Consultant

“Sponge Counts”

Value Improvement Team Training

ADT Interfaces with Micropaq

Wireless Patient Monitoring

Infusion Pumps (Smart Pumps)

CPOE: Zynx Phase 2

Language Line Enhancement

Vocera

Equipment Tracking

CPOE

Expanded Use of Vocera

Care Fusion Implementation

Planning for Meaningful Use

VNA Heart Failure

Telemonitoring Program

Wireless Bar Coding-Breast Milk

Enhanced Suicide Risk Assessment


Insight Heart Failure (Symptom Self-

Assessment)

Virtual Education & Simulation Training

Center (June)

Spill Stations Designed and Ordered

Capnography (End-Tidal CO2

Monitoring) During Code Blue

Radiation Therapy

Positioning Software

Enhanced Central Line Checklist

Implemented Baseline Pulse Oximetry

in OB Triage, L & D and Antepartum

Areas

Standardization of Web Page to Mobilize

Anesthesia Services

Interpreters

Care Visibility

CPOE: Zynx Phase 3

Enhanced Web Paging

Winter Weather Communications

Enhanced Multum Alert View

for Duplicates, Allergies and

Major-Contraindicated Drug-

Drug Interactions.

Automation of “Event Follow-Up”

Implementation of Meaningful Use

WORK & TUMBLE 27635 C.Care (Cover) 1 A 06/26/2012 07:52:31 CyanMagentaYellowBlack

2012 ANNUAL REPORT ON

Quality andSafety


Chris t iana Care Heal th System

In all that we do, Christiana Care strives to serve everyone as respectful, expert caring partners in their health. This is the Christiana Care Way, and it is our promise to each person who trusts us to care for

them. Embedded in this promise is a commitment to transform how we deliver that care.

This report tells the story of our journey to transform care, quality and safety. Our physicians, nurses and staff are collaborating on new and better ways to enhance safety; to achieve high reliability in consistently delivering safe, effective care through evidence-based practices and outcomes research; and to leverage technology to advance our quality and safety goals. It highlights improvements that

signifi cantly reduce the risk of infection and harm. Our Value Improvement Teams set the standard for the more effi cient use of available resources and adherence to national guidelines. Our journey is not only creating value for Christiana Care; other health systems throughout the nation are learning from our journey.

Our commitment to transformation and innovation is showing dramatic results in operational effi ciencies, including shortened length of stay, fewer readmissions and improved outcomes. Most importantly, we are increasing the value of care for our patients because we work with them and not merely for them. This is a testament to the power of the Christiana Care Way.

Robert J. Laskowski, M.D., MBAPresident and Chief Executive Offi cer

A message from the President and CEO

Creating a Safe Culture .................................................................................................................................................. 1

Achieving High Reliability .......................................................................................................................................... 16

Leveraging Technology ............................................................................................................................................... 32

Awards, Recognition & Achievements .................................................................................................................... 39

PO Box 1668Wilmington, Delaware 19899-1668www.christianacare.org

Christiana Care is a private, not-for-profit regional health care provider and relies in part onthe generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit christianacare.org/donors.

12PERF2

Synchronized Admissions Teams collaborate on interdisciplinary assessment. See pages 21-22.

27635_Cover_Layout 1 6/26/12 7:23 AM

The Christiana Care Quality and Safety Program

The Christiana Care Quality and Safety Program strives to achieve care that is safe, effective, patient-centered, timely, effi cient and equitable.

To achieve these goals, the program targets three strategic areas: creating a safe culture, achieving high reliability and leveraging technology.

2007

DVT Prophylaxis Development

(Planning)

Institute for Safe Medication

Practices (ISMP)

Assessment of CCHS Medication

Safety (Planning)

Medication Safety Offi cer (Planning)

5 Million Lives Campaign:

• System Wide Skin Team to Prevent

Pressure Ulcers

• Reduce MRSA

• High Alert Medications;

Anticoagulation Team

• Surgical Care Improvement

Program (SCIP)

• Heart Failure, Heart Disease and

Stroke: “Get with the Guidelines”

• WISH program

• Board Report of Key Measures

EMAR Implementation

Barcoding (Bedside

Specimen Labeling)

Sentinel Event Database

Bed Management System

Perioperative Documentation

Pharmacy Order Management

System (POMS)

Delaware Health Information

Network (DHIN)

CPOE: Zynx Implementation (Order

Sets/Standards Development) Phase I

Electronic Signatures

Th Ch i i C Q lli dd S ff P i

CREATING

A SAFE CULTU

RE

ACHIE

VIN

G H

IGH

REL

IABI

LITY


QUALITYAND

SAFETY


Every individual shares a deep commitment to make

safety a priority. Christiana Care’s culture of safety

is characterized by our patient-centered care, open

communication, a blame-free environment and

collective responsibility for safety.


Health care organizations are complex entities

where the risk for accidents and injury runs

extremely high. High Reliability Organizations

(HROs) avoid catastrophes and accidents despite

the dangers inherent in their businesses.

Christiana Care employs best practices of other

high-risk industries in order to achieve the

defi ning characteristics of HROs.


Our commitment to invest heavily, yet prudently, in

technology—whether for patient care equipment,

electronic medical records or operational software to

streamline our effi ciencies—leads to safer, better

care and ultimately greater value for our patients.

O u r J o u r n e

Partners in Learning for Safety/ Just

Culture Council

Human Resources and Safety Standards

for Event Follow Up

‘Good Catch’ Recognition

Safety Mentor Education

and Development

No Harm Intended Sessions

Speak Up Patient Safety Guide

Safety First Advisory Council

Safety in New Employee

Orientation/ On Boarding

Enhanced Focus on Excellence

(FOE) Awards

Powered Industrial Truck Policy,

Education and Inspection Program


Safety First Learning Report

Enhancements for Follow Up

Just Culture Concepts (Planning)

Human Factor Analysis for Flex

Monitoring

Team Training

Transparency Concepts

Focus on “No Harm, Any is Too Many”

2008 2009 2010 2011 2012

n e y — P R O G R A M I N I T I AT I V E S 2 0 0 7 t o 2 0 1 2

Culture Survey (October)

Culture of Responsibility Phase I (June)

SAFE Weekly Huddles

Human Factors Analysis for

Radiation Oncology

Disclosure Policy & Process

Interdisciplinary Rounds

Cultural Diversity & Inclusion

Quarterly Environment of Care

Consultant Assessments

Specialized Training on Compressed

Gas Safety

Culture of Responsibility Phase II (Oct.)

Standarized Hand Off s for Transitions of

Care in Women’s Health

Embracing Patient Centered Care

through Implementation of AIDET

Unit Based Clinical Leadership Teams

5C Nursing Home Project

Bedside Shift Report

Employee Wellness

TRP Safety Education Module

Facilities and Services Safety


Slip, Trip Fall Workgroup Established

Department Level Focused Safety Training

Culture Survey (January)

Culture of Responsibility (Planning)

Patient and Community Involvement

Post Event Debriefs Partners in

Safety Updates

Enhanced Disclosure Process

Patient/Family Centered Care

Worker Fall Protection Policy

Skylight Safety Assessment

BEAT Training Classes

Arc Flash Policy and Program

Safe Work Permit Improvements

Culture Survey (April)

Culture of Responsibility

Phase III (October)

Employee Safety Handbook

Workplace Violence


VP Level Monthly Injury

Summary Reports

Contractor Safety Training

Video Updated

Workplace Safety Risk Review

Evaluation Completed by

Conner Strong

Formalized Systemwide “Good Catch”

Program (March)

Clinical Documentation Project

MRSA

National Patient Safety Goals:

• Management of Anticoagulation

• Improving Recognition and Response

to Changes in Patient Condition

“Never Events” Present on Admission

Hospital Consumer and Assessment

Provider Survey (HCAPS)

Medication Safety

Medical bariatric FMEA

Disease Specifi c Certifi cation

• Stroke Program

Comprehensive Unit-Based Safety

Program (CUSP)

Magnet Recognition

Flu Vaccine Program

Surgical Safety Team Checklist

Pregnancy Screening in

Non-OB Locations

SWAT (Synchronized Wilmington

Admission Team)

Obstetrical Emergency Response

Team (OBERT)

ED SPEED

Pharmaceutical Waste Management

Program Implemented

Disease Specifi c Certifi cation (May):

• Heart Failure

• Hip

• Knee

Recertifi cation Disease Specifi c

Stroke Program

Best Practices for Better Care

Partnership for Patients

Christiana Rapid Transfer Initiative

Proactive Assessment of Communicating

Patient Preferences/Goals of Care

ED SHARP

Heart Failure Transformation Team

ED Triage Redesign

National Patient Safety Goal:

Reduce Risk of Healthcare

Associated Infections:

• Central Line Associated

Blood Infections

• Multiple Drug Resistant Organisms

• Prevention of Surgical Site Infection

Prevent Harm from High Alert

Medications (Hydromorphone)

Disease Specifi c Certifi cation Planning

• Primary Stroke Center

Hand Hygiene Campaign

ED Super Track

Pilot Early Warning System (EWS)

Patient Identifi cation Best Practice

Leadership Forum to Reinforce Culture

of Responsibility Concepts

SWAT launches at Christiana

Human Factors Consultant

“Sponge Counts”

Value Improvement Team Training

ADT Interfaces with Micropaq

Wireless Patient Monitoring

Infusion Pumps (Smart Pumps)

CPOE: Zynx Phase 2


Vocera

Equipment Tracking

CPOE

Expanded Use of Vocera

Care Fusion Implementation

Planning for Meaningful Use

VNA Heart Failure

Telemonitoring Program

Wireless Bar Coding-Breast Milk

Enhanced Suicide Risk Assessment


Insight Heart Failure (Symptom Self-

Assessment)

Virtual Education & Simulation Training

Center (June)

Spill Stations Designed and Ordered

Capnography (End-Tidal CO2

Monitoring) During Code Blue

Radiation Therapy

Positioning Software

Enhanced Central Line Checklist

Implemented Baseline Pulse Oximetry

in OB Triage, L & D and Antepartum

Areas

Standardization of Web Page to Mobilize

Anesthesia Services

Interpreters

Care Visibility

CPOE: Zynx Phase 3

Enhanced Web Paging

Winter Weather Communications

Enhanced Multum Alert View

for Duplicates, Allergies and

Major-Contraindicated Drug-

Drug Interactions.

Automation of “Event Follow-Up”

Implementation of Meaningful Use

WORK & TUMBLE 27635 C.Care (Cover) 1 A 06/26/2012 07:52:31 CyanMagentaYellowBlack

Qual i t y and Sa f e t y Annual Repor t | 1Qual i t y and Sa f e t y Annual Repor t | 1


Instrumental to our commitment to make every patient encounter one of greater value is our determination to provide safety, quality and effi ciency in all that we do. Our landmark effort this year in building a Culture of Responsibility underscores that safe practices can neither be dictated by management nor guaranteed by policies and procedures or by technological advances alone. Because the

nature of our industry is for care to be provided to humans by humans, we acknowledge that the potential for error is inherent. One of the most important factors in achieving safe patient care is overt, palpable and continuous commitment from organizational leadership and staff to foster an environment that encourages and supports safe and reliable care.


2 | Chr is t iana Care Heal th System

Our Journey in Culture of ResponsibilityCreating an ingrained culture of safety within health care—one in which every member of the team aligns in common pursuit to uncover and eliminate even the slightest potential for harm—is essential to preventing errors and in delivering a safer, more effective care experience for those we serve. In one of our health system’s most signifi cant culture shifts, Christiana Care frontline employees, physicians and leadership are forging an unprecedented journey toward a Culture of Responsibility. This calls upon individual and collective responsibility to identify safety risks in our environment.

A Culture of Responsibility is a commitment to create an environment of shared responsibility among all members of the health care team, from leaders, to physicians and staff, and those who create and administer the systems in which care is delivered. The focus is on improving systems and creating a learning environment that encourages colleagues to voice concerns, raise issues and report errors and near misses without fear of retribution or punitive action.

Recognizing that mistakes will happen, Culture of Responsibility helps us defi ne and manage human error, at-risk and reckless behavior to create a consistent managerial approach that removes the potential for unsafe behavior. Ultimately, it will help us design safer systems, support safer behaviors and create a standard for how to treat colleagues when errors do occur.

Frontline staff, physicians and system leadership are integral partners in this renewed culture that:

Creates an open learning environment where staff feel comfortable talking about errors and have time to refl ect upon how we might do things differently.

Focuses on responsible behavioral choices while avoiding individual blame.

Strives to understand why humans make mistakes, drift and participate in at-risk behaviors.

Analyzes adverse clinical events focusing on what happened, what normally happens, why it happened and what we can do to prevent it from happening again.

Consoles professionals who make an error, coaches those who drift into at-risk behavior and disciplines reckless behavior.

Limits the use of warning and punitive actions to where they will benefi t and improve safety.

Supports our staff by designing systems that will reduce error and drift as a result of competing demands, such as turnover time, broken systems and misinformation.

Culture of Responsibility fosters learning environment

To date, more than 300 managers and physician leaders have been trained

in Culture of Responsibility concepts as part of a multi-year phased

implementation plan.

Qual i t y and Sa f e t y Annual Repor t | 3

“Every day, every where, every one. Culture of Responsibility gets us all thinking about our shared responsibility for making things better.”

—Michele Campbell, RN, MSM, CPHQ, FABC, Corporate Director, Patient Safety and Accreditation

Promote an Open and Fair Culture

• Error reporting is transparent.

• The erring professional feels safe reporting errors, giving others the opportunity to learn from them.

• Near misses are reported as a learning opportunity to reduce future risk or error.

Manage Behavioral Choices

• Understands and anticipates that humans will and do make mistakes.

• Management of behavioral choices allows achievement of desired safety outcomes.

Four cornerstones support our Culture of Responsibility:

Advance Our Learning Culture • Acknowledges the thirst for knowledge

and need to understand both individual and organizational risk.

• Those involved learn from their mistakes and share this learning in a way that supports performance improvement and encourages safe behavioral choices.

Design Safe Systems

• Managers and employees work collaboratively to design systems that anticipate human error, capture errors before they reach the patient or employee, and that allow for recovery when errors do reach the patient.



The number of patients harmed or at risk for harm has been reduced by 10 percent due to a steadfast and shared commitment by leadership and frontline staff to four key priorities:

Reducing the risk of health care–associated infections through surveillance and prevention.

Achieving high reliability through adoption of best practices and a focus on National Patient Safety Goals and practices.

Implementing Medication Safety Practices.

Identifying, reporting, managing and learning from near misses and adverse events.

Defi ning harm and riskPreventable harm is categorized into seven key areas. Each occurrence or event of harm is counted and compared to the previous year-to-date to determine the percent change. The concept of “any is too many” resonates with frontline staff to reduce and eliminate patient harm. Variations from safe practices and processes that place patients at risk for harm are counted to further limit the potential for patient harm.

Christiana Care achieves goal to reduce harm by 10 percent

Strategy to achieve long-term goal of eliminating preventable harmAchieving the long-term goal to eliminate preventable harm required greater focus on priority setting and execution. To strengthen these functions, Christiana Care restructured its Quality and Safety Program, beginning at the leadership level. Organizational priorities based on the Annual Operating Plan and Long-Term Strategic Goals now fall under three major areas:

1. Safety First (Eliminate preventable harm).2. Clinical Excellence (Evidence-based practice).3. Think of Yourself as a Patient (Patient care experience).

Each area of focus sets specifi c priority-driven targets for the patient care unit level. Interdisciplinary unit-level Value Improvement Teams (VITs) trained in performance improvement science drive daily actions to reduce patient harm, improve quality of care and enhance patient satisfaction. The Offi ce of Quality and Safety and Operational Excellence support project-based work, education and training, and mentoring for unit-based VITs. From the unit-level Value Improvement Teams to the senior leadership suite, the renewed focus to improve safety, quality and effi ciency in every patient encounter is an important step toward creating greater value in the overall care experience.

Seven Categories of Preventable Harm1. Hospital Acquired Infections2. Medication Safety Events3. Falls with Major Injury4. Hospital Acquired Pressure Ulcers –

Stage 3 & 45. Non-ICU Code Blues6. AHRQ Patient Safety Indicators7. Other Serious Safety Events

As a result of these actions, we reduced

the number of patients harmed or at

risk for harm by 10 percent.


0

425

850

1275

1700

0

425

850

1275

1700

1653

1351

FY 11 FY 12

Harm

302 fewer patients were harmed compared to the same time period last year.

# of

Pat

ient

s H

arm

ed

0

2

4

6

8

10

0

2

4

6

8

10

J09A S O N D J F M A M J J10A S O N D J F M A M J J11 A S O N D J F M A

Harm rate decreased by 18 percent.

Preventable Harm Rate

trend

Har

m p

er 1

,000

pat

ient

day

s



AHRQ 2010CCHS 2010CCHS 2009CCHS 2006

Nonpunitive response to error survey composite.

0

20

40

60

Nonpunitive

0

20

40

60

S feel like their mistakes are held against them.

When an event is reported, it feels like the person is being written up, not the problems.

S worry that mistakes they make are kept in their

e.

Christiana Care strives for AHRQ top decile in safety

One of our long-term goals is to place in the top decile performance compared to other hospitals participating in the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture, which assesses hospital staff perceptions about patient safety issues, medical errors and event reporting.

We believe that our journey toward a Culture of Responsibility will help address one of the key opportunities for improvement identifi ed in FY 2010 survey data—nonpunitive response to error.

Key areas of focus to achieve top decile performance are:

Best Practices around transparency – Good Catch recognition; walking rounds; sharing reported adverse events and lessons learned through system improvements; and continued No Harm Intended sessions.

Engagement of middle management – Embedding Culture of Responsibility into our leadership behaviors; strengthening and re-engineering unit-based CUSP teams into data-driven unit-based Value Improvement Teams; conducting purposeful rounds and coordinating interdisciplinary post-event debriefs at the point of care.

Providing feedback and accountability – Timely event follow-up and learning through our Culture of Responsibility; technology-enhanced event follow-up; safe practice behavior monitoring feedback; and our hand hygiene campaign.

Optimizing survey data – Using organizational and local qualitative and quantitative data related to the specifi c dimensions of culture to assess effectiveness of interventions and our new Quality and Safety structure.

Nonpunitive Response to Error

Improvement demonstrated andis better than national levels.

% P

ositi

ve R

espo

nse



Launched in March 2012 as part of the journey toward a Culture of Responsibility, the “Good Catch” tiered reward program recognizes staff members who identify and report

“near misses.” Good Catches increased monthly from 8 – 16 percent of all reporting since implementation, leading to mitigation of harm to our patients in such areas as:

Patient Identifi cation. Test, treatment and procedure. Environment. Change in patient status. Medication, IV and blood. Equipment and supplies.

The program engages staff to be attentive and intervene to prevent harm. It also encourages them to suggest opportunities for improvement in system design. By

encouraging more reporting, the program will enhance the system’s ability to learn from trends and improve the culture of safety. It also supports achievement of our fi ve-year goal to become a national leader in quality and safety and achieve top decile performance in the AHRQ Hospital Survey on Patient Safety Culture.

Rewarding those who speak up not only gets staff involved in patient safety, but, more fundamentally, it changes staff perceptions about reporting Good Catches.

Good Catch program strengthens staff voice in patient safety

“Speaking up constructively and intervening to prevent harm not only protects the patient, but also protects the health care professionals involved.”—Anabelle Navarro, RN, BSN, PCCN, CCRN, Christiana Hospital Cardiovascular Critical Care Complex – Surgical

0%

25%

50%

75%

100%

0%

25%

50%

75%

100%

7% 7% 5%6% 8% 8% 8% 8% 16% 15%

11-Jul 11-Aug 11-Sep 11-Oct 11-Nov 11-Dec 12-Jan 12-Feb 12-Mar 12-Apr

No Evidence of Injury or HarmCorrected Before Reached Patients (Good Catch)

Good Catch reporting, as a percentage of all events, has doubled since the March 2012 kickoff.

FY 2012 Near Miss EventsGood Catch Program Kickoff 3/1/12

% o

f Rep

orte

d Ev

ents



Post-event debriefs help clinical team members identify system and communication issues relating to adverse events and near misses.

Discussions focus on system issues rather than individual behavioral choices, allowing participants to discuss

events, in a supportive, learning environment. A clear and common understanding of the facts allows all to discover what can be done differently to mitigate further harm to our patients.

Post-event debriefs enhance learning from adverse events

0% 20% 40% 60%0% 20% 40% 60%

Strongly Agree

Agree

Neither

Disagree

Strongly Disagree

90 percent of participants tell us they have learned from the discussions. 98 percent would participate in another debrief, given the opportunity.

N=320

50%

63%

75%

88%

100%

50%

63%

75%

88%

100%

7176 76.6

2006 2009 2010

Debriefs led to an 8 percent improvement in organizational learning.

P <0.001

Statistically Signifi cant Improvement

% P

ositi

ve R

espo

nse

Organizational Learning-Continuous Improvement Direct/Indirect Care Providers

Lessons Were Learned in Discussing Event



40%

50%

60%

70%

80%

90%

100%

40%

50%

60%

70%

80%

90%

100%

10-Dec 11-Feb 11-Apr 11-Jun 11-Aug 11-Oct 11-Dec12-Feb 12-Mar

Discharge Date

Patient and family centered approach leads to better care for our patients

Wilmington Hospital’s emphasis on patient and family centered care—placing patients in equal partnership with the health care team—is shifting the culture from one of doing things to and for patients, to one of working with patients and their families. Recognizing that patients tend to view the health care team as the experts, staff now stress that it is the patient and his or her family who are the experts on their individual needs. Combining their input with the science offered by the health care team creates a more effective plan of care.

Patient and family-centered initiatives improving the care experience include:

One Voice Steer Committee (focused team effort on improving communication).

Bedside shift-to-shift reports (involving nurses, technicians, patient and family).

In-room white boards (provide two-way communication, engage patient and family in plan of care, customize care coordination and discharge planning, hold staff accountable and promote collaboration between patient and health care team).

AIDET (staff reminder to Acknowledge, Introduce, predict Duration, provide Explanation, and Thank.)

Hourly rounds (staff proactively check on patient comfort and needs before issues emerge that may negatively impact safety or satisfaction).

Patient and Family Advisory Council.

With patient and family centered care practices in place, the percentage of patients giving Wilmington Hospital top rating has increased by more than 14 percent.

Overall rating of care

Patient and Family advisers share invaluable insight to improve care experienceA cadre of 12 community members—all either former Wilmington Hospital patients or family

members—share their experiences with hospital management and staff at monthly forums, offering

a unique perspective to help shape policies, programs, facility design and day-to-day service

interactions to continuously improve the care experience.

Percent of patients rating us 9 or 10trend

% T

op B

ox (9

–10)

Discharge Date



“We don’t want to fi nance unnecessary care; we want to fi nance care that adds value to our patients because that, in the end, is most sustainable.”—Peter L. Slavin, M.D., President, Massachusetts General Hospital

“The concept of value is grounded in the needs of our neighbors, as they perceive them.”Robert J. Laskowski, M.D., MBA, President and CEO, Christiana Care Health System and Founder, Christiana Care Value Institute

“It’s about learning what we used to know; the things we knew before we became so well educated.”Chris Coons, U.S. Senator, Delaware

“To tap into the value proposition, health care must address the emotional side of the equation.”Arkadi Kuhlmann, HBA, MBA, LLD, ING DIRECT USA’s founder

The medical profession must refocus attention on the patient to deliver quality care at greater value, according to speakers at the Christiana Care Value Institute’s inaugural symposium “Value: Medicine’s New Frontier.”

More than 200 health care experts from many of the

nation’s top institutions discussed how returning to the basics of medicine—listening to the patient, better use of resources and a greater emphasis on quality and safety—can transform patient care and deliver far greater value.

Christiana Care established the Value Institute to study and design solutions to the questions of value in the real world settings of health care delivery. It aims to implement strategies to achieve better health outcomes at lower costs.

The speaker lineup included widely respected thought leaders in the health care industry. Virginia L. Hood, M.D., immediate past president, American College of Physicians; David B. Nash, M.D., MBA, dean of the Jefferson School of Population Health; Michael Lauer, M.D., director of the Division of Cardiovascular Sciences at the National Heart,

Lung and Blood Institute, National Institutes of Health; Peter L. Slavin, M.D., president of Massachusetts General Hospital; U.S. Senator Chris Coons (Delaware) and Arkadi Kuhlmann, HBA, MBA, LLD, founder of ING DIRECT USA, all joined Christiana Care President and CEO Robert J. Laskowski, M.D., MBA, on the dais.

“Value is more than the benefi ts of cross serving our patients’ needs,” said Dr. Laskowski in his address, “Value:

Value Institute encourages providers to start with the patient


Surgical symposium offers insight to function, effi cacy, cost and use of devicesChristiana Care’s OB/GYN Value Improvement Team presented a comprehensive review of cost

effectiveness data and comparative use of supplies and equipment relative to value at a December

2011 Value Institute-sponsored symposium entitled “Defi ning Value in the Surgical Environment.”

The symposium highlighted evidence-based guidelines to review and evaluate outcomes, quality

and cost of the 14 priciest devices used by the departments of Surgery and Obstetrics and

Gynecology. Surgeons received a detailed listing of GYN surgical supplies used in the preceding 18

months, as well as the hospital average supply cost for each procedure, allowing them to reassess

individual surgical preferences based on best available data and apply new practices, if appropriate,

to maximize value while maintaining optimal outcomes.

Keynote speaker Barbara Levy, M.D., former president of the American Association of Gynecologic

Laparoscopists and a frequent guest on “The Oprah Winfrey Show,” suggested that with the right

steps in place, gynecologists can successfully perform hysterectomies on an outpatient basis,

reducing the need for inpatient stays and reducing costs substantially.

Mark J. Garcia, M.D., RSIR, chief of Interventional Radiology at Christiana Care and one of the few

interventionalists nationwide specializing in the treatment of chronic clots, compared the clinical

effectiveness and cost effi ciency of fi broid embolization to other surgical methods.

the Patient’s Perspective.” He added, “Those who deliver and fi nance health care must continually remind themselves that it is, fi rst and foremost, the patient who is served.”

“Our issue of patient care, what the individual ‘feels,’ appears to matter at least as much as the facts,” he said. “We who lead health care must understand these feelings as well as the facts if we are to improve quality and safety

and reduce costs.” Dr. Laskowski outlined his views in an April 26, 2012 op-ed on The Hill Congress Blog.

The April 30 debate covered conserving resources at the physician-patient level; quality and safety in health care, including educational reform for medical students; addressing consumers’ emotional assessment of the value equation; the scientifi c value of clinical trials; ways to make health care more affordable; and returning to the basics of care.



0

625

1250

1875

2500

0

625

1250

1875

2500

11-Jul 11-Aug 11-Sep 11-Oct 11-Nov 11-Dec 12-Jan 12-Feb 12-Mar

Advancing health care equity through cultural awareness, education and qualifi ed medical interpretation

Our patients’ increasing cultural and linguistic diversity creates unique challenges for patient safety. Our ability to provide safe, high quality and equitable care depends on understanding the unique cultural needs of our patients and using qualifi ed resources to communicate safely and effectively.

Christiana Care’s Center for Diversity, Cultural Competence and Communications offers various role-based education programs, including online educational modules, simulation

labs, departmental training, online resources and co-sponsored educational events with Nursing, Patient Safety, Quality and other departments. This year, we launched the fi rst Diversity and Cultural Competency e-Learning module, which helps generate awareness and knowledge among employees of Diversity and Inclusion strategy expectations, basic concepts related to cultural competence, impact of language barriers on quality and patient safety, and available resources and tools.

A critical goal in establishing a culture of safety is the increased use of appropriate and qualifi ed interpretation

resources to communicate with patients who have limited English profi ciency, and the elimination of “ad-hoc” interpretation by family, friends or staff members who have not been tested or trained as medical interpreters.

Qualifi ed interpreters reduce such common errors as misinterpretation of medical information, violation of confi dentiality laws and confl icts of interest.

While telephonic interpretation provides immediate access to qualifi ed interpreters, this communication method is not always appropriate or feasible due to the complexity of the information being transmitted, patient mental status or other barriers. Christiana Care has increased staffi ng to four full-time Spanish-speaking medical interpreters. The number of in-person interpretation encounters has increased to an estimated 550 per month.

More than 200 consent forms, patient education and other documents are now translated into Spanish, with translation planned for other languages.

Christiana Care’s network of 625 Cyracom telephones provides immediate access to trained and qualifi ed interpreters in more than 170 languages. The top fi ve languages in 2011 were: Spanish, Brazilian, Portuguese, Arabic, Mandarin and Korean. From July 2011 to March 2012, telephonic interpreters assisted in 16,095 patient encounters in 25–30 languages per month.

FY12 Telephonic Interpretations

All LanguagesSpanishNon-Spanish

# of

Tel

epho

nic

Inte

rpre

tatio

ns



0%

25%

50%

75%

100%

0%

25%

50%

75%

100%

Overal

l Rati

ng

of Care

Comm

unica

tion –

Nurse

s

Comm

unica

tion –

Docto

rs Resp

onse

of

hospita

l staff

Hospita

l en

viron

men

t

Pain

man

agem

ent

Comm

unica

tion –

Med

icatio

ns

Discha

rge

Proc

ess

Christiana Care (July 11–Mar 12) National Median

Christiana Care continues to exceed the national median in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) value-based scores in all but two

areas—hospital environment and discharge planning. Scores relating to how well we prepare patients for leaving the hospital on the HCAHPS survey—a government study for measuring patient perception of care across the country—escalated by as much as 22.7 percent on one nursing unit. A current average of 77.2 percent for all units combined indicates a positive trend.

Discharge planning focuses on needs at homeA renewed focus on consistently asking patients and their loved ones if they need help once they leave the hospital—in some cases supplemented by a phone call checking on the patient at home—is improving patient satisfaction with our discharge process.

Improving our hospital environment An audit measuring noise level variations and observations in eight rooms at Christiana Hospital will provide valuable guidance in improving our hospital environment scores. Unit-based pilots are also studying ways to make patients more comfortable, such as:

Replacing wheels and castors on hospital equipment, such as blood pressure carts and IV poles.

Providing dual earpiece television headsets.

Placing or adjusting silencers on doors in patient care areas.

Installing white noise units and closing patient doors to minimize noise from the nursing station fi ltering into patient rooms.

HCAHPS scores exceed national median in most areas

Christiana Care scores above national levels in 6 of 8 survey areas, with the strongest performance in nursing and physician communication and pain management.

Patient Satisfaction

Top

Box

Scor

e (9

–10)



0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

CY2000 CY2002 FY2004FY2006

FY2008FY2010

FY2012

Employee Safety efforts create safer work environment

Commitment to Safety First helps drive lost time injuries rate below industry averageA systemwide commitment to Safety First, supported by sustained efforts to reduce lost time injuries (LTIs), continues to promote a safer work environment for Christiana Care employees. In FY 2011, the system adopted an aggressive goal of reducing LTIs below the national average of 1.7 (as benchmarked by the Bureau of Labor Statistics). Impressively, Christiana Care’s actual LTI rate for that period decreased to below 1.5. This represents a 33 percent reduction in injuries from FY 2010 to FY 2011 (176 injuries in FY 2010; 118 in FY 2011).

The Injury Reduction Team continues its efforts to further reduce workplace injuries, committing to maintain a

lost time injury rate below 1.4 in FY 2012. The team is also expanding efforts to reduce all three categories of recordable injuries—those causing employees to lose time on the job; those that require the employee to assume restricted duty; and those, while not impacting the employee’s ability to work, still result in the need for medical treatment—with an established goal of reducing total recordable injuries to below 5.5 in FY 2012.

Christiana Care’s Employee Safety Program is a signifi cant approach, incorporating technology, wellness and educational programming, aimed at changing behavior and practices, and, ultimately, keeping those who provide care throughout our facilities safe and on the job.

Lost Time Injury Rate

Christiana Care’s PEEPS© (Patient, Environment, Equipment, Posture, Safety) Employee Injury Prevention Program is credited with signifi cantly reducing the number of lost time injuries suffered by nurses and patient care technicians due to transferring and repositioning patients. Lost time injuries decreased by 85 percent over the last decade.

trend

Inju

ries

per

200

,000

Hou

rs W

orke

d



0% 25% 50% 75% 100%0% 25% 50% 75% 100%

Able to identify ETOH withdrawal

Comfortable with CIWA

Able to communicate with team members

Able to identify delirium

Comfortable with CAM

While working with robots and mannequins is paramount to honing technical skills required in patient care, there is no stand-in for human interaction when it comes to improving doctors’ and nurses’ ability to handle emotionally charged clinical situations. A collaboration between Christiana Care Health System and the University of Delaware, as one of the

Delaware Health Science Alliance initiatives, sets the stage for nurses and residents to gain experience and confi dence in

handling patients experiencing the effects of either alcohol withdrawal or delirium.

As a human-centered teaching tool, the process also allows the “patient” to offer health care providers such constructive feedback as “too much medical terminology,”

“not enough eye contact” or “so focused on reviewing charts and checking IV lines that the patient felt ignored.”

Simulated scenarios drive interprofessional communication

CIWA = Clinical Institute Withdrawal Assessment CAM = Confusion Assessment Method ETOH Withdrawal = Alcohol withdrawal

Surveys show that practicing with actors increases nurses’ and residents’ ability to recognize and treat potentially aggressive symptoms, as well as to communicate more effectively with team members.

Simulated Scenarios% Positive Responses


Inspired by high reliability organizations in other risk-laden industries, such as aviation and nuclear power, health care governing bodies such as the Joint Commission, the federal Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services are calling for industry-wide restructuring of leadership, goals and operations to ensure consistently reliable levels of safety and quality when it comes to patient care.

Christiana Care fervently embraces this opportunity to work toward near-perfect processes and to sustain the

highest levels of safety and quality. Employing robust process improvement methods, such as Lean and change management, we are better able to identify root causes for systemic challenges and to create consistently employable solutions for success. Measuring and reporting outcomes leads to greater transparency and higher accountability.

While health care, in its service to people, will never be 100 percent reliable, our commitment toward achieving high reliability leads to a safer, more effi cient, more cost-effective and higher quality care delivery system of value for our community.




Christiana Care’s all-out effort to eliminate central line associated bloodstream infections (CLABSI) is credited with a 44 percent decrease overall, with a majority of improvement realized in the intensive care units.

Using the Comprehensive Unit-Based Safety Program (CUSP) approach to identifying and learning from defects, Christiana Care joined a national collaborative to address the signifi cant increase in patient morbidity and mortality, higher length of stay and greater costs associated with CLABSI.

CUSP teams introduced several initiatives to improve insertion techniques, including:

Proper hand hygiene.

Full barrier drapes.

Skin preparation with chlorhexidine before insertion.

Use of Biopatch® dressing (chlorhexidine impregnated sponge) that, unless compromised, is changed every seven days. This reduces the prior practice of more frequent dressing changes with greater associated opportunity to compromise the line.

Avoiding femoral lines or changing site as soon as possible.

An automated Central Line Insertion Checklist is incorporated in the Powerchart electronic medical record. Nurses monitor and complete the checklist for all central line insertions and are empowered to stop the process if any checklist items are not complete. Nurses now assess daily the necessity of all invasive devices, including central lines.

Central line carts are now available all units, and central line insertion simulation training is now required of all medical/surgical residents.

CUSP approach helps reduce central line associated bloodstream infections

0

10

20

30

40

50

60

0

10

20

30

40

50

60

50

28

-44%

FY11 FY12

The number of patients harmed by CLABSI has decreased by 44 percent.

Central Line Associated Bloodstream Infections

Num

ber o

f Pat

ient

s H

arm

ed

to



0

20

40

60

80

100

0

20

40

60

80

100

95

27

-72%

FY11 FY12

There were 68 fewer VAP cases this year. Efforts continue toward reaching the goal of zero VAP and sustaining improvements over time.

Ventilator Associated Pneumonia

Reducing the risk of health care –associated infections

40%

50%

60%

70%

80%

90%

100%

40%

50%

60%

70%

80%

90%

100%

9-Jun 9-Nov 10-Apr 10-Sep 11-Feb 11-Jul 11-Dec 12-Apr

Hand Hygiene Trend

We exceeded our handwashing goal of 90 percent in fi ve of the last six months.

Goal 90%

Unit-specifi c strategies to prevent Ventilator Associated Pneumonia (VAP), outlined by the Comprehensive Unit-Based Safety Program (CUSP) teams and the Device and Procedures Task Force, include:

Head of bed >30 degrees. Improved oral care (chlorhexidine). Sedation vacations. Daily weaning attempts.

Aggressive VAP prevention efforts continue through daily evaluation of the patient’s readiness to extubate and monitoring compliance with nursing interventions. CUSP teams concurrently review and discuss patient-specifi c strategies and share successes with bedside staff across nursing units.

Num

ber o

f Pat

ient

s H

arm

ed

% o

f Obs

erva

tions



VTE incidence rate improves by 62 percent

A pre-operative risk assessment tool is the driving force behind a successful effort to help prevent venous thromboembolism (VTE), leading to a 62 percent improvement in the incidence of pulmonary embolism (PE) or deep vein thrombosis (DVT).

DVT is a blood clot in a deep vein, typically in the legs; the clot inside the blood vessel is called thrombosis. The thrombosis can dislodge, or embolize, without warning or symptoms and travel to the lungs, causing a life-threatening pulmonary embolism.

To reduce harm associated with VTE, a Steer Committee focusing on surgical patients recommended the following pre-operative prevention strategies to complement the risk assessment tool:

Implementation of an evidence-based algorithm to guide selection of appropriate prophylaxis based on the patient’s risk score.

Generation of a daily unit-level list of patients not receiving prophylaxis to prompt caregivers to intervene at point of care.

Compliance with VTE prevention guidelines will be concurrently monitored through the Lighthouse system in the Powerchart electronic patient record in accordance with Meaningful Use requirements. Lighthouse enables clinicians and frontline staff to immediately identify and intervene on patients without appropriate prophylaxis to prevent pulmonary embolism/DVTs.

VTE prevention is an identifi ed priority based on the Agency for Healthcare

Research and Quality (AHRQ) Patient Safety Indicators, as well as comparative

results from the National Surgical Quality Improvement Project (NSQIP).

0%

0.5%

1%

1.5%

2%

2.5%

3%

0%

0.5%

1%

1.5%

2%

2.5%

3%

10-Jul 10-Sep 10-Nov 11-Jan 11-Mar 11-May 11-Jul 11-Sep 11-Nov 12-Jan

Post-operative VTE rate

The percent of patients with VTE decreased by 62 percent.

% o

f Sur

gica

l Cas

es

trend



Admissions from the Emergency Department (ED) to an inpatient unit arranged in concert by an experienced physician, resident, nurse, clinical pharmacist and social worker/case manager team working as a Synchronized Admission Team are improving quality and effi ciency in the delivery of care.

Data shows a reduced length of stay, eliminating the need for Rapid Response Team (RRT) calls in the fi rst 24 hours of the patient’s stay, while demonstrating no increase in readmission

rates or ED boarding hours. The process also increases core quality measure compliance for treatment of congestive heart failure, acute myocardial infarction and pneumonia—with pneumonia compliance reaching 100 percent.

Synchronized admission makes the entire admissions process more expedient and effi cient. Within minutes of receiving the alert of a patient requiring admission, the team huddles to review all available information in the electronic health record. They then meet as a team with the patient and family

Synchronized approach leads to safer patient-centered admissions

Staff report that synchronized admission promotes a smooth work fl ow, facilitates

communication among all stakeholders and promotes quality and safety during

the transition from the Emergency Department to the inpatient unit.

0

1

2

3

4

5

0

1

2

3

4

5

3.83.55

3.22

Pre-SWAT Non-SWAT SWAT

Hospital Average Length of Stay

Effi cient admission processes and improved safety led to a 9 percent decrease in length of stay.

Num

ber o

f Day

s



to collect additional information, allowing the patient to share his or her story only once to all involved in the admissions process. Each member then carries out his or her respective role in the admissions process, including partnering with the patient and family members for the plan of care.

Among its many benefi ts, the process offers the potential to reduce medication errors by ensuring the placement of medication orders by physicians at the time of admittance; consultation with the pharmacist at the time of order

0

5

10

15

20

25

0

5

10

15

20

25

11

23

2

Pre-SWAT Non-SWAT SWAT

1.2%

1.0%

0.8%

0.6%

0.4%

0.2%

0.0%

Rapid Response Team Calls within 24 hours of leaving ED

Num

ber o

f RRT

Cal

ls

% o

f pat

ient

s

Effective communication and appropriate patient placement signifi cantly reduce the need for calls to the Rapid Response Team.

RRT within 24 hrs

% of patients

Piloted at Christiana Care’s Wilmington campus in 2009 and expanded to

the Stanton campus in January 2012, this re-engineered admissions process

addresses the National Quality Forum’s national priorities of promoting

effective communication and care coordination, as well as ensuring person-

and family-centered care.

entry; patient knowledge of the rationale for medication prescriptions; more accurate and timely medication allergy review; more timely medication order processing; fewer phone calls made to clarify medication orders with physicians; increased formulary compliance; and by giving the pharmacist a bedside role in patient care.



0

1

2

3

3

4

5

0

1

2

3

3

4

5

4.73 4.51

3.71

Baseline Jul10–Jun11 Cohorting Aug11–Oct11 SIDRs Nov11–Apr12

Inpatient average length of stay decreased by 22 percent thanks to structured interdisciplinary rounds.

Inpatient Average Length of Stay

0%

3%

7%

10%

13%

17%

20%

0%

3%

7%

10%

13%

17%

20%

17.7%

15%13.2%

Baseline Cohorting SIDRs

SIDR process led to a 25 percent reduction in 30-day readmission rates.

Readmissions within 30 Days of Discharge

Creation of a team-based approach to care that incorporates Structured Interdisciplinary Bedside Rounds (SIDRs) on one Christiana Hospital medical unit points to improved quality and safety, more effi cient hospital operations and better communication between the physician and unit staff.

Physician-led SIDRs occur daily at the patient’s bedside, involving the patient and family, physician, bedside nurse, charge nurse, clinical pharmacist, respiratory therapist,

case manager and social worker. The patient and family are integrally involved in discussions, including plan of care and tentative discharge date, and participate in completing the safety checklist. Afternoon huddles were also implemented to enhance safe and effi cient transitions out of the hospital.

SIDRs demonstrate impressive results to date. Plans are to spread to other hospitalist-based units.

Structured interdisciplinary bedside rounds improve safety and effi ciency

Num

ber o

f Day

s%

of P

atie

nts



Heart Failure core measure performance rises steadily

Core measures for heart failure treatment are rising steadily and improving the reliability of care for patients with heart failure. Progress includes:

More timely identifi cation of patients requiring specialized heart failure treatment.

More appropriate bed assignments from the Emergency Department to the heart failure unit or appropriate cohort.

Reduced length of stay.

Reduced 30-day readmissions.

Improved patient satisfaction.

Greater compliance with evidence-based guidelines.

One of nation’s busiest for heart failure careChristiana Care is one of the nation’s busiest heart failure treatment centers, ranking anywhere from fi fth in volume

HF Overall Core Measure Performance improves each yearHeart Failure Core Measure Composite Score Since Program Inception

70%

75%

80%

85%

90%

70%

75%

80%

85%

90%

79.5

76.2

86.285.1

87

90

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Compliance with core measures increased by 20 percent through efforts of the Heart Failure Program.

for mid-acuity to 22nd for high-acuity patients. More than 90 percent of heart failure patients admitted to Christiana Care come through the Emergency Department. Nearly two-thirds of patients with heart failure are cared for by a select group of hospitalists, community cardiologists or primary care physicians. Due to bed availability or cohorting for comorbidity, approximately half of the patients are admitted to the dedicated heart failure unit at Christiana Care’s Stanton campus; the other half are admitted throughout the nursing units at both campuses. By engaging those providing the majority of heart failure care in the value improvement effort—and by involving representatives from the Emergency Department and the Visiting Nurse Association, which provides ongoing home disease management—the Value Improvement Team is working to improve the reliability of heart failure care at any touch point throughout the health system.

Christiana Care’s heart failure program holds the Joint Commission Gold Seal of Approval ™.

trend

Com

posi

te S

core


Value score cards track Value Improvement Team progressChristina Care is reducing variation in care and achieving high reliability through population-based Value Improvement Teams. Heart failure, acute myocardial infarction (heart attack), pneumonia and complications following surgery are among the priority areas where we focus on delivering greater value to our patients.

Heart Failure

ACTUAL O/E or TARGET PROGRESS

Guideline Compliance

Discharge Instruction* 92.5% +

Evaluation of LVS Function 100.0% +

ACE/ARB for LVSD 100.0% +

Outcomes

Patient Satisfaction 89% +

Mortality 3.8% ○

Readmission 24.8% +

Cost/Utilization

Length of Stay 4.25 +

Estimated Direct Cost $7,867 +

Value Based Purchasing Impact +

Current Value Score 83.1 B

BASELINE 79.9 C+

Acute Myocardial Infarction



PCI Within 90 Minutes of Arrival* 96.9% +

Aspirin at Discharge 100.0% +

Statin at Discharge 96.2% +

Outcomes


Mortality 4.5% +

Readmission 12.5% -

Cost/Utilization




Current Value Score 85.2 B

BASELINE 84.0 B

Acute Myocardial Infarction – Mean time to percutaneous coronary intervention decreased by 9 minutes, mortality improved by 8%, estimated cost savings of $1.5 million.

Heart Failure – 8% improvement in core measures, 20% reduction in readmissions, cost savings of $0.6 million.


KEY TO SYMBOLS

Guideline Compliance:* Measure is included in VBP

>= Threshold (for measures with

baseline performance < threshold)

Between baseline & threshold

< Baseline

Outcomes: Observed to Expected <= 1.0

O/E > 1.0 and <= 1.10

O/E > 1.10

Progress: YTD compared to baseline

+ Improving toward target

- Worsening compared to target

○ Flat compared to target

Pneumonia



Blood Culture Pre Antibiotic* 89.4% +

Initial Antibiotic Selection* 86.0% ○

Pneumococcal Vaccination 100.0% +

Infl uenza Vaccination 100.0% +

Outcomes


Mortality 0.8% ○

Readmission 7.4% +

Cost/Utilization



Value Based Purchasing Impact ○

Current Value Score 87.4 B+

BASELINE 76.9 C

Pneumonia – 7% increase in core measures, 14% reduction in readmissions, 7% decrease in length of stay, cost savings of $0.5 million.

Surgical Care Improvement Project



Prophylaxis Antibiotic Pre Incision* 97.5% +

Prophylaxis Antibiotic Selection* 99.2% ○

Prophylaxis Antibiotic Discontinued* 99.1% +

Postop Glucose Control* 100.0% +

Periop Beta Blocker* 98.5% ○

VTE Prophylaxis Order* 100.0% +

VTE Prophylaxis Given* 100.0% +

Postop Catheter Removed 94.1% +

Postop Normothermia 93.3% +


Composite Score 93.0 +

Current Value Score 95.8 A

BASELINE 94.2 A

Surgical Care Improvement Project – Improvement in 7 of 9 measures.



parameters is discussed with the patient, fi eld clinician and doctor, as warranted, to plan appropriate interventions.

VNA home health nurses use a coaching approach to empower patients to manage their chronic disease. Following evidence-based care plans, they educate patients on symptom recognition, disease process, treatment regime,

medication management and, if appropriate, telehealth. Physical therapists may also work with these patients on energy conservation and increasing endurance. A VNA pilot program studies the benefi ts of having a respiratory therapist educate patients on medication and equipment.

When patients learn how to better manage their condition, fewer emergency room visits are needed. Many times, VNA’s timely intervention means less time in the emergency room and less need for costly hospitalization.

COPD disease management program reduces hospitalization

“Patients who participate in their care through daily monitoring connect the dots to identify that healthy behaviors coincide with feeling their best.” —Gale Bucher, MSN, RN, COS-C, Director of Quality & Risk Management, Christiana Care Visiting Nurse Association

0%10%20%30%40%50%60%70%80%90%100%

0%10%20%30%40%50%60%70%80%90%100%

Acute

Car

e

Hospita

lizat

ion

Emer

gent

Care

Impro

vem

ent

in D

yspnea

Impro

vem

ent i

n

Ambulat

ion

Impro

vem

ent

in Ea

ting

Impro

vem

ent

in B

athin

g

Impro

vem

ent i

n

Bed Tr

ansfe

rring

Dischar

ge to

Comm

unity

Impro

vem

ent i

n

Oral M

ed

Man

agem

ent

Outcomes for COPD Patients CY2011

Patients enrolled in Christiana Care VNA’s disease management program do better in dyspnea (shortness of breath), ambulation, nutrition, bathing, bed transfer and oral medication management, and are less likely to need hospitalization than the national reference.

*Strategic Healthcare Programs, LLC

Innovative telehealth technology, which allows Christiana Care’s Visiting Nurse Association (VNA) to monitor appropriate patients with chronic obstructive pulmonary disease, plays a key role in improving patient outcomes and leads to 13 percent fewer hospitalizations than the SHP* reported national reference.

Telehealth allows direct daily cellular transmission of vital signs, such as weight, blood pressure and pulse oximetry, and other symptom information to a nurse who reviews the data. Any information outside the patient’s doctor-ordered

% o

f Pat

ient

s

CCHS VNA*Reference



0%10%20%30%40%50%60%70%80%90%

0%10%20%30%40%50%60%70%80%90%

On-Time On-Time plus 5 min On-Time plus 10 min

25

30

35

40

45

25

30

35

40

45

10-Jun 10-Aug 10-Oct 10-Dec 11-Feb 11-Apr 11-Jun 11-Aug 11-Oct 11-Dec

In its fi rst few months, a restructured process fl ow—spearheaded by the Perioperative Services Financial Strength and Operational Effi ciency Steer group—is already improving value to surgical patients by minimizing patient waits and synchronizing care tasks.

The improvement starts days before surgery when a case posts to the Christiana OR. More than 90 percent of patient charts are now complete 48 hours prior to

Perioperative Services redesigns process fl ow to improve effi ciency

surgery—negating historic last-minute surgical delays due to incomplete documentation. The group also streamlined processes on the day of surgery through effi cient assignment of patient care tasks and by improving handoffs and communication among the Special Procedures Unit, Prep & Holding, the Operating Room and the Post-Anesthesia Care Unit. Their efforts increased OR turnaround time by 20 percent, increased the percentage of fi rst case on-time starts by 65 percent and lowered costs.

Process fl ow improvement decreased operating room turnover time by 8 1/2 minutes—a 20 percent reduction. With more than 50 surgeries scheduled a day, that translates to seven hours.

Room Turnover Time

Med

ian

Min

utes

% o

f Fir

st C

ases

On Time Surgical Case Starts

baseline

BaselineCurrent

Percentage of fi rst cases started on time improved by 65 percent. Almost 90 percent now start within 10 minutes of scheduled time.


Christiana Care is taking a leading role in developing national guidelines for the obstetrical practice of episiotomy, the surgical incision to enlarge the vaginal opening during childbirth in order to aid delivery and prevent tissue damage. Evidence shows that the procedure, once thought to prevent more serious vaginal tears and reduce the patient’s risk of incontinence, in fact increases the risk of serious lacerations and contributes to stool incontinence.

Christiana Care and the National Perinatal Information Center (NPIC) petitioned the National Quality Forum (NQF) to support the goal of establishing episiotomy rate as an indicator of the quality of perinatal services. NQF’s November 2011 endorsement takes the standard of low episiotomy rates a step closer to becoming adopted

by the Joint Commission. Matthew Hoffman, M.D., MPH, Christiana Care’s director of OB/GYN Education & Research, serves on the Joint Commission Technical Advisory Panel, which makes the fi nal decision on all adopted quality markers.

Christiana Care launched an educational program for OB/GYN providers on the procedure and the lack of benefi t to patients in October 2008. Between the fi scal years 2008–2010, Christiana Care’s episiotomy rate declined 55 percent. In 2010, only 1 percent of the health system’s obstetricians had an episiotomy rate of more than 20 percent, compared to 25 percent of physicians in 2004. The system’s overall episiotomy rate is currently under 2 percent.

Christiana Care helps develop national episiotomy guidelines

“In the future, hospitals will be judged on their episiotomy rates as a quality marker. Christiana Care is already there.”—Matthew Hoffman, M.D., MPH, Director of OB/GYN Education & Research

0%

3%

5%

8%

11%

13%

16%

0%

3%

5%

8%

11%

13%

16%

FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 YTD(March 2012)

Between fi scal years 2008 and 2010, Christiana Care’s episiotomy rate declined 55 percent. Currently, our rate is under 2 percent.

Episiotomy Rate FY04 - FY11

Epis

ioto

my

Rate



Improves reliability; shortens length of stayThe Christiana Rapid Transfer Initiative: MICU Alert ensures that acutely ill Emergency Department (ED) patients are either rapidly transferred to the Medical Intensive Care Unit (MICU) or, in high capacity situations when a MICU bed is not readily available, stabilized and intensively cared for right in the ED by a dedicated MICU team.

The initiative, which expanded from pilot to deployment in January 2012, ensures a highly reliable, consistent level of care and expedites critical clinical decision making and

therapy for patients requiring the most intense level of care. It also frees up Emergency Department beds and ED staff resources required by critically ill patients.

Median response time to ED is under 15 minutes.

Median ED length of stay reduced by 47%, or 4.2 hours (compared to the baseline time period January–March 2011).

Projected to save 3,967 ED hours this year.

Average MICU length of stay reduced by 1.5 days.

MICU Alert expedites care

Emergency Department Length of Stay

For the ED length of stay above the 25th percentile, the new process statistically shortened the LOS for our sickest patients.

ED L

engt

h of

Sta

y (H

ours

)

2010

0

10

20

30

40

2011 2012



New system gets cases scheduled sooner; enhances productivity Productivity is at an all-time high for the Christiana Surgicenter thanks to an improved scheduling model that allows greater room availability to about 200 community surgeons. The facility now schedules 20–45 cases per day; about 7,000 each year.

A new approach to surgical scheduling, based on type of surgery instead of the traditional block-by-surgeon model, allows surgical practices to schedule cases more promptly and shaves weeks off of the time patients previously waited for worrisome diagnostic procedures at the Christiana Surgicenter. Not only does the move free up desirable OR time and improve accessibility for surgeons and patients, it also improves effi ciency at the Surgicenter itself. In the fi rst nine months of the new service-specifi c scheduling model, cases increased by 2.6 percent after eight consecutive years of declining surgical volume, and productivity soared by 19.6 percent per operating room.

Historically, operating rooms allocated blocks of time to select high-volume surgeons, reserving a room and staff

regardless of whether the surgeon actually scheduled a case for that time slot. As competition in the ambulatory surgery market increased in recent years, the Surgicenter found itself unable to meet scheduling requests from other practices due to block time. Surgical volume decreased while operating rooms sat empty—staffed and ready—but with no scheduled cases.

The revised scheduling model allocates OR time by service

line, and no longer limits blocks to a specifi c surgeon. Cases are now scheduled fi rst come, fi rst served. Blocks of time continue to be allocated based on historical use by service line, with gynecology cases accounting for more than 40 percent of block time. One un-blocked room is on reserve for last-minute add-ons.

With this dramatic, but necessary shift from traditional OR scheduling, accessibility is enhanced, wait times are reduced, cases are no longer unnecessarily turned away, and overall provider and patient satisfaction levels have increased.

An “out of the block” approach to surgical scheduling

500

660

820

980

1140

1300

500

660

820

980

1140

1300

1054

1253

19%

2010 2011

Number of Cases per Operating Room

The Christiana Surgicenter achieved a 19 percent increase in OR productivity with the improved scheduling process.

# of

Cas

es



Christiana Care’s Project Engage is successfully transitioning a high rate of addicted patients with substance-related medical problems to community-based treatment programs following screening, intervention and referral by engagement specialists embedded within both Christiana and Wilmington hospitals. In September 2011, White House Deputy Director of the Offi ce of National Drug Control Policy David K. Mineta visited Christiana Care to learn more about the program that, in its pilot phase at the Wilmington campus, achieved:

A $1.1 million anonymous gift expanded Project Engage in November 2011 from a Wilmington campus–based pilot to a fully funded three-year program now launched at the Stanton campus, as well, with two additional patient engagement specialists. A full-time social worker—an expert in addiction-related community resources—serves both campuses as team leader. The gift also funds a robust program evaluation conducted in collaboration with Christiana Care’s Center for Outcomes Research and the University of Pennsylvania.

Since the pilot’s launch in September 2008, Project Engage specialists have worked with 667 patients, 36 percent of whom are now successfully transitioned to community based substance abuse treatment. A recent health care cost analysis by DPCI-Aetna reveals $190,000 in inpatient savings when comparing the pre- to post-intervention costs of 30 patients seen in 2011.

Project Engage is in collaboration with Brandywine Counseling & Community Services and Aetna Medicaid Plan Delaware Physicians Care for innovative reimbursement and access to fi scal outcome data.

Project Engage transitions addicted patients to community-based treatment

“We’re going after people who are very dependent and stuck in that revolving door between the community and the emergency room and the hospital. It burns up tremendous health care resources and doesn’t tend to the

root cause issue, which is their addiction.”—Terry Horton, M.D., Chief of Addiction Medicine

30–40% increase in drug treatment utilization

$89,000 savings

33% reduction in emergency room and inpatient utilization

88% increase in primary care utilization

n

Qual i t y & Sa f e t y Annual Repor t | 32


Long recognized for its capacity to help us provide more sophisticated care, technology now, too, is credited in limitless ways with making that care safer and more effi cient. Electronic health records connect thousands of providers throughout the state with common access to patient health histories, lab and procedure results, vaccination data and medication lists, leading to more carefully aligned, coordinated care. Computerized order entry negates the risks associated with interpreting handwritten physician orders and allows the pharmacy to immediately screen prescriptions to

verify accuracy and effi cacy. Interpretation of transmitted data allows a real-time approach to disease management and alerts clinicians to the possibility of required intervention.

Technology will never completely replace paper, nor can it ever negate the need for human knowledge or talent. But it is of inestimable worth in helping us to enhance the quality and safety of our care, as well as to measure and report successes and opportunities.

Qual i t y & Sa f e t y Annual Repor t | 3232 | Chr is t iana Care Heal th System



Christiana Care’s four certifi ed electronic health record (EHR) platforms—PowerChart, Centricity, GEMMS and AllScripts—are aligned to meet Stage 1 criteria and proceed to Stage 2 for operational use of 19 pre-defi ned Meaningful Use criteria by June 2012.

This fi rst stage confi rms that an electronic health system is capable of capturing and sharing required information, such as demographics, medications, allergies, lab results and clinical decision support. Future stages require that the EHR helps advance clinical processes and contribute to improved outcomes.

While Meaningful Use aligns with and will provide fi nancial support to execute Christiana Care’s clinical Information Technology strategy, it goes far beyond dollars and cents to ensure safer, more reliable and more effi cient care. Electronic health records reduce medication errors caused by illegibility. Prescriptions go directly to the pharmacy, increasing effi ciency. Shared information among providers allows ready access to

clinical outcomes and public health data, helping to improve performance in managing chronic diseases. Repeated tests and other ineffi ciencies are eliminated, and evidence-based results on treatment alternatives and outcomes are readily available to clinicians.

Part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, Meaningful Use provides incentive dollars, and likewise carries stiff penalties, to ensure that providers complete three stages of requirements by 2015. In FY 2012, Christiana Care is expected to receive approximately $2.7 million in stimulus funds from the state Medicaid program for adopting, implementing or upgrading an EHR, with a grand total of approximately $17 million from both state and federal programs over the six-year Meaningful Use timeframe.

Electronic health records poised to demonstrate Meaningful Use

“Meaningful Use ensures that the investment in electronic health records impacts the quality of care delivered to patients.”—Janice Nevin, M.D., MPH, Chief Medical Offi cer

Targeted areas for Meaningful Use:CPOEProblem ListMedication ListMedication Allergy ListRecord Vital SignsRecord Smoking StatusRecord DemographicsPatient-Specifi c EducationMedication Reconciliation

Meaningful Use• Improves quality, safety and effi ciency.• Improves care coordination.• Engages patients and families in their care.• Improves population and public health and

reduces disparities in care.• Ensures privacy and security protections.



Electronic sign-in system streamlines trauma response

54%

38%

6% 2%

43%

41%

12%4%

Trauma bays are hectic, crowded environments with multiple providers caring for critically injured patients. Responders’ photos, names and role appear on the screen promoting communication and teamwork and clearly defi ning each responder’s role at sign in.

A multidisciplinary team of trauma responders, Emergency Department practitioners and clerical staff, and Information Technology developers designed and built the customized electronic process credited with:

Improving communication. Enhancing identifi cation of role delineation. Reducing the noise level in the trauma bay. Reducing the number of non-participating personnel

in the room.

A custom-designed electronic communication tool streamlines Christiana Care’s trauma response documentation system, allowing responders to work quickly and seamlessly, while addressing trauma resuscitation challenges, such as role delineation, crowd control issues and noise-related concerns.

The system features easily viewable 22-inch monitors posted outside the trauma room; 42-inch screens inside. These large displays replace conventional paper forms on clipboards for easy and simultaneous viewing of trauma-related information, including pre-hospital reports and trauma responder sign-in. This reduces the need for verbal repetition of the report—a prime contributor to the increased noise level and care provider interruptions trauma teams struggled with using the old paper system. Electronic sign-in also solves the problem of identifying gowned, gloved and masked responders for documentation required by the American College of Surgeons.

92 percent of respondents agreed or strongly agreed that the process is simple and that the system improves identifi cation of staff in the trauma bays.

Improves Identifi cation of Staff

84 percent of respondents say the information displayed improves identifi cation of who is fi lling each role.

Improves Identifi cation of Roles

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree

Strongly AgreeAgreeUndecidedDisagreeStrongly Disagree



Information Week 500 ranks Christiana Care among nation’s top in innovation

Trauma room touchscreens lauded as “idea to steal”Information Week 500 recognized Christiana Care’s use of large touch-screen monitors to better manage Emergency Department trauma rooms among the “20 IT innovative ideas to steal.” The magazine also ranks Christiana Care among the top 500 (#232) of North American enterprise IT.

The International Data Group’s Computerworld Honors Program selected Christiana Care’s Information Technology team from among 500 nominees for a 2012 Laureate award in the health category for the health system’s Insight software. This self-assessment tool promotes meaningful dialogue between patients and their physicians by allowing patients to report severity of symptoms and how those symptoms affect quality of life using a tablet-based, clinician-friendly wireless format.

The tool was piloted for use by patients with cancer or heart failure and will soon be released to a wider patient audience for use with an Apple iPad.

Seventy-six percent of patients report they like using Insight, with 67 percent saying the tool better prepares them to speak with their doctor.

Teresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services, and Mitchell Saltzberg, M.D., medical director of the Heart Failure Program, along with Information Technology team members Mike Bledsoe, Jon Reynolds, John DiGiovanni, and Catherine Burch, are named as 2012 Computerworld Honors Laureates for their innovative thinking and for their clinical and technical expertise.

Christiana Care also earned Top Five recognition in Computerworld’s health category competition at its annual awards ceremony in June 2012.

Computerworld bestows Laureate award for self-assessment software



A more streamlined “smart” process incorporated into the Powerchart electronic health record ensures that all eligible patients now receive seasonal infl uenza and pneumococcal vaccinations, contributing to a safer care environment.

Vaccination rates rose steadily with the process redesign coinciding with the start of infl uenza season in October 2011, followed by the launch of the “smart” pneumococcal vaccination process in January 2012 in accordance with

Electronic health record improves vaccination rates

regulatory changes for public reporting of these measures. Both rates are now steadfast at 100 percent for patients with pneumonia, and exceed 90 percent for all eligible patients.

Electronic health records are an instrumental tool in completing assessment, administration and documentation in a timely manner, leading to effi ciencies and safety enhancements. The renewed process simplifi es the vaccination process, aligning it with nursing workfl ow.

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

Jul-09 Nov-09 Mar-10 Jul-10 Nov-10 Mar-11 Jul-11 Nov-11 Mar-12

Pneumococcal Vaccination

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

Aug-09 Dec-09 Mar-10 Jul-10 Nov-10 Mar-11 Jul-11 Nov-11 Mar-12

Infl uenza Vaccination

% o

f Qua

lifi e

d Pa

tient

s

trend

Electronic health records help track compliance with standing orders for all qualifi ed patients. Historically measured for pneumonia patients for public reporting, Christiana Care’s infl uenza vaccination rate reached 100 percent between December 2011 and February 2012—prime infl uenza season.



Analysis may help defi ne why patients are codingResearch fueled by innovative fl ex monitoring technology suggests that a slow heart rate known as bradycardia—not fast or erratic episodes of ventricular tachycardia or fi brillation as previously believed—is the most common cause of a non-ICU code blue (cardiopulmonary arrest) in the hospitalized patient. Those patients that experience the bradycardia prior to the code blue have a much worse prognosis, suggesting that bradycardia may be a key indicator of impending cardiopulmonary arrest.

The fi nding, published online by Resuscitation in March 2012, underscores a need for better and more consistent monitoring of patients outside the intensive care unit.

Flex monitoring technology shows predictive pattern in Code Blue

Telemetry monitoring depicts a predictive pattern in code blue.

Now that research suggests the technology can actually detect if a patient is going to code, a team can be dispatched sooner to initiate life-saving care.

Christiana Care’s cutting edge fl ex monitoring telemetry system, noted among the largest, most advanced in the United States, allows uninterrupted telemetry monitoring of any patient at any location throughout Christiana and Wilmington hospitals.

Christiana Care researchers joined colleagues from Children’s Hospital of Philadelphia to author the study.



The Vocera two-way, real-time, hands-free communication system allows Christiana Care nurses and patient care technicians to remain with their patients while keeping abreast of information that formerly tied them to the computer or telephone. The technology also improves effi ciency by locating the right person in time-critical situations, allows information to be broadcast to multiple users simultaneously—critical in convening resources to mitigate and manage patient safety issues—and improves communication both among departments and between nurses and physicians.

More than 28 departments throughout the health system are now linked via Vocera, which uses voice activation to directly contact either an individual team member or the person fi lling a particular role on that shift.

Prior to Vocera, when the fl ex monitoring team needed to contact the unit regarding a critically ill patient, the call went to a central line. Urgent calls now go directly to the patient’s nurse, allowing him or her to remain at the bedside while in communication. The system also allows ancillary departments and nurses to more effi ciently prepare for patient handoffs.

Vocera improves communication and patient safety

Prior to Vocera, it took a nurse between 2–5 minutes

to log on to a computer, look up a number in the

directory and place a telephone call. Vocera enables

immediate notifi cation.

Vocera targets for quality and safety:• Patient safety.• Patient fl ow.• Staff effi ciency.

6,120 Vocera calls 3 saved minutes306 hours staff remained involved in patient care

X =


The Christiana Care Breast Center at the Helen F. Graham Cancer Center achieved the American College of Radiology Gold Standard in Imaging Accreditation in breast magnetic resonance imaging (MRI).

Christiana Care’s Center for Heart & Vascular Health holds the American Heart Association/American Stroke Association’s Get with the Guidelines® Gold Plus Quality Achievement Award for Stroke and Gold Quality Achievement Award for Heart Failure.

Becker’s 2011 Hospital Review/Becker’s ASC Review lists Christiana Care among the Best Places to Work in Healthcare.

The Centers for Medicare & Medicaid Services presented Certifi cates of Excellence to Christiana Care for collaboration in hospital-acquired methicillin-resistant staphylococcus aureus (MRSA) and pressure ulcer prevention projects conducted by Quality Insights of Delaware.

Diversifi ed Clinical Services recognized Christiana Care’s Wound Care for delivering outstanding results in wound healing and patient satisfaction for 12 consecutive months.

The Foundation for the Accreditation of Cellular Therapy accredited Christiana Care’s Bone Marrow Transplant Program for high quality medical and laboratory practice in cellular therapies.

GetWellNetwork presented the Care Process Integration Award to Christiana Care at the organization’s third annual Patient Care Awards.

For the third consecutive year, the Society of Thoracic Surgeons granted a three-star gold standard rating to Christiana Care’s Center for Heart & Vascular Health. Fewer than 15 percent of the more than 1,000 heart programs surveyed achieve this highest designation bestowed in the comparison of the quality of heart surgery among U.S. hospitals.

Standard & Poor’s upgraded Christiana Care’s long-term debt rating to AA, indicating “very strong capacity” to meet fi nancial obligations.

Thomson Reuters named Christiana Care a 2012 recipient of its Healthcare Advantage Award, which recognizes the use of data analytics to improve quality of care and business results.

Training magazine ranked Christiana Care’s employer-sponsored training and development program number 60 in the Top 125 companies in the nation.

U.S. News & World Report ranks Christiana Care among the Top 10 Best Hospitals in the Philadelphia Metropolitan Area for high performance in 11 adult medical specialties.

Awards, Recognition and Accomplishments FY 2012


IN THE SPOTLIGHT NATIONALLY

Christiana Care achieved a hospital safety score of “A” from The Leapfrog Group in the fi rst-ever report card on safety in the nation’s hospitals.

The Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange recognizes Christiana Care’s efforts in applying high reliability concepts in creating and sustaining a Safety Mentor Program, the Sepsis Alert campaign, the eCare system and Alcohol Withdrawal Risk Evaluation and Treatment guidelines.

Christiana Care’s Community Clinical Oncology Program ranks among the nation’s top enrollers in cancer clinical trials in the newly formed Alliance of Clinical Trials in Oncology, placing sixth in treatment trials and fi rst in cancer control trials that seek to prevent cancer or control its incidence.

The Association of American Medical Colleges features Christiana Care’s Unit-Based Clinical Leadership Model on MedEdPORTAL®, the association’s peer-reviewed publication service and repository for medical and oral health teaching materials, assessment tools and faculty development resources.

In collaboration with ECRI Institute, in June 2012 Christiana Care hosted the national conference, “Building Bridges: Connecting Comprehensive Event Investigation with Effective Analysis and Strategic Correction of Causative Factors.”

Christiana Care holds Joint Commission Disease Specifi c Certifi cation for joint replacement (hip and knee) and Advanced Certifi cation for heart failure and primary stroke center. Certifi cation acknowledges compliance with consensus-based national

standards, effective use of evidence-based clinical practice guidelines to manage and optimize care, and an organized approach to performance measures and improvement activities.

The U.S. Department of Health and Human Services selected Christiana Care as one of 16 Independence at Home participants. A provision of the Affordable Care Act, this three-year, in-home pilot program encourages doctors to visit the sickest Medicare benefi ciaries in their homes to avoid unnecessary emergency room visits, hospitalizations and long-term care.


IN THE SPOTLIGHT REGIONALLY

The News Journal names Christiana Care a Top Workplace Employer, ranking it sixth in the large workplace category and best in career opportunities.

Christiana Care is an approved participating hospital in Jefferson Medical College’s Delaware Branch Campus.

Christiana Care’s Stanton campus is designated a Level-2 pediatric center, and the Wilmington campus is designated a Level-3 pediatric center in Delaware’s newly launched Pediatric Emergency Care Facility Recognition Program.

The Helen F. Graham Cancer Center joins Philadelphia’s Wistar Institute and Temple University in developing the world’s fi rst practical blood test for lung cancer.

Christiana Care is teaming up with Thomas Jefferson and Temple universities in Philadelphia to form one of only nine elite National Institutes of Health Heart Failure Clinical Research Centers in the nation, providing scientifi c leadership for the seven-year project that focuses on small-to-intermediate randomized clinical trials devoted to improving outcomes for patients with heart failure.

IN THE SPOTLIGHT AT CHRISTIANA CARE

Focus on Excellence Awards

Christiana Care’s Ninth Annual Focus on Excellence Awards program formally recognized 24

teams of employees and physicians whose projects demonstrate improvement in process or outcomes using the Plan-Do-Check-Act model.

The annual gathering is a way for Christiana Care employees and physicians to celebrate shared beliefs, including a culture of safety and commitment to value.

President’s Award

A Multidisciplinary Approach to Reducing Unit Acquired Pressure Ulcers

Value Award

Impact of a Dedicated Respiratory Team: Liberating Patients from Ventilation

Clinical Excellence – Gold

S.O.S.! Standardized Order Sets Answer a Distress Call for Inpatient Chemotherapy

Clinical Excellence – Silver

Improving Processes for Vaccine Compliance


Clinical Excellence – Bronze

Individual Discharge Assessment: Identifi cation of Patients at Risk for Readmission

Safety First – Gold

Reducing Peripheral Long Line Associated with Blood Stream Infectionsin Preterm Infants

Safety First – Silver

Post Event Debriefs: “Facts as Known”

Great Place to Work

Keeping Employees Healthy for Life

Think of Yourself as a Patient

Phase II: Innovation in Patient Education

Financial Strength

Prescription Drug and Pharmacy Restructure

Nursing Excellence –

Empirical Outcomes

Falls Prevention Champion Team at the Center for Advanced Joint Replacement


Exemplary Professional Practice

Daily Communication and Goal Planning Board


New Knowledge – Gold

Cozy Cuties: Reducing Delivery Room Hypothermia


New Knowledge – Silver

Improve Pain Assessment and Documentation


Structural Empowerment

Hand Hygiene Campaign: Get Your Clean On


Transformational Leadership

Building Nursing Quality and Safety

Learning Excellence

Quality TIPS (Teams Improving Processes)

Residents’ Award

Hemoglobin and Lead Screening

Operational Improvement – Gold

Heart & Vascular Intervention Services: Redesigning a System for Success

Operational Improvement –

Honorable Mention

Trauma Sign-in Initiative

Excellence in Community Health – Gold

Chemotherapy in the Home: Changing the Process to Improve Patient Safety

Excellence in Community Health –

Honorable Mention

Improving Therapeutic Time in Range for the AMO Anticoagulation Patients

Employee Safety

Ceiling Mounted Lift Usage in the Christiana Emergency Department

People’s Choice

Safe at Home Base: Improving Discharge Medication Reconciliation


PRESENTATIONS

“The Road Less Traveled: An Adult Combined Medical and Surgical Intensive Care Unit’s Journey to Integrate Patient and Family into the Health Care Team.” June 2012. 5th International Conference on Patient and Family-Centered Care. Washington, DC.

“Medicine Unit Structured Interdisciplinary Rounds to Improve Patient Safety.” June 2012.2012 AAMC Integrating Quality Meeting. Chicago.

“Improving Quality and Cost – A Value Team Approach.” May 2012. Visiting Nurses Association of America Hospice and Home Health Conference. Phoenix.

“Christiana Care’s Home Visit Program: Further Success in House Call Medicine.” May 2012. American Geriatric Society Conference. Seattle.

“Using a Value Score Card to Improve Quality and Decrease Costs While Enhancing the Patient Experience.” May 2012. Thomson Reuters Advantage Conference. Orlando.

“Post-Event Debriefs: A Commitment to Better Care for Our Patients and Staff.” May 2012. National Patient Safety Foundation Patient Safety Congress. Washington, D.C.

“Measuring and Improving the Value of Healthcare Using a Value Score.” May 2012. American Society for Quality World Conference on Quality and Improvement. Anaheim.

“Transforming Healthcare Through a Unit-Based Clinical Leadership Model.” May 2012. SCIM Annual Meeting: Innovations Poster Session 1. Orlando; and March 2012. AIAMC Annual Meeting. Tucson.

“Case Study for Curriculum Development for Medical Education: A Six-Step Approach.” March 2012. AIAMC National Initiative III: Improving Patient Care Through Medical Education, Meeting Two. Tucson.

“Teamwork and Technology; A Unique Collaboration for Patient Safety with an Automated Implantable Cardioverter-Defi brillator (AICD), Neuromuscular Electrical Stimulation and Flexible Monitoring;” “Interprofessional growth: Building a model for advanced nursing practice in rehabilitation;” and “Show That We Care Campaign: Working Smarter Using State-of-the-Art Technology.” November 2011. 36th annual Association of Rehabilitation Nurses Education Conference. Las Vegas.

“Determining the Most Up-to-Date CMS Regulations and How it Impacts Hospital Operations.” October 2011. World Congress 8th Annual Observation Patient Management Conference — West Coast. San Diego.

“OB/GYN Value Improvement Team Project.” October 2011. CWISH 2011 Annual Conference. Pittsburgh.

“Creating an Education Program for Competent Care of the LVAD Patient in a Preimplantation Facility.” June 2011. American Association of Heart Failure Nurses (AAHFN) Annual Conference. Seattle.


PUBLICATIONS

“Epidemiology of stillbirth in low-middle income countries; a global network study.” Acta

Obstetricia et Gynecologica Scaninavica. September 2011.

“The impact of guidelines limiting elective delivery prior to 39 weeks on rates of elective induction and cesarean delivery: 552.” American Journal of Obstetrics & Gynecology. 2011; 204(1): SS21–S222.

“Balancing the Risks and Benefi ts of Proton Pump Inhibitors.” Annals of Family Medicine. 2011; 9(3):200–202.

“Experiences with Community Kangaroo Mother Care in Very Low-Income Settings.” Current Women’s Health Reviews. August 2011; Vol. 7(3):310–316(7).

“Chemotherapy in Home Care: One Team’s Journey towards improving Patient Safety.” Home Healthcare Nurse — Medscape/WebMD on “HIV/Aids at 30.” (http://www.medscape.com/viewarticle/746153).

“Prevalence and Outcomes of Same-Day Discharge After Elective Percutaneous Coronary Intervention Among Older Patients.” Journal of the American Medical Association. 2011; 306(13):1461–1467.

“Ensuring Safe and Quality Medication Use in Nuclear Medicine: A Collaborative Team Achieves Compliance with Medication Management Standards.” Journal of Nuclear

Medicine Technology. 2012 Jan 25.

“Obesity and Cancer Screening According to Race and Gender.” Journal of Obesity. Volume 2011, Article ID 218250, 10 pages doi: 1155/2011/218250.

“Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy.” New England Journal of Medicine. 2011; 365:2255–2267.

“Nurse Staffi ng, Hospital Operations, Care Quality, and Common Sense.” Nursing. August 2011.

2012 annual report on to ey n journe our quality and...

Documents