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THA Hospital Improvement
Innovation Network (HIIN)
Monthly Check-In
2-21-18
• Site Visits
• Contact List
• Workforce Resilience Webinar Series
• Sepsis Webinar Series
• Sepsis Consultation Service
• Success Story Articles
• HIIN Quarterly Survey—due to
[email protected] by March 9
Reminders
Health Equity
and Addressing Disparities
*Diversity can include racial, ethnic, gender, cultural, language, socioeconomic or other relevant factors. THA Responses: 57 / 77 hospitals (74%)
HRET Responses: 1,315 / 1,683 hospitals (78%) Source: THA HIIN Quarterly Survey conducted Nov. 2017
TCPS HIIN Health Equity Survey
TCPS HIIN Health Equity Survey
TCPS HIIN Health Equity Survey
TCPS Performance with Updated Baselines
Includes Only Tennessee Partners
* MRSA and CDIFF SIR are calculated on a quarterly basis. Data shown is for January – September
This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.
This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.
Topic Reporters Events Rate HRET Rate
Readmissions - 30 Day 123 50,880 8.486 8.473 Readmissions - Medicare 121 30,304 11.318 11.246
Sepsis - Postoperative 79 211 0.399 0.4177 Sepsis - Hospital Onset Mortality 104 1,975 35.656 21.173 Sepsis - Overall Mortality 104 5,408 20.425 12.568
VTE 88 336 3.142 3.000
Hospital Claims and PSI Harms THA Partners and HRET HIIN Rate Comparison
January – September 2017
Data Source: THA HIN and HRET Comprehensive Data System: Tennessee hospitals
HIIN Self-Reported Measures THA HIIN and HRET HIIN Rate Comparison
February – October 2017
This information is prepared and protected in accordance with the Tennessee Patient Safety and Quality Improvement Act of 2011. T.C.A. 68-11-272.
Topic Reporters Events Rate HRET Rate
ADE – Anticoagulation* 58 3,343 15.019 3.381
ADE – Glycemic* 52 15,283 19.014 4.634
ADE - Opioids 55 2,810 1.097 0.584
Falls with injury 62 844 0.568 0.693
Pressure Injuries 53 242 0.091 0.219
WS - Patient Handling 52 420 0.119 0.122 WS - Workplace Violence 53 184 0.051 0.081
Data Source: THA Report Distributor and HRET Comprehensive Data System: Tennessee hospitals only
* Measure definition differs between THA HIIN and HRET HIIN
Adverse Drug Events
(ADE)
• HRET HIIN measure for opioid ADE
– Numerator = Number of patients treated with
opioids who received naloxone
– Denominator = Number of patients who
received an opioid agent
– Includes inpatient and outpatient
– Excludes Emergency Department
Adverse Drug Events (ADE) Opioids
Adverse Drug Event – Opioids
2017 TN Harms TN Rate HRET Rate
February 322 1.14 0.54
March 302 1.00 0.52
April 339 0.95 0.52
May 316 1.12 0.63
June 302 1.06 0.58
July 328 1.28 0.65
August 319 1.07 0.61
September 298 1.23 0.58
October 284 1.18 0.63
Num
ber
of patients
who r
eceiv
ed a
n O
pio
id r
evers
al
De-identified Hospitals
Num
ber
of patients
who r
eceiv
ed a
n O
pio
id r
evers
al
De-identified Hospitals
Num
ber
of patients
who r
eceiv
ed a
n O
pio
id r
evers
al –
Rate
per
100
De-identified Hospitals
------------------------------------------------------------------------------------------------------
HRET National Average: 0.584
Num
ber
of patients
who r
eceiv
ed a
n O
pio
id r
evers
al –
Rate
per
100
De-identified Hospitals
------------------------------------------------------------------------------------------------------ HRET National Average: 0.584
• Are there particular areas of the hospital
with high Narcan use to target?
– Procedure areas, ICU, wards?
• Are there specific patient populations?
– Opioid naïve, post-surgical patients, patients
on pain pumps?
• Are we doing sedation assessments on
patients?
ADE Questions
• THA HIIN data:
– From inpatient claims - provisional
– 66 TN hospitals
• Three metrics:
– Post-operative sepsis rate (AHRQ PSI-13)
– Hospital-onset sepsis mortality rate
– Overall sepsis mortality rate
Sepsis Measures
• Mortality
– Inpatient sepsis deaths only
– Patients aged 18-89 years
– Primary discharge diagnosis = an ICD-10
code for severe sepsis or septic shock utilizing
AHRQ PSI-13 criteria
– Hospital-onset sepsis identified by “No” on
“Present on Admission” flag
• Post-op Sepsis
– AHRQ PSI-13 criteria
Sepsis Data Definitions
Data pull: 1-19-2018
Mortalities Cases Mortality Rate
Hospital Onset Sepsis
Mortality 1728 5180 33.36%
Overall Sepsis Mortality
5211 27889 18.68%
Sepsis Mortality
18.6% of the total sepsis cases are hospital onset sepsis,
but account for 33.2% of the sepsis mortalities.
October 2016 through September 2017
0.61
0.41 0.00
0.50
1.00
1.50
2.00
2.50
3.00
Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17
Post-op Sepsis Rate - 10/16 thru 9/17 THA HIIN Hospitals (n=49)
Comparison to HRET HIIN Hospitals (n=904)
THA HRET
• Are you tracking overall sepsis and hospital-
onset ? Are you seeing the same prevalence
and trends? – If so, is hospital onset sepsis medical vs surgical population?
– Associated with devices or specific procedures?
– ICU or floors at diagnosis?
– Are EHR/clinical systems triggering alerts effectively?
• Would committee members be willing to review
10 of your charts for root causes to better
understand the issue and design interventions?
Sepsis Questions
• Care Transitions Coordinator Coalition Meeting – Thurs., March 8
• Medication Safety Summit – Thurs., April 26
• TCPS Regional Meetings – Tues., April 10 – Knoxville
– Thurs., April 12 – Nashville
– Tues., April 17 - Memphis
• Sepsis Readmissions Workshop – Weds., May 9
• Health Equity Summit – Thurs., May 17 (tentative)
Upcoming Events
HIIN Participation Recognition
Request the number that you need by contacting Teresa Benedetti at [email protected] or 615.401.7414.
Retractable pen pull with dry erase marker
Questions and comments?