At St. John Hospital & Medical Center in Detroit, Dr. Mohamad G. Fakih developed standards that have greatly reduced the incidence of infections caused by central line and urinary catheters. He shares his protocols with physicians and clinicians in Ascension Health, the hospital's parent network.
Now, Partnership for Patients, a federal initiative, is creating a platform that should make it easier to share his findings with other networks and hospitals intent on improving patient safety and reducing health care-acquired conditions.
"This will accelerate learning for everyone by creating an expanded network of knowledge and bold goals," Ann Hendrich, vice president of clinical excellence operations for Ascension Health, said of Partnership for Patients. "We see this as a terrific way to align our health ministries with a focused network of hospitals nationwide."
St. Louis-based Ascension Health and San Francisco-based Dignity Health, formerly Catholic Healthcare West, are the two members of CHA to receive inaugural grants directly through the program, which is managed through the Centers for Medicare and Medicaid Services Innovation Center. The center and the Partnership for Patients were established in the health reform law of 2010.
In addition to Dignity Health and Ascension Health, the first round of grants totaling $218 million and announced in December go to 24 other organizations also designated as "Hospital Engagement Networks." Ascension Health received $8.4 million, while Dignity Health secured $8 million in funding. The CMS innovation center plans to distribute a total of $500 million to the Hospital Engagement Networks to fund development of learning collaboratives, training programs and quality tracking programs to improve patient safety and keep health cost increases in check. CMS said that more than 3,200 hospitals and 3,900 doctors and nurses groups, consumer groups, health plans, employers and unions have joined the public-private initiative since its launch last April.
SSM Health Care, based in St. Louis, is among the health systems and hospitals involved in the program through Premier, an alliance of hospitals working to improve care and reduce costs. Premier is a designated Hospital Engagement Network and received a grant of $24 million.
The Hospital Engagement Networks will track data and share information within their own systems through training programs and websites. CMS will monitor the networks to track progress and share information nationally.
Fostering systemic change
In addition to Fakih's work in reducing catheter-related infections, Ascension Health's contributions to the national cause of quality improvement will include information on efforts at five of its hospitals to reduce shoulder dystocia during deliveries and systemwide practices to reduce pressure ulcers and falls. Hendrich said Ascension Health will be able to make its studies more comprehensive, expand training programs within Ascension Health's 70-hospital system and provide information nationally through Partnership for Patients.
Fakih is medical director of infection prevention at St. John. He also cochairs the Ascension Health Infection Prevention Steering Committee. Hendrich said his work is part of an Ascension Health program begun in 2003 to reduce preventable medical errors. Fakih established protocols to reduce the inappropriate use of central line and urinary catheters, and created teams that regularly monitor patients with catheters and remove them if the use doesn't meet the protocol.
Robert J. Henkel, president and chief executive of Ascension Health, said Ascension Health "shares the Partnership for Patients' passion and drive to continue to prevent avoidable injury in our hospitals and in others across the country."
Do no harm
As part of the Partnership for Patients, Dignity Health will emphasize its work on severe sepsis, in both prevention and treatment, and reducing preventable readmissions for such conditions as diabetes or congestive heart failure. In a statement released by Dignity Health, Dr. R. Phillip Dellinger, director of critical care at Cooper University Hospital in Camden, N.J., and a leader in blood-poisoning studies, said Dignity Health has "demonstrated the power of a well-organized quality program that both reduces morbidity and mortality while also achieving significant cost savings."
Dignity Health said its sepsis program saved nearly 1,000 lives and reduced hospital costs by $36.5 million over a three-year period.
Said Lloyd Dean, president and chief executive of Dignity Health, a 40-hospital system, "Our goal has always been to be part of the solution to the nation's health care crisis."
Dr. Robert Wiebe, Dignity Health's chief medical officer, will supervise the system's projects in the Partnership for Patients initiative. Another goal of its work as a Hospital Engagement Network is developing systems to reduce falls by patients in emergency departments. Dignity Health's goal is to reduce falls by 40 percent at five large hospitals that account for 35 percent of the falls reported throughout its system, said Barbara Pelletreau, the system's senior vice president for patient safety and clinical risk management.
Pelletreau said Dignity Health will work to double its improvements in avoiding preventable hospital readmissions through strategies that include "patient perspective and a more robust community partnership approach." She said that will include meetings with members of patient councils and specific education programs for hospital staff, updates at shift changes, use of social media among employees and training videos.
Eye on the ball
Dr. Scott Endsley, vice president and chief medical officer for SSM Health Care's Patient Safety and Quality Center, said Premier will not disburse grant money among participating hospitals. Instead, Endsley said, Premier will conduct in-house training and education in SSM hospitals, including individual coaching, to help the hospitals meet goals.
Endsley said SSM hospitals will work with Premier advisors on issues including reducing fall risk, adverse medical events, and hospital-acquired infections and catheter-associated urinary and bloodstream infections. He said all 16 SSM hospitals will participate through the Patient Safety and Quality Center.
"By participating in the Partnership for Patients initiative, we are renewing our focus and dedication to providing safe, high-quality and cost-effective patient care," Endsley said.
Marilyn Tavenner, a lead federal administrator in the project, said the intent is to make medical care "safer, more reliable and less costly." Its goal is to reduce hospital-acquired conditions by 40 percent and avoidable hospital readmissions of Medicare patients by 20 percent over the next three years.
The federal agency said achieving those goals would prevent 60,000 deaths, and eliminate 1.8 million in-hospital injuries to patients and 1.6 million preventable readmissions.
Driving toward zero errors
Hendrich said Ascension Health will use the contract to pay for more thorough studies, full reports to the federal program managers and expanded training programs for staff at its hospitals. Ascension Health plans to add four more employees for the work.
Hendrich said the federal project will help Ascension Health build upon its own efforts, begun eight years ago, to reduce medical errors to zero. In 2003, the system reviewed medical records of 6,000 deaths of patients who had not been admitted for end-of-life care. It estimated that 900 of those deaths could have been prevented. For the year 2008, after the hospitals had implemented a series of best practices to eliminate preventable injuries and death, Ascension Health estimated that 1,500 lives had been saved as a result.
"Our bold goal remains zero preventable deaths and avoidable injuries," Hendrich said, and working with Partnership for Patients will help achieve that.
The Patient Protection and Affordable Care Act committed $1 billion to HHS for programs that will work through Medicare to improve U.S. health care. In addition to the money pledged to the Partnership for Patients effort, HHS said last April that it would make $500 million of that sum available through its Community-based Care Transitions Program.
"The Partnership for Patients is helping the nation's finest health systems share their knowledge and resources to make sure every hospital knows how to provide all of its patients with the highest quality care," U.S. Department of Health and Human Services Secretary Kathleen Sebelius said in announcing the grants.
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