EQUIPS (Externship in Quality Improvement and Patient Safety)
To train the next generation of physicians, University Hospitals launched an innovative resident training program in quality called EQUIPS (Externship in Quality Improvement and Patient Safety), allowing residents to spend a full month immersed in quality education. These residents pick a quality improvement project for the year and see their project through to implementation in collaboration with UH Quality Institute staff.
Surgical Safety Checklist
UH kicked off the process of implementing the surgical safety checklist in unprecedented fashion by closing the operating rooms (ORs) for an entire morning so that staff could attend a mandatory safety conference at which the checklist project was launched. Ongoing annual OR safety conferences are held and have been expanded to UH surgery centers, system hospital ORs, and procedure areas.
“Time to” Campaign Measures Timeliness in Care
University Hospitals’ Chief Medical Officer Michael Anderson, MD, talks about the creation of a “Time to” campaign to measure timeliness, including extensive monitoring of such processes as how long it takes to give a patient a prescribed antibiotic, how long it takes to obtain lab results, and how long it takes to admit or discharge a patient.
Accountable Care Organization (ACO)
System Chief Medical Officer Eric Bieber, MD, talks about the creation of an Accountable Care Organization (ACO) for all employees and their families enrolled in UH’s health plan. Since 2011, the UHACO has helped improve the health and wellness of approximately 25,000 employees and dependents enrolled in a UH medical plan.
Formalized Check Lists to Help Reduce Infection Rates
University Hospitals was able to reduce infection rates by instituting formalized check lists and bundles when performing procedures such as starting central lines.
Quality Scorecards for System-Wide Quality Metrics Reporting
The development of quality scorecards for all levels of the organization enables system-wide reporting for timely information on quality metrics. Data are available on the University Hospitals intranet and monthly department profiles are provided to the medical staff leadership.
Electronic Medical Record (EMR) System at UH
System Chief Medical Information Officer Jeffrey Sunshine, MD, talks about the implementation of University Hospitals’ state-of-the-art Electronic Medical Record (EMR). Electronic medical records are being used to reduce medication and other errors.
System Quality Assurance Application MIDAS Tracks Patient Care
The implementation of a system quality assurance application called MIDAS provides the ability to look at patient care over time. The system currently includes our inpatient facilities, outpatient clinics and extended care facilities. This also provides the ability to track patient outcomes and identify any handoff issues that may impact the quality of care. The system is able to track readmissions to any UH system hospitals and revisits to any of our system emergency departments. UH also uses a clinician portal that has been instrumental in providing the medical and nursing staff with access to patient information across the continuum.
Mission Possible Initiative at UH Rainbow Babies & Children’s Hospital
UH Rainbow Babies & Children’s Hospital’s “Mission Possible” initiative is part of a national collaborative to eliminate preventable harm in our nation’s children’s hospitals. The goal is to establish an environment of high reliability around safety where every individual, be it valet services, environmental services, clinical staff, etc., makes a commitment to safety, providing clear and concise communication and supporting a questioning attitude.
CLIPSS (Clinical Leadership in Patient Safety Standards)
A monthly quality review audit process called CLIPSS (Clinical Leadership in Patient Safety Standards) covers many standards of care and is performed by hospital leadership. The results of these quality audits are communicated to all managers and then posted on the intranet.
TeamSTEPPS System Helps Improve Communication Among Medical Teams
TeamSTEPPS is an evidence-based system to improve communication and teamwork skills among health care professionals. It is also a powerful solution to decrease adverse outcomes and improve patient safety within the organization. TeamSTEPPS helps to produce highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients.
Patient Advocacy and Shared Stories (PASS) Electronic Reporting System
A more robust, updated electronic reporting system called Patient Advocacy and Shared Stories (PASS) places emphasis on transparency for reporting, prioritizing, and acting on incidents. Since 2008 when the updated electronic system was implemented and hospital-wide education conducted, reporting has increased three-fold. Weekly leadership meetings are held with membership from risk management, quality management, pharmacy, physician staff, and clinical operations to review all reports and determine needed follow-up such as directing the case to an appropriate quality assurance committee. Each report is reviewed by the applicable quality assurance committee, where follow-up is determined.
UH Seidman Cancer Center Patient Experience of Care
UH Seidman Cancer Center patient experience of care requires health care professionals to address every aspect of a patient’s encounter at the hospital, including the individual’s physical comfort, emotional and spiritual needs. Among many resources including patient satisfaction surveys and a suggestion box for feedback, we also have a Patient and Family Advisory committee who provides leaders and staff with feedback on many aspects of the hospital including art work and inpatient room design elements.