Knowledge on the Go

Engaging stakeholders in quality through system communications

This episode features a team using a systemwide approach to communicate quality data and engage their stakeholders. Through this ongoing process, they have forged relationships that have improved patient care throughout the Intermountain Healthcare organization.
 
Guest speakers:Bonnie Gregson, MSN, CPHQSystem Quality Senior Clinical Operations ManagerOffice of Patient ExperienceIntermountain Healthcare
 
Daniel Barker, MBA, RRTClinical Operations ManagerOffice of Patient ExperienceIntermountain Healthcare
 
Moderator:Margaret Rudisill, MS-HQS, RNPI Program DirectorVizient
 
Show Notes:
[01:26] Developing communication process to impact each care site
[02:34] Communication channels
[03:18] Engagement approach – a non-threatening attitude
[05:36] Looking at gaps to reduce PSI 3s (patient safety indicator for pressure ulcers)
[06:14] “What if” calculator for care site benchmarking
[07:04] Sharing systemwide – “system learning”
[09:05] Quality Insights Dashboard – sharing PSI data and best practices systemwide
[11:29] Other communication approaches across the system
[13:18] Beyond PSIs – mortality, QAPI data
[14:38] Not about reducing the numbers
[16:18] “Fail fast, move forward”
 
Links | Resources:
Recent PI Collaborative broadcast featuring Bonnie Gregson and Danny Barker discussing their quality approach at Intermountain Healthcare: Click Here
To contact Knowledge on the Go: picollaboratives@vizientinc.com
To contact Bonnie: bonnie.gregson@imail.org
To contact Danny: daniel.barker@imail.org
 
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Using AI for early detection of sepsis

CDC statistics suggest that one in three people who die in a hospital have sepsis. Furthermore, in almost 87% of cases the patient had sepsis or a sepsis-causing infection before admission to the hospital.
Innovative healthcare organizations are increasingly using artificial intelligence (AI) technology to combat sepsis.
In this episode, Dr. Joe Cummings explains the technology and shares the latest developments in the battle against sepsis.
 
Guest speaker:Joe Cummings, PhD Technology Program Director Vizient 
 
Moderator:Shannon HalePerformance Improvement Collaboratives DirectorVizient
 
Show Notes:
[01:36] Basic definition of artificial intelligence (AI).
[02:21] AI subtypes important to the sepsis discussion.
[03:49] More on how AI can combat sepsis.
[05:39] Barriers to implementation.
[09:55] Other AI models and their results.   
[11:33] What the future holds for sepsis models. 
[12:20] Advice to organizations interested in AI options for sepsis.
 
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A Patient-Centered Approach to Optimizing Ambulatory Access

Facilitating access to care for patients is focused on ensuring timely, necessary, and appropriate health care services. Improving access to care is a strategic priority for most health systems and a challenge for nearly all.
 
The Association of American Medical Colleges and Vizient recently collaborated on a study regarding a patient-centered approach to optimizing ambulatory access.  Guests on this episode discuss those findings and   insights from ambulatory care leaders, physicians, and staff in five academic medical centers whose organization's access performance has been outstanding.
 
Guest Speakers:Nicole Spatafora, MS-HSMAVP, Performance ImprovementPI CollaborativesVizient
 
Danielle Carder, MSCSenior Program Specialist, Access & Clinical InnovationsAssociation of American Medical Colleges
 
Moderator:Courtney Furrow-White, MPM, RNSenior Performance Improvement Program DirectorVizient
 
Show Notes:
[01:28] General findings from the project, including primary drivers of success.
[04:12] More details about what the framework.
[04:56] The role engaged leadership plays in success.
[06:03] Supporting foundational leadership and culture with organization-wide structure and standard processes.
[07:08] Actionable data and analytics.  
[09:43] Optimizing care delivery.
[11:50] The role of workforce engagement in reducing turnover and burnout.
[13:28] Leveraging technology.  
[16:36] Summary of the project findings.
[17:44] Recommendations for organizations that want to incorporate this framework.
 
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The State of Indirect Spend and its Importance in Healthcare

Indirect spending is defined as any purchase or services that are internal or external to a healthcare organization but fall outside of med-surg supplies, pharmacy, physician preference items (PPI), and capital. You might be surprised to learn that indirect spending accounts for up to 30% of a hospital’s total operating expenses.
Today’s guests discuss the current state of indirect spending, its importance in the healthcare space, and some of their success stories. 
 
Guest speaker:John AndrewsStrategic Sourcing Manager - Purchased ServicesBusiness Diversity ManagerRush University Medical Center
 
Hawanya Blakely, MBAStrategic Sourcing Manager - Purchased Services Purchasing & ContractingRush University Medical Center
 
Moderator:LaTammy Marks, MBA, BSN, RNPerformance Improvement Program Director, PI CollaborativesVizient
 
Show Notes:
[02:04] The state of indirect spend within healthcare organizations today.
[03:33] How Rush University Medical Center took a proactive approach to identifying indirect spend opportunities.
[05:01] Why Rush University Medical Center made indirect spending a priority.
[07:51] How leadership sponsorship contributed to their success.
[09:12] Where a healthcare organization should start. 
[10:23] Importance of participating in the Vizient Reducing Variation Indirect Spend Benchmarking Study.
[11:25] Understanding your indirect spending and the number of vendors that you’re using within a specific category.
[12:07] Importance of aligning across various system facilities.
 
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New multi-cancer early detection test

Early detection of cancer can dramatically increase the efficacy of curative treatment. Unfortunately, early screening tests exist for only a small number of cancers, meaning most are not diagnosed until symptoms arise in the later stages of the disease.
 
Better cancer screening is, therefore, a major focus area for clinical performance improvement. Marilyn Sherrill talks with Dr. Joe Cummings about a new genomic test that can theoretically screen for more than 50 different types of cancer using a small blood sample, and what the future may hold for this technology.
 
Guest speaker:Joe Cummings, PhD Technology Program Director Vizient 
 
Moderator:Marilyn Sherrill, RN, MBAPerformance Improvement Program DirectorVizient
 
Show Notes:
[01:28] The Grail Galleri liquid biopsy test.
[02:18] Sampling methodology.
[02:55] The analytic process of the Grail Galleri test, and some developmental history.
[04:01] Testing methodology is based on methylation patterns.
[05:36] Results of the clinical studies to-date, and status of ongoing studies.
[08:13] Early adopters include some larger healthcare systems and, potentially, anyone willing to self-pay.
[09:04] Test costs and preliminary cost/benefit anaylsis.
[11:02] Considerations re: payers’ willingness to cover test costs.
[12:09] Looking forward to trial results and potential FDA approval.
[13:05] With many companies doing R&D in the liquid biospy field, the development of competing and complementary tests is to be expected.
 
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Sepsis Awareness Month: Sepsis Early Recognition

As sepsis continues to be a major cause of death representing a substantial healthcare burden, Vizient hosted a performance improvement collaborative focused on sepsis early recognition. Shannon Hale explores guidelines and best practices with collaborative participant Amy Lorenz of Covenant HealthCare. 
 
Guest speaker:Amy Lorenz Lead Quality Improvement SpecialistCovenant Healthcare
 
Moderator:Shannon Hale Performance Improvement Collaboratives DirectorVizient
 
Show Notes:
[01:03] Covenant Healthcare identified sepsis fallouts in order to enhance education related to Center for Medicare and Medicaid Services (CMS) guidelines.
[01:59] Covenant created an online reference tool — a sepsis awareness page —to communicate about guideline revisions and fallout areas with all clinical staff.
[03:27] The sepsis awareness page was promoted to educate clinical staff and ensure usage.
[04:08] Executive and physician-driven support strongly enriched the collaboration.
[05:06] Covenant provides sepsis awareness page data monthly.  
[05:40] Lack of education about and awareness of the CMS guidelines has been the greatest challenge.  
 
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High Reliability Culture

A high reliability organization is an organization that has experienced significant success in avoiding harm within an environment of high complexity and risk. These organizations create a collective state of mindfulness that produces an enhanced ability to discover and correct errors before they escalate into a crisis. Marilyn Sherrill discusses high reliability culture with Dr. Michael Leonard of Safe & Reliable Healthcare and Dr. Gena Futral from Vizient.  
 
Guest speaker:Michael Leonard, MDFounder, Chief Medical OfficerSafe & Reliable Healthcare LLC
 Gena Futral, DHA, RN, CPHQ, FACHEExecutive Principal, Reliability and Management SystemsVizient
 
Moderator:Marilyn Sherrill, RN, MBAPerformance Improvement Program DirectorVizient
 
Show Notes:
[01:42] Background information about Safe & Reliable Healthcare LLC and culture.
[02:30] Why Vizient has partnered with Safe & Reliable Healthcare LLC.
[03:20] Safe & Reliable Healthcare’s high reliability framework.
[05:13] The synergies between Vizient and Safe & Reliable Healthcare.
[06:38] The importance of culture and why it is a starting point for this work.  
[09:00] Measuring culture: survey results and what that data means.
[10:37] Vizient’s methodology for helping organizations along their high reliability journey, including LENS, Safe & Reliable Healthcare’s management and communication technology.
[15:14] Advice for organizations considering a high reliability journey, and last thoughts.
 
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Immune Globulin

Jim Lichauer, Meryl Biksacky, and Conor Hanrahan discuss the strategies Intermountain Healthcare implemented to improve their immune globulin utilization.
 
Guest speaker:Meryl Biksacky, PharmDPharmacist, Drug Information SpecialistDrug Shortage Management CO-LeadIntermountain Healthcare Drug Information Services
 
Conor Hanrahan, PharmD, MS, BCPS, CPHQMedication Policy, Outcomes and Stewardship DirectorSystem PGY1 Pharmacy Residency Program DirectorIntermountain Healthcare Pharmacy Services
 
Moderator:Jim Lichauer, PharmD, BCPS, FASHPSr Performance Improvement Program Director, PharmacyVizient
 
Show Notes:
[01:50] Intermountain Healthcare is a complex system.
[03:19] Challenges included the size and scale of the organization, drug shortages, as well as technology and data capture issues.
[05:30] The development of IG appropriate use guidelines was intricate and enterprise-wide.
[08:21] A medication use evaluation was conducted.  
[10:08] Evaluation of adherence to weight-based dosing strategies produced shocking results.  
[11:41] Surveying stakeholders revealed a lack of awareness of internal guidelines and standards. 
[12:42] A formal policy to optimize IG weight-based dosing is in the process of being approved.
[13:35] Advice for those planning similar strategies includes system-wide collaboration, establishing and monitoring adherence rates, standardization, and quantification of cost savings.
[15:12] Intermountain Healthcare has exciting developments on the horizon.
 
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Redesigning Ambulatory Care

In this episode, IU Health Southern Indiana Physician’s Service Line Administrator discuss their experience with the Redesigning Ambulator Care Collaborative. Each participant chose a performance improvement project to address and Elizabeth Thompson shares the rather surprising discovery the team made and the solution that made a difference.
 
Guest speaker:Elizabeth Thompson, BS, MSLService Line AdministratorIU Health Southern Indiana Physicians – Surgical Specialties
 
Moderator:Courtney Furrow-White , RN, MBAPI Program Director, PI CollaborativesVizient
 
Show notes:
[01:17]  IU Health Southern Indiana Physicians choose their improvement project
[02:14]  What prevention was missing—or was it?
[03:01]  What they learned about their data
[03:58]  Solving the code crisis
[05:29]  Pseudo codes
[06:16]  Working with IT
[08:11]  Lessons learned
[09:06]  How the collaborative experience leads to progress
[10:08]  Advice for your journey
 
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Augusta University Medical Center’s Interhospital Transfers

Marilyn Sherrill and her guests, Dr. Matthew Lyon and Dr. Max Bursey, take a deep look at Augusta University Medical Center’s successes and challenges regarding Interhospital transfers.      
 
Guest speakers:
Max Bursey, DOAssociate Professor, Service ChiefDepartment of Emergency MedicineMedical College of Georgia at Augusta University
 
Matthew Lyon, MDAssociate Dean, Experiential Learning Director, Center for Ultrasound EducationVice-Chair, Department of Emergency MedicineMedical College of Georgia at Augusta University 
 
Moderator:Marilyn Sherrill, RN, MBAPerformance Improvement Program DirectorVizient
 
Show Notes:
[01:36] Georgia is unique in that it has a large number of rural hospitals, requiring a large number of interhospital transfers for high acuity cases.
[03:50] Telemedicine and ED-based critical care services have aided rural hospital quality of care and decreased the need for transfers.
[05:48] These two services have evolved from intervention in the ED only to a holistic program of care for patients in rural hospitals.
[07:38] The ED ICU service provides inpatient level care to patients waiting on an ICU bed and “short-stay” ICU patients, and works closely with the telemedicine critical care to prevent and manage transfers.
[09:53] Telemedicine interacts with Emtala in ways that allow rural hospitals to admit and keep a broader selection of patients.
[11:13] Challenges have included the need for training providers on the use of telemedicine, and training and staffing ICU-level nurses in the ED ICU and in rural hospitals.
[13:53] Starting slow and adequately training staff are important best practices.
[16:03] Telemedicine isn’t going anywhere and should be utilized fully, and included in the work of the ED.
 
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