Climbing Toward Success with Simple Improvements

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Climbing Toward Success with Simple Improvements

• Chesapeake General Hospital
• Chesapeake, Virginia

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Chesapeake Health

• Located in southeastern Virginia
• Community hospital
• 310 licensed beds
• Approximately 16,000 admissions per year
• The busiest ER in the area 61,000 visits for
  FY2005
• Deliver more babies than any local civilian
  hospital in the area

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2005 A Year of Change

• New Chief Executive Officer
• Overhaul of the Performance Improvement Plan
• Change in PI methodology from FOCUS-PDCA to
  FAST-PDCA
• Results-driven data analysis
• New Performance Improvement department

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Wheres our dot?
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A Hard Look at the Data

• Were in the 10th decile

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Smoking Cessation Advice/Counseling
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Discharge Instructions
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A Moment of Truth
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A Moment of Truth

• Performance thresholds - hospitals in the HQID
  project have raised the bar - we have been
  stagnant.
• The big question do we drop out of the project?
• Inspiration We can do it! Chesapeake Health
  wants to stand at the podium and talk about their
  success.

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Next Steps

• Incorporate FAST-PDCA methodologies for rapid
  improvement
• Charter an interdisciplinary team
• Identify quick-wins and apply simple system
  changes for improvement

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A Small Change Leads to a Big Success
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PI Methodology FAST-PDCA

• F Focus on a
• specific aim
• A Analyze basic
• data
• S Select potential
• changes
• T Test the
• proposed changes

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Focus on a Specific Aim

• Provide appropriate discharge instructions to
  100 of our heart failure patients within 12
  months.
• Provide smoking cessation advice/counseling to
  100 of our heart failure patients within 6
  months.

FAST-PDCA
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Analyze Basic Data

• February 2005
• 2 of the heart failure patients received
  appropriate discharge instructions.
• 25 of heart failure population who smoked (or
  had smoked within 12 months of admission)
  received smoking cessation advice/counseling.

FAST-PDCA
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Select Potential Changes

• Team prioritized changes
• Studied what has worked at other hospitals
• Focused on what would be simple changes where
  we would achieve rapid success
• Solution implement a CHF discharge guide

FAST-PDCA
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Test Changes
FAST-PDCA
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Plan

• Develop CHF Discharge Guide to include
• Activity level
• Diet
• Discharge medications
• Weight Monitoring
• Follow-up appointment
• What to do if symptoms worsen
• Include smoking cessation advice/counseling
• Attach discharge instructions to the guide

FAST-PDCA
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Plan

• Restructure Case Management assignments to have 2
  Case Managers facilitate the use of the discharge
  guide and provide ongoing education to the
  medical and nursing staff.
• Communicate progress by providing ongoing HQI
  data.

FAST-PDCA
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Do

• CHF Discharge Guide went live late March.
• Case Manager facilitators laboriously provided
  ongoing education and instructions.

FAST-PDCA
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Smoking Cessation Advice/Counseling
FAST-PDCA
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Discharge Instructions
Change Implemented - CHF Discharge Guide
FAST-PDCA
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Have our Process Improvements Impacted the
Quality of our Patient Care?
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HF Readmission Rate
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Act to Hold the Gains

• We recognize we did not meet our aims
• Identified barriers to success
• Case Mangers juggling multiple responsibilities.
• Admission working diagnosis different from final
  diagnosis.
• Discharge process variation as (1) we have a
  manual automated system and (2) multiple
  discharge forms.
• Winter hit heart failure patients were placed
  in any available bed (ED Observation unit,
  Womens Unit).

FAST-PDCA
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Next Steps

• Incorporated additional PDCA cycles
• Improvements made
• Created a position in the PI department to
  coordinate cardiac clinical quality improvement.
• Worked with Nursing to develop a universal
  discharge tool. Turned off the computer
  discharge. Implemented June 1st.
• Implemented a cardiac physician progress note.

FAST-PDCA
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Questions?