Texas Hospitals leading the way in quality and patient safety

Special to Medical Journal – Houston By Dan Stult z, M.D., FACP, FACHE, President/ CEO, Texas Hospital Association

Hospitals exist to promote health and healing. Even one patient harmed by one mistake is one too many. They are missionbound to be invested in patient safety and quality improvement, and striving to deliver the highest-quality care is a daily responsibility.

Quality improvement is not new for hospitals, but what is new is the level of interest from government, payors and consumers in measuring and evaluating hospitals’ performance on quality and patient safety. For example, as of October 2011, hospitals are required to report information on infections acquired during a hospital admission to the Texas Department of State Health Services. Shining the public spotlight on these data reveals that Texas hospitals have outperformed hospitals nationally in reducing surgical site infections and central line-associated bloodstream infections, two of the most costly and deadly of health care-acquired infections. This accomplishment translates to complications avoided and lives saved. This type of success is achieved because of Texas hospitals’ commitment to quality and patient safety and because of their willingness to work together on initiatives that will improve care for all patients. The Texas Center for Quality & Patient Safety, a member of the Texas Hospital Association’s family of companies, is working with Texas hospitals throughout the state on a number of collaborative initiatives to improve care.

These initiatives aim to:

• Eliminate preventable errors and reduce adverse events;

• Improve teamwork and communication; and

• Engage patients and families.

Through Partnership for Patients, a national initiative of the Center for Medicare & Medicaid Innovation, nearly 200 Texas hospitals are working together to reduce 10 of the most common health care-associated infections and readmissions, including adverse drug events, pressure ulcers, and catheter-associated urinary tract infections. The goal is to reduce hospital-acquired conditions by 40 percent and preventable readmissions by 20 percent by December 2013. TCQPS is working with more than 70 of these hospitals to achieve this goal. As of September, 72 percent of participating hospitals have reduced 60 percent of all applicable conditions by at least 30 percent or had no conditions or readmissions for 12 months or longer. The reductions have been most dramatic for ventilator-associated pneumonia and central line-associated bloodstream infections.

Two of the most common and fatal of health care-acquired infections are the target of the TCQPS HAI Prevention Collaborative. As part of this collaborative, 17 Texas hospitals are working towards reducing certain surgical site infections and central line-associated bloodstream infections by 20 percent by the end of this year. Among this initiative’s many accomplishments is the achievement of 100 percent of participating hospitals maintaining a zero rate of infection for patients following surgery involving a coronary artery bypass graft with a chest incision.

Preventing medical errors and improving patient safety by improving communication among providers and building teamwork skills are the goals of the TeamSTEPPS Initiative. More than 400 hospital staff at 33 hospitals have undergone extensive training in leadership, situation monitoring, mutual support and communication to create an environment that promotes patient safety and putting the patient first.

The other critical piece for improving patient outcomes is patient and family engagement. In partnership with the Institute for Patient and Family Centered Care, TCQPS works with 65 hospitals to provide specific, actionable steps that providers and administrators at multiple levels can take to engage patients and families in their care to help reduce preventable infections and readmissions after hospital discharge.

These are just a few of the quality and patient safety investments that Texas hospitals are making with leadership and guidance from the Texas Hospital Association to improve care and reduce preventable errors and infections. From data-driven projects to reduce hospital-acquired conditions to education and training focused on hospital culture, Texas hospitals are continually working to maximize patient outcomes and provide the right care at the right time in the right place. ▼