November/December 2007

IHI Learns About Campaign Successes at Catholic Health Initiatives Hospitals

The 5 Million Lives Campaign’s Fall Harvest found that Catholic Health Initiatives hospitals have made noteworthy improvements in patient care and safety.

11-07MercyMedicalCenter Photo

Leaders at Mercy Medical Center, Nampa, Idaho, presented some of the hospital’s successful patient safety and quality of care programs to IHI representatives during IHI’s Fall Harvest Campaign.

During the Fall Harvest, which took place October 25–November 7, representatives from the Institute for Healthcare Improvement (IHI) visited one hospital in each state to celebrate the results of interventions and initiatives promoted by the campaign. The IHI representatives “harvested” ideas that the organization will share across the nation during its continuing campaign to prevent five million incidents of patient harm. In three states, the high-performing hospital chosen for IHI’s visit was a Catholic Health Initiatives hospital. Fall Harvest hosts included Mercy Medical Center, Nampa, Idaho; Mercy Medical Center-Des Moines, Des Moines, Iowa; and St. Mary’s Healthcare Center, Pierre, S.D. St. Mary’s Healthcare Center, Pierre The IHI team that traveled to Pierre, S.D., saw how this smaller, rural facility — three hours away from the nearest tertiary care facility — successfully implements campaign initiatives. “While we have addressed all of the campaign initiatives, we have the most data on patient outcomes for our rapid response team, so that’s what we chose to discuss,” said Debbie Brakke, vice president for outcomes and service excellence at St. Mary’s. “This is also the intervention that has the greatest positive impact on our patient outcomes.” St. Mary’s implemented the team in October 2005, during IHI’s original 100,000 Lives Campaign. Since then, codes at the hospital have decreased 50 percent. The hospital will implement family and patient activation of its rapid response team during 2008. The IHI representatives also asked the St. Mary’s team to discuss a safety initiative outside those promoted by the 5 Million Lives Campaign. “We told them about our falls prevention program,” said Anita Baker, manager of quality improvement at St. Mary’s. “We involved staff nurses and other members of our health care team on a committee that analyzed data on patient falls and created an action plan.” With a new patient needs assessment tool, one-on-one nursing and the installation of some new equipment, St. Mary’s has reduced the incidence of patient falls by more than 70 percent. Mercy Medical Center, Nampa In Nampa, the Mercy staff shared its accomplishments in several areas, including treatment for congestive heart failure (CHF). For the past 20 months, Mercy has maintained perfect care for CHF patients, which requires 100 percent compliance with four measures of care. The staff uses concurrent coding, a process in which case managers and coding managers collaborate to ensure that all CHF patients are coded within two days of admission. This enables case managers to ensure that the patients receive all four CHF care measures before they are discharged. The IHI representatives also learned about Mercy’s “code 90” for patients who come to the emergency department with an acute myocardial infarction (AMI). “Everyone at Mercy knows what code 90 means,” said Ryan Lund, director of performance improvement and case management for Mercy. “The code mobilizes a team that transfers the patient directly to the cardiac catheterization lab and starts invasive intervention.” One result of code 90 is that Mercy had the best “door-to-balloon” time — the time a patient with an AMI?waits before receiving balloon angioplasty — in the state for 2006. Mercy Medical Center-Des Moines At Mercy Medical Center-Des Moines, door-to-balloon time was also a topic of discussion for the Fall Harvest. Mercy has achieved an average time of less than 60 minutes for AMI cases in a 60-mile radius. The IHI visitors were also able to watch Mercy’s cardiac catheterization lab in action. “When we took the group to see the lab a patient had just come in, so the IHI team saw everything that we do for AMI,” said Monica Gordon, clinical safety coordinator for Mercy. “They were impressed when, after completing their interventions, the staff brought the family into the lab to talk with the care team and with the patient. The IHI staff complimented us on this example of our commitment to person-centered care.” The IHI representatives also discussed Mercy’s current streak of 29 months without a case of ventilator-associated pneumonia in the coronary care unit, as well as the hospital’s overall expertise in critical care. “The IHI team visited each of our adult critical care units and took time to talk with staff members in each one,” said Gordon. “I think our critical care staff really appreciated that.” In addition to the nation-wide attention earned by being selected to be a Fall Harvest hospital, the three Catholic Health Initiatives hospitals raised their quality and safety profiles in their communities. Representatives of state health care and quality organizations, plus members of the media, also attended the Fall Harvest tours. “We had some very positive coverage in two local newspapers as a result of the IHI visit,” said Lund. “The Fall Harvest visit and the opportunity to share our success was a very positive result of being involved in the 5 Million Lives Campaign.