Medical Executive Committee highlights
Highlights from the June meeting of the Medical Executive Committee (MEC) follow. The meeting was chaired by Kenneth Lee, MD, president, MEC, UPMC Presbyterian.
President’s report
Dr. Lee announced that Margaret Reidy, MD, has accepted a new role as president of the UPMC Rehabilitation Network. Dr. Lee congratulated Dr. Reidy on her promotion and thanked her for her contributions while serving as vice president of Medical Affairs at UPMC Presbyterian and the medical director of Care Management, UPMC Presbyterian Shadyside. He noted that Dr. Reidy has been instrumental in leading successful initiatives to address patient flow, risk management, and other challenging issues.
Dr. Lee introduced Robert Friedlander, MD, who recently was appointed chairman for the Department of Neurological Surgery. Dr. Friedlander previously served as professor of neurosurgery at Harvard Medical School and vice chairman of neurosurgery and associate director of cerebrovascular surgery at Brigham and Women’s Hospital in Boston.
Quality Improvement update
Jill Larkin, director, Quality Improvement, discussed April’s performance on core measures for treatment of acute myocardial infarction (AMI), heart failure, pneumonia, and the Surgical Care Improvement Project (SCIP). The hospital’s performance on these core measures is reported on the Centers for Medicare and Medicaid Services (CMS) consumer website. Performance in the core measures also impacts CMS reimbursements to providers. Additional core measures for outpatient services are being added.
Ms. Larkin also noted there are opportunities for performance improvement. For example, within the SCIP initiative, providers are reminded to ensure that the following core measures are completed and documented:
- Perioperative antibiotic administration should be initiated within one hour of the surgical incision and within two hours if patients are receiving vancomycin or fluoroquinolones, because of the longer infusion time of these drugs.
- Antibiotic should be appropriate to the specific surgical procedure.
- Antibiotics should be discontinued within 24 hours after surgery end time and within 48 hours for cardiac procedures.
- Patients who routinely take a beta-blocker should continue their beta-blocker on the day of surgery. Missing a beta-blocker dose during the perioperative period is associated with increased morbidity and mortality.
- Immediate postoperative glucose control has been correlated with a reduction in surgical infection. This SCIP measure is used to assess the percent of cardiac surgery patients with controlled 6 a.m. blood glucose (less than or equal to 200 mg/dL) on postoperative day one (POD 1) and postoperative day two (POD 2) with surgical end date being postoperative day zero (POD 0).
HCAHPS survey
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the national methodology used by CMS to measure and compare patient satisfaction results among hospitals throughout the country.
A section of the HCAHPS survey asks patients to rate how well their physicians communicated with them. One of these questions asks “During this hospital stay, how often did doctors explain things in a way you could understand?” Effective explanations can be enhanced by doing the following:
- Use simple, easy-to-understand terminology whenever possible.
- Speak slowly, clearly, and at an appropriate volume.
- Avoid medical jargon and abbreviations.
- Check for patient understanding, comprehension, and agreement.
- Ask if there are additional questions or areas needing clarification.
A useful technique for assessing patient comprehension is the “teach back” method, in which patients are asked to restate the rationale and plans in their own words. The physician could say, for example, “OK, Mr. Jones, I know that when you get home, your family is going to want to know what we talked about today about your pain. What are you going to tell them?”
Readmissions
Dr. Reidy explained that rates for patient readmissions within seven days and 30 days of discharge have become a matrix of growing importance for Medicare reimbursement. Other payers are following Medicare’s lead and will use readmission rates in determining reimbursement levels.
Care managers and other staff monitor readmission data to determine the top diagnosis-related groups (DRGs) for readmissions. Trends are identified and appropriate actions taken. The strategy was deployed to address spinal fusion readmissions related to infection. A team led by Carlene Muto, MD, MS, medical director, Infection Control, was formed to reduce spinal fusion readmissions by making specific changes. Velcro straps were replaced with rubber straps, which are easier to clean and do a better job holding patients in position. A dressing kit was standardized, and patients were instructed to bathe or shower with a ChloraPrep wash for the three days prior to the procedure.
Administrative update
John Innocenti,president, UPMC Presbyterian Shadyside, presented the following administrative updates:
- Overall, May was a strong month. Admissions surpassed the budgeted projection for the month. Liver transplants also exceeded the budgeted projection. Emergency Department visits did not meet their budgeted projection, while surgeries were down slightly.
- A busy construction season is under way. The new LHAS Presby Floral & Gift Shop opened on the first floor. This was followed by the opening of the new lobby entrance. The schedule calls for completion of a PNC Bank in mid-July and a Starbucks in September. The bank and coffee shop also will be located on the first floor. The demolition of the DeSoto Wing of the former Children’s Hospital of Pittsburgh of UPMC will be an ongoing project throughout the summer. After the demolition, the area will be restored as green space. The multiphase renovation and expansion of the Emergency Department also has begun.
- The staff vacancy rate is less than 4 percent. There is a large pool of qualified applicants to fill existing openings.
Nurse recruitment
Holly Lorenz, chief nursing officer and vice president, Patient Care Services, noted there are few nursing vacancies at this time. However, UPMC wants to attract recent nursing graduates so they are available to fill positions as they open. To accomplish this goal, new nursing graduates are being hired as nursing assistants and assigned additional duties such as completing blood draws, starting intravenous lines, testing for blood glucose levels, and transporting patients who are on monitors.
The strategy will create more time for staff nurses to remain on their units to provide direct patient care. It also will enable UPMC to hire new nurses who will be prepared to step in to staff nurse vacancies as they occur and maintain strong ties with the schools of nursing.
UPMC eRecord update
Vivek Reddy, MD, medical director, Hospital Information Technology, announced that the integration of anesthesia data into eRecord recently went live at Children’s Hospital of Pittsburgh of UPMC. With this implementation, anesthesia data automatically are collected from OR anesthesia devices. The anesthesia module of eRecord provides an integrated electronic medication administration record. Standardizing the workflow and the integration of key anesthesia data improves the accuracy and completeness of the eRecord, while supporting quality of care for UPMC patients.
The automated documentation provided by the anesthesia module of eRecord will allow an anesthesiologist to spend less time documenting and more time focusing on patient care. Magee-Womens Hospital of UPMC will be the pilot site for the use of the anesthesia module in adult care. This implementation is scheduled for September. The anesthesia module is scheduled for deployment at UPMC Presbyterian in February 2011.
Restraint use documentation
Orders for restraints have lacked proper specificity regarding the extremity to be restrained. The redesigned eRecord restraint order set streamlines much of the documentation involved in ordering, continuing, and canceling restraints. When applicable, a box will appear to select restraint location (left upper extremity, right upper extremity, left lower extremity, or right lower extremity).