CHS Quality Initiatives
CHS has a very extensive quality improvement/patient safety program. Some of the key initiatives that the organization has focused on are as follows:
CHS Pinnacle Award for Quality & Patient SafetyInaugurated in 2015, the CHS Pinnacle Award for Quality & Patient Safety recognizes performance improvement projects from throughout the system, with winners announced at an annual conference held in the spring. Modeled after the Healthcare Association of New York State’s Pinnacle Award—which was presented to two CHS hospitals for two consecutive years, 2017 and 2018—this is CHS’s way of honoring those who are enhancing the delivery of health care and promoting patient safety in both acute and continuing care settings. Clinical teams from all six CHS hospitals and the continuing care division submit collaborative projects with measurable results for consideration. In partnership with and support from The Joint Commission, this initiative reflects CHS’s No Harm Campaign and is a component of the system-wide Performance Improvement Plan.
No Harm Campaign
Launched in 2013, CHS’s No Harm Campaign, along with the Daily Patient Safety Principles, is advancing the health system’s High Reliability journey, linking key quality measures across the entire continuum of care. Each year, patient care teams from across CHS are presented with the Certified Zero Harm Award for achieving zero harm events for certain indicators at their facilities for at least 12 consecutive months. These include: early elective delivery, surgical site infection, central line-associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). Flawless performance for these measures is formally recognized by CHS’s leadership and communicated to all personnel in Nassau and Suffolk. In addition, CHS inaugurated the Driving to Zero Award in 2016 to acknowledge the successful implementation of the Joint Commission Fall Reduction Targeted Solutions Tool. This initiative further supports highly reliable, safe care.
Reduction of Antipsychotic Medication Use
CHS's Our Lady of Consolation Nursing & Rehabilitative Care Center earned the 2014 HANYS Pinnacle Award for Quality and Patient Safety for its "Managing Behaviors Without Medication: Providing Care to Special Populations" initiative. The program achieved a 23% overall improvement of decreased antipsychotic medication use, employing an interdisciplinary approach incorporating Lean Six Sigma.
Urinary Tract Infection Reduction Initiative
Urinary tract infections (UTIs) are the most common hospital-acquired infection, with 80% of infections attributed to the presence of an indwelling catheter. UTIs can increase complications and prolong hospitalization. Beginning in 2009, CHS developed an interdisciplinary team tasked with decreasing the incidence of health care-acquired infections across the continuum (hospitals, home care and long-term care facilities) using evidence-based guidelines from authorities such as the Centers for Disease Control to standardize catheter insertion techniques, catheter maintenance and early discontinuation to prevent infection. The team has been successful in significantly decreasing UTIs by more than 50%. The team continues to work on further decreasing UTI rates and catheter use.
Inappropriate antibiotic use has been associated with increasing bacterial resistance and other serious complications such as clostridium difficile diarrhea nationwide. Beginning in 2012, CHS developed an interdisciplinary team to develop a rational, systematic approach to the use of antimicrobial agents. The Antimicrobial Stewardship Team was developed to optimize selection of antimicrobial agents and duration of therapy to maximize patient outcomes and minimize complications.
Reduction in Congestive Heart Failure Readmissions
Heart failure (HF) affects some 6 million people in this country and results in I million hospitalizations per year. HF is a chronic, relapsing condition that often leads to repeat hospitalizations. Readmission to the hospital is anxiety-provoking for patients and their families, and exposes patients to nosocomial infections.
CHS provides a variety of services designed to improve the symptoms of HF and reduce the patient's risk for rehospitalization. In our hospitals, our physicians and nurses ensure that patients are prescribed medications that have been proven not only to relieve symptoms and improve prognosis but also to reduce the need for hospitalization.
The management of HF is complex, and it is critical that patients and their families understand their disease and its management. Beginning in the hospital, patients are educated by nurses, dietitians and other health care professionals using the "teach-back" approach, which has been proven to increase patient understanding.
As patients improve and approach hospital discharge, care managers begin the discharge planning process by assessing the patient’s needs and home environment. Some patients will require additional rehabilitation in a skilled nursing facility, while others may be followed by CHS home care staff. The nurses ensure that patients are compliant with their diet and medications and can detect early signs that a patient’s condition may be worsening. Prompt intervention by the nurse and the patient’s physician at this point can often avoid rehospitalization.
The organization continues to examine ways to assist patients with the management of their disease, allowing patients to function as normally as possible and to avoid additional hospitalizations.
Six Sigma Initiative
Lean Six Sigma is a continuous improvement strategy that addresses defects and wasted effort in a process. Originally developed in the 1980s in the manufacturing industry, Lean Six Sigma has been extremely successful in improving processes. Today, Lean Six Sigma is widespread throughout all industries, including health care. CHS is one of the leading health care organizations currently using the Lean Six Sigma approach to improve patient care and satisfaction. Streamlining processes and addressing root causes for common errors can make a hospital safer for patients. CHS is creating a special infrastructure of trained Black Belts and Green Belts who are experts in these performance improvement methods. Since 2009, Lean Six Sigma has been used to improve processes such as improving stroke care, improving patient flow from the ED to a hospital bed and improving patient satisfaction.