Comparison of Hospital Points to National Benchmark: Florida

Published Date: 17 Oct 2017

HOSPITAL DATA POINTS COMPARED WITH STATE AND NATIONAL BENCHMARKS

• DOUGLAS WINTER

Analyze and summarize the results. Are there significant outliers? Try to summarize the results as comparable, unfavorable, or favorable to the state and national benchmarks.

I compared three hospitals in my general area to ten different data points that were also compared to the state and national averages. The areas within the statistics I compared were in timely & effective manor, survey of patients experience, readmissions, complications & deaths, and use of medical imaging. Following the data comparisons, I included a brief explanation of the data point being examined, along with potential causes, improvement suggestions, and outliers when found.

Timely & effective manor

First data point: Outpatients having surgery who received an antibiotic at the right time (within one hour) before surgery. Hospital staff should make sure surgery patients get antibiotics at the right time. It is important to receive antibiotics pre-operation due to the possibility of wound infections from surgical procedures. Research has shown patients who have received antibiotics prior to surgery were less likely to get wound infections.

Results: Florida Hospital Memorial and Florida Hospital Flagler rated 100%, above the state and national averages of 99% and Flagler Hospital rated 98% only one percent below the state and national average.

Potential causes for the problem: Their protocol for patients to receive an antibiotic earlier or after surgery is not being followed. An in-service need’s to be scheduled to make sure all staff is following protocol guidelines and new employees are being trained correctly as well.

Process improvement suggestions to improve the results: Their teams of operating room nurses, surgeons and anesthesiologists need to analyze and refine the processes with the goal of having 100 percent of their surgical patients receive an antibiotic within one hour prior to any scheduled surgery.

Second data point: Heart attack patients given a prescription for a “statin” at discharge. Most patients who have had a heart failure and who take a “statin”, Ace inhibitor have fewer symptoms, feel physically better, and are less likely to return to the hospital.

Results: Florida Hospital Flagler and Florida Hospital Memorial tied at 100% outperforming the state and national averages, and Flagler Hospital rated 97% under the states 99% and national average at 98%.

Potential causes for the problem: Statin protocol is neglected, no one held accountable, no regularly scheduled meeting or in-service are being conducted.

Process improvement suggestions to improve the results: Flagler Hospitals team of operating nurses, physicians need to pay closer attention to assure their patients receive a “statin” at discharge and strive to reach a goal of 100 percent of their patients receive a “statin” Ace inhibitor at discharge to maintain a continuity of care.

Third data point: Pneumonia patients given the most appropriate initial antibiotic(s). Pneumonia is a long infection which is caused by bacteria or a virus. If the pneumonia happens to be caused by bacteria then the infection will be treated by an antibiotic that is specific for bacteria, and if the pneumonia is caused by a virus a specific antibiotic will then be used for viral infections.

Results: Florida Hospital Flagler tied with the state at 98%, outperforming the national average at 95% and Flagler Hospital scored 94% below all comparisons. In addition, Florida Hospital Memorial scored 97% above the national average, and 1% below the state averages.

Potential causes for the problem: Each staff member needs to follow a respiratory protocol, and if pneumonia is identified, that protocol needs to be followed. Blood cultures are not performed, and the potential for giving the patient the wrong antibiotic is high. Protocols are not followed, no accountability, or in-service are being regularly held.

Process improvement suggestions to improve the results: All three of the hospitals require improvement and need to make sure patients whose initial emergency room blood culture was performed prior to the administration of the first antibiotic in order to provide the most appropriate care.

Survey of patient’s experience

First data point: Patients who reported that their nurses "always" communicated well. This is important for any patient staying at a health care facility, and is asking if nursing explained things clearly, listened, and listened carefully to the patient, and treated the patient with courtesy and respect.

Results: All comparisons’’ performed poorly, Florida Hospital Flagler and the state tied at 75% While Florida Hospital Memorial tied with the national average at 79%, leaving Flagler Hospital below the other comparisons at 73%. All comparisons are well below an acceptable benchmark of 100%.

Potential causes for the problem: Health care staff gets busy, and they tend to have so many things they are thinking about and they neglect to fully communicate with the patients. Also people assigned to a bed are not looked at as patients but a body and communication tends to be non-existent.

Process improvement suggestions to improve the results: All comparisons failed in this analysis. Patient satisfaction is top priority, and should be for most health care organizations. Every member of the team needs to be reminded that every patient regardless of ethnicity, creed, demographics, etc. deserves communication and respect. Regularly scheduled meetings, and in services regarding patient communication, and care in order to make the patient feel comfortable and looked after.

Second data point: Patients who reported that their pain was "always" well controlled. Again all comparisons failed this part of the analysis. Pain management should be top priority with those patients that are not scheduled for immediate surgery. Patient satisfaction, and recovery will be all the better if they are well controlled.

Results: Again, all comparisons failed in this part of the analysis. Florida Hospital Memorial and the national average tied at 71%, while Florida Hospital Flagler was 69% and Flagler Hospital at 67% and the state average at 68%. All comparisons in this data point fell short of the acceptable level of 100%.

Potential causes for the problem: Health care staffs are not fully aware of the pain each modality can cause and influence the outcome of patient care. They tend to be removed, for example a patient has an abscess to his lower leg, yet he says he is in pain but I am removed from his discomfort because all I see is an abscess. Although he is in pain and the health care worker needs to be reminded that it may only be an abscess to them, but to the patient it constitutes the end of the world.

Process improvement suggestions to improve the results: The three hospitals compared need to setup a mandatory in service by floor with a committee and their manager to remind everyone the importance of pain management. Remind everyone that they are patients and not textiles, and yes your shifts are busy, but never forget that it is our responsibility to care for them and caring for them includes pain management, and if the patient say’s to you that this pain is a 10 out of a 10, talk with their physician to see if anything can be done.

Third data point: Patients who reported that staff "always" explained about medicines before giving them to them. Patients want to know, they want to be informed and feel about the medications they are taking while in the hospital. It is further important to know what patients are feeling about their hospital experience and by asking patients if their nurse communicated with them about their medication before dispensing it will effectively let the hospital staff know where they need improvement in order to enrich the patients overall hospital experience

Results: Florida Hospital Flagler and the state average tied at 60%, Florida Hospital Memorial rated 65% and Flagler Hospital rated 57% and the state at 64%. All comparisons data points fell short of an acceptable 100%.

Potential causes for the problem: Protocols not being followed, no in services to remind nurses to communicate with their patients more effectively. Not acknowledging patient satisfaction surveys to find areas that need attention.

Process improvement suggestions to improve the results: It is important for the patients to feel comfortable and have a feeling of well-being so when they have a concern or have a question they will feel free to ask. Monthly in service meeting reminding to encourage staff to have a positive attitude, to be more approachable, about hospital image, go over patient satisfaction survey results.

Readmissions, complications & deaths

First data point: Rate of unplanned re-admission for heart attack patients. The percutaneous coronary intervention (PCI) re-admission data point evaluates and compares “unplanned re-admissions” which may take place within 30 days after discharge and after a PCI procedure. In addition, this data point takes into account the level of a patient’s illness before being admitted into the hospital, and the differences along with re-admission percentages that may be coincidental. For example, patients who have underlying medical diagnoses that are not seen with younger healthier patients were not included in this data point.

Results: Florida hospital Flagler scored 19.4%, just below Florida Hospital Memorial at 19.9%, and Flagler Hospital was at 17.9 and below the state and national averages of 18.3%.

Potential causes for the problem: Patients are not clinically able to be discharged, are not properly instructed on the methods to reduce the risk of infections, their medications need to be reconciles, and they need to be encouraged to call for assistance to their primary care provider, or given a number to call at the participating hospital (Meyer, & Rybowski, 2004, p.viii).

Process improvement suggestions to improve the results: Ensure the patients are stable and clinically able to be discharged, this will help reduce the risk of infections, assist them with reconciling their medications, encourage and improve communications with their providers in transitioning of care, encourage, train patients on strategies promote disease management principles and educate patients on what symptoms to monitor, who to contact with questions and where and when to seek follow-up care (Meyer, & Rybowski, 2004, p.10).

Second data point: Death rate for Heart attack patients: Percutaneous coronary intervention (PCI) is what health care providers call. door-to-balloon time, and this time frame is 90 minutes from the time the patient arrives at the hospital suffering from a heart attack and also (PCI), such as angioplasty when a catheter with a very small balloon is inserted into the blocked artery and inflated in order to open up the vessel.

Results: Florida Hospital Flagler rated 16.7% and while Florida Hospital Memorial rated 15.5%, while Flagler Hospital is 14.4% below the state and national average of 15.2%.

Positive outlier: Flagler Hospitals results is 2.3% lower than Florida Hospital Flagler, 1.1% lower than Flagler Hospital and .8% lower than the state and national averages. Flagler Hospital’s lower results may be attributed to having regular monthly meeting that involve key hospital staff and emergency medical responders designed to review heart attack cases, and having a cardiologist nearly on site most of the time, and part of the care team to encourage problem solving by immediate hospital staff and not the responsibility of only nurses but the entire team (D’Eugenio, 2012, p.1).

Potential causes for the problem: This data point has many variables and is dependent upon the level of patient’s general health in the hospitals geographical area. That is why this data point has already been adjusted for patient characteristics that may make death or unplanned readmission more likely, regardless if any of the compared hospitals are providing higher quality of care. Some of the characteristics included are age of the patient, past medical history, and co-morbidities that the patient had when they were admitted to the hospital and a known health risk that can to increase the patient’s risk of dying or of having an unplanned readmission.

Process improvement suggestions to improve the results: As performance improvements are identified then appropriate problem-solving techniques can be employed. Beginning with putting together an action plan, that can change certain patterns set by physicians that have been identified as possible contributors with the death rates for heart attack patients. Also, accountability measures should be enforced to hold appropriate department staff accountable for protocol adherence, critical paths to follow through, and enforcing the plan towards improving outcomes, policies that enhance efficiency, and fluid communication across departments.

Medical Imaging

First data point: Outpatient computed topography (CT) scans of the chest that were "combination" (double) scans. This data point only applies to Medicare patients that were treated in the hospital and does not include ambulatory or inpatient settings of the hospital. The lower the percentage the better and points to the efficient use of medical imaging for that hospital being compared. In addition, it is important not to expose the patient to contrast material and or unnecessary radiation exposure.

Results: Florida Hospital Flagler scored the highest at 2.9% and Flagler Hospital tying with the national average at 2.7% and Florida Hospital Memorial rated well below the other comparisons at 1.4% and the state scored better than the other comparisons except Florida Hospital Memorial with 2.4%.

Positive outlier: Florida Hospital Memorial scored 1.4% which is 1.5% better than the highest scoring hospital at 2.9% and 1.3% better than the national average at 2.7%.

Potential causes for the problem: The primary cause for double C.T. scan results, its over use in general is caused by emergency room physicians since they are more apt to order expensive tests that can have high levels of radiation, and which are also not needed “It is easier to order a test than to take extra time to explain to a patient why it is not needed” (Parr, 2014, ND, p.1). Florida Hospital Memorial contributing cause may include using C.T. scans only as a diagnostic tool and not as a screening modality, while the other comparisons seem to follow defensive medicine techniques, and or illustrating a wide spread disengagement between the physicians and their patients.

Process improvement suggestions to improve the results: It is important to encourage patients to question their physician’s motives, consult with their physicians. Patients need to know why tests are being ordered and what impact will the test have on their treatment Parr, 2014, p.1). Physician’s need more frequent in services regarding hospital expenditures, assign quality control measures to each physician in order to track unnecessary procedures and to follow-up with the physicians to encourage other means to same problem. Florida Hospital Memorial contributing cause may include using C.T. scans only as a diagnostic tool and not as a screening modality,

Second data point: Outpatients who received cardiac imaging stress tests before low-risk outpatient surgery. The heart’s ability to respond to stress is necessary to understand if the patient is scheduled for surgery. The physicians need to know what levels of stress the patient’s heart is capable of handling. For instance, a cardiac stress test is not required for a colonoscopy, cataract surgery, biopsies, because this kind of procedure will not over task the heart, and poses very little risk to the patient unlike, bypass surgery for example.

Results: Florida Hospital Flagler scored 6.6% and Florida Hospital Memorial at 5.5% only 2% higher than the national average of 5.3%, while the state scored 6.4% and the outlier in this data point is Flagler Hospital at 9.3%.

Negative outlier: Flagler Hospital is performing far more cardiac imaging scans at 9.3% than necessary and is higher than the lowest reporting percentage by 4%. This procedure places the patient(s) at greater risk, introducing contrast and intentionally stressing the heart muscle in order to locate any problems (Einstein, 2014, p.1).

Potential causes for the problem: Not looking into other means of diagnosing, not following the cardiac imaging protocol or critical paths in place, staff members are not held accountable to improve patient safety, enhance efficiencies through standardizations. Lack of physician, floor managers, and charge nurse in-services to make sure staff is following protocol guidelines.

Process improvement suggestions to improve the results: Ensure cardiac imaging protocols are in place as well as critical paths, assure all staff personal having direct contact with patients are held accountable, schedule monthly in-service’s, and assign physicians case managers to coordinate and facilitate care with all their patients in order to help facilitate use of technology better and with less risk.

References

D’Eugenio, R. (2012). Key factors linked to lower death rates among patients with heart attacks.

(1). Retrieved from http://medicine.yale.edu/news/article.aspx?id=944

Einstein, A. J. (2014). Radiation from cardiac imaging tests. Questions you should ask. (1).

Retrieved from http://circ.ahajournals.org/content/127/11/e495.full

Meyer, J. A., Silow-Carroll, S., Kutyla, T., Stepnick, L. S., Rybowski, L. S. (2004). HOSPITAL

QUALITY: INGREDIENTS FOR SUCCESS—OVERVIEW AND LESSONS LEARNED. Retrieved from http://www.commonwealthfund.org/programs/quality/761_Meyer_hospital_quality_overview.pdf

Parr, J. T. (2014). Overuse of CT scans adds to cost. Fort Bend Indiana.(1). Retrieved from

http://fbindependent.com/overuse-of-ct-scans-adds-to-cost-p2851-89.htm