To measure quality of care, we track how often certain things occur and compare that to how often they happen in other similar healthcare organizations. When these events happen less often, it means we are incorporating best practices that enable us to provide better care. We use these quality indicators to assist us in improving our processes to ensure better outcomes for our patients.
We use a database that allows us to compare our organization’s clinical outcome performance with that of other hospitals, set benchmarks for performance, as well as run comparisons within our own organization. This comparative database has data from 288 hospitals, both academic and community, across the nation and provides us with the information we need to drive our quality improvement and patient safety initiatives aimed at improving patient care and outcomes.
Sepsis is one of the leading causes of death in hospitalized patients. As part of a recent M Health initiative to reduce sepsis, we implemented an early sepsis identification protocol in our hospital emergency departments. By implementing an alert system when a patient's vital signs indicate early signs of an inflammatory response, a nurse can request a lactic acid draw, the results of which are reviewed and evaluated by the physician. They can then implement appropriate fluid or antibiotic therapies. This early identification protocol has resulted in a reduction of sepsis mortality rate by 2.8%, from 14.83 to 11.99% at University of Minnesota Medical Center.
30-Day Readmission (Percentage)
The 30-day readmission rate is measured as a percentage of patients who had an inpatient (observation status excluded) hospitalization and were subsequently admitted to the hospital within 30 days.
University of Minnesota Health continues its focus on reducing the readmission rates for our patients in the following ways:
- Providing the information that patients need well in advance of elective procedures, to ensure they are well prepared for their recovery
- Ensuring that patients have a clear plan of care upon leaving the hospital, like understanding their medications and who to contact with questions
- Communicating with patients in a timely manner after leaving the hospital to answer questions and coordinate care
- Improving and standardizing treatment of patients with complex medical conditions, like liver failure or heart failure
- Making it easier for patients to communicate with their care team
- Working with the University of Minnesota Medical School and School of Nursing to educate future clinicians on the challenges patients face when navigating healthcare
Pressure ulcers are the breakdown of skin tissue, not present on admission, caused by sitting or lying in the same position for a long period of time. They are typically the most reported adverse health event. According to the Agency for Healthcare Research and Quality, each year more than 2.5 million people in the U.S. develop pressure ulcers. The injuries to the skin and underlying tissue are painful and increase risk for infection or other complications. Here are ways we are working to reduce the incidence of pressure ulcers:
- Three NICU staff members were recruited as their unit “skin champions.” As a result, they began using a skin integrity risk assessment, added skin assessment documentation and began quarterly pressure ulcer prevalence and incidence studies.
- Intensive care nursing staff and respiratory therapy staff are working together to improve skin assessment under respiratory equipment
- We are exploring community practice related to “standard” off-loading mattress for the intensive care patient.
- We are developing staff education related to thorough skin assessment under and around medical devices and accuracy of pressure ulcer risk assessment to ensure we identify all patients at risk for development of pressure ulcers
We report the number of stage 3, 4 or unstageable pressure ulcer events to the State of Minnesota.
Falls Resulting in an Injury Severity of Moderate or Greater Harm
Falls are the most common adverse event in hospitals. Each year, somewhere between 700,000 and 1 million people in the United States fall in the hospital. A fall may result in fractures, lacerations or internal bleeding, leading to increased health care utilization. University of Minnesota Health makes reducing and eventually eliminating falls that result in injury a top priority. Some of our efforts include:
- Implementing the Minnesota Hospital Association (MHA) Falls Tool - a new risk assessment and intervention to prevent falls and falls with injury
- Aligning interventions with the specific risks identified in the risk assessment
- Purchasing new beds equipped with bed alarms and pressure reduction mattresses, among other innovations
- Reviewing and improving processes to promote awareness of fall prevention responsibilities and interventions
We measure and report the number of inpatient falls associated with an injury severity of moderate or greater that we report to the State of Minnesota.
Central Line Associated Blood Stream Infection (CLABSI) in the Intensive Care Unit (ICU)
A CLABSI is a laboratory-confirmed bloodstream infection where a central line or umbilical catheter was in place for more than two calendar days and the line was in place on the date of infection or the day before. We measure this rate per 1,000 line days in the ICU.
CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable. We work to reduce the number of CLABSIs by:
- Reviewing cases to identify trends and opportunities for improvement
- Implementing best practices for insertion and maintenance of a central line or umbilical catheter as recommended by the Centers for Disease Control and Prevention (CDC)