The Joint Commission has 1700
areas of performance: Stroger’s Big Five are Environment of Care; Life Safety
(both focused on the building); Infection Control; Provision of Care; and Performance Improvement (how to use data).
Each has a multidisciplinary subgroup assigned to it, which meets weekly. The Life Safety team has called for increased
training and closer supervision of contracted staff such as Sheriff’s personnel
who bring prisoners into the hospital.
There’s now a hotline to report problems with cleanliness and all staff
are urged take personal responsibility
for hand-washing and IV removal to prevent infection.
The Provision of Care group
has focused on special care for vulnerable populations (pediatric, psychiatric
and the elderly). In response to a
question, Dr. Das noted that the needs of non-English speakers are addressed
through a 24-hour phone interpreter service.
Reports from the Medical
Staff Executive Committees
No report from Provident; Dr.
Wakin was absent.
Dr. Goldberg of Stroger
reported a focus on meeting the time frames of the Affordable Care Act: “We
want patients to keep choosing us.” He
invited Board members to schedule attendance at the “Schwartz rounds” to learn
about the hospital’s multidisciplinary approach. In response to a question Goldberg said the
use of Electronic Medical Records (EMRs) had not reduced physician productivity–“the doctors just spend more
time.”
Electronic Medical Records
Update from Chief Information Officer Dr. Hota
Chairman Michael again cautioned
the staff to “make sure we’re not collecting useless information.” The CORE Center reported an inability to
complete departure notes in the new EMR, and asked for additional office
support to relieve doctors and nurses of the task. Dr. Hota noted that the hospital earned $12
million in Federal incentives ($44,000 per “eligible provider,” of whom there
are 400) this year for meeting the EMR requirements of the Affordable Care Act,
which include not only a specific timeline but specific prescribed software. (These compliance subsidies will continue, at
a steadily reducing level, til 2016, when they’ll be replaced by penalties for
failure to comply.)
Committee member Dr. Munoz
pointed out that if doctors did all the EMR departure notes (include review of
all medications and aftercare instructions for patients) themselves they’d only
be able to see two patients an hour, and urged the staff to consider whether
someone else could take on the task. Dr.
Hota responded that each clinic establishes its own work-flow.
On July 31 the system
installed 1800 new computers and set up Web training to handle the continuous
inflow of new staff and supplement the ½-time trainer. By now 98% of the nurses and 70+% of the
doctors are trained. In some areas EMR
use is very good: 100% of vital signs are recorded electronically and most
divisions are using e-prescribe.
Chairman Michael asked the staff to prepare an estimate of necessary
additional training resources.
Current Quality
Measures/Reporting
PQRS (the Physician Quality
and Reporting System) suffers from slowdown due to overuse, but CCHHS is adding
additional servers and other infrastructure which will save time and the
number of clicks per transaction.
The system is now working
with Microsoft to have its old databases converted for use on the new system by
exporting them to a Virtual Private Cloud Database. In addition, they’re using an open-source
reporting system created by two staff members using free software, which will
be easier to tweak and update than software provided by a vendor. Again personnel is needed: a team of
data analysts and additional training.
Chairman Michael asked whether it was clear what should be measured. Hota responded that there were plenty of
“obvious targets.”
Developing a Quality
Dashboard
The staff proposed that the
CCHHS Dashboard include:
1.
Core Measures
2.
Hospital-acquired conditions
3.
Re-admission (though may result from outside factors,
e.g. lack of primary medical care)
4.
Immunization
5.
Patient satisfaction (driven by the experience
coming in the door and going out the door, plus “how we talk to you while
you’re here”)
Chairman Michael suggested
that the Committee make recommendations about what to include on the Dashboard,
and share those with the full Board at its next meeting.
Dr. Das explained that the
design of the dashboard should reflect the system’s aims, whether comparative
or strategic. An individual
dashboard can show both absolute
measures (e.g. numbers of timely catheter removals, because Medicare/Medicaid
will no longer reimburse hospitals for procedures resulting in catheter-related
infections) and comparative measures (throughput in the emergency department:
the state average is 2 hours, ours is now 10; how are we progressing?). CCHHS will focus first on patient-safety and
hospital-acquired conditions (falls, trauma, infections) because there are protocols
to prevent these harms. The Chair asked
to see these statistics monthly, and Dr. Das agreed to come back in November
with a recommendation of what the Committee should examine every month.
Updating the Quality Plan
The current quality plan will
cover CCHHS through accreditation, but the system is now considering
improvements for 2013 and should have a new plan by this year’s end. The main aims should come from the medical
staff and be considered by the Committee and then the full Board. Dr. Murray of the Public Health Department
reminded the Committee that the plan must look beyond the hospital at things
like whether there are populations in Cook County that are inequitably served,
and Dr. Mason concurred: “Public health is more important than what we [at the
hospital] do.” Chairman Michael
suggested separating aims within CCHHS’s control from those that are not; the latter requires engaging outside partners such as
the state and other hospitals. He also
stressed making sure the system is using the right data: there is a lot of
information about Medicare patients, but 40%
of CCHHS's patients are uninsured. Dr. Mason
pointed out the importance of measuring employees’ experience and satisfaction.
Patient Safety Indicators
In response to an earlier
question by Committee member Mary Driscoll, Chairman Michael reported the
advice of legal counsel that the Committee can’t review individual cases in
which patient safety has become an issue without compromising patient
confidentiality. But as the Committee
needs to be aware of safety issues, two of its members (Drs. Velzquez and
Munoz) have agreed to serve on existing hospital committees and report back to the
Committee on those issues. Driscoll
agreed the Committee didn’t need to see individual cases but “we need to
understand the process.” The chair
promised that Dr. Mason would continue to educate the Committee on these
issues, “but the key is learning about problems before they’re lawsuits. We can’t do that here, but we’ll participate
in existing committees and hear about risk management.”
--Submitted by Observer Kelly Klein
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