CCHHS Quality & Patient Safety Committee Meeting January 16, 2013

The Observer arrived after the meeting had started, and the Committee was watching a video focused on how to handle errors and accidents from the standpoint of public and legal exposure. The takeaway: "Choose your lawsuits wisely," be transparent, encourage discussion of mistakes by staff and Board and recognize that public attention, however painful, may bring improvement. Dr. Raju then noted that core data about adverse events will be posted on the CCHHS public Website.

Chairman Michael instructed the staff to provide the Committee with 2012 quality metrics for the next meeting, so it can settle the "Big Dots," overall goals for improvement during 2013.

Nursing Chief Russell reported that the system had fewer retirements than anticipated and thus is less short-staffed, so that "we didn’t have to shut anything down." CCHHS is vaccinating its staff against flu on a continuous basis and has had no outbreak to date.

Dr. Dave Barker reported on the Ruth Rothstein CORE Center, the comprehensive HIV/AIDS treatment facility now expanded to handle the needs of those with other infectious diseases. CORE Center did exceptionally well in 2012, or else its goals were set artificially low:

• Goal of 55,000 routines HIV tests; actually conducted 66,000. Ultimate goal 80,000, which would allow testing every five years of everyone in the relevant community.
• Goal of 99% access to primary care within 10 days; achieved 100%.
• Goal of 80%+ patient satisfaction; achieved 83%.
• Goal of 90% viral load below 1000; achieved 90%. (Those who fail have relapsed into IV drug use; 30% of the CORE Center’s patients have active substance abuse problems.)
• Goal of 75% patient-would-recommend; achieved 81%.
• Goal of 10% or fewer patients receiving meds at CORE; achieved 5.9%, which means budgetary savings.

Peer counselors administered the survey to 588 patients in the CORE waiting room, about 10% of the program’s clinical population. Waiting room patients are disproportionately walk-ins (who haven’t been treated) or the sickest patients (whose treatment is going badly) so it may over-sample problems. But the survey will be repeated in this fashion 3 times/year; CORE regards this as more representative than ‘press-ganging,’ or mass administration of a survey by mail, phone or e-mail. Barker was particularly proud of adjectives describing CORE as "excellent," "respectful" and "friendly," and in the reduction of descriptors such as "busy" and "rushed." Using electronic medical records (EMR) should free up more time for providers to spend with patients, but for the moment, according to Barker, "CORE provides good care and lousy documentation." There are too many providers and too few medical assistants. There should be 2.5-3.5 assistants per doctor, but CORE never exceeds 1:1. For the same reason, CORE has not yet completed the change away from written orders and prescriptions. Another doctor noted that this is a national problem: EMR software was designed to improve billing and not the quality of care. She asked for redoubled efforts to make EMR changes uniformly across the system, because every change affects the flow of care. "Flow should drive what happens with EMR rather than the other way around."

CORE did badly (30-40%) in assuring after-hours access to providers. Of its 80 primary care providers, many are part-time, and CORE has relied on their individual availability to patients. Now it has hired an answering service to improve responsiveness.

Goals for 2013:

• Secure certification as a Patient Centered Medical Home for HIV/AIDS.
• Gain access to special software to aid reporting and reduce personnel hours of data entry.
• Provide real-time Quality Assurance data to providers to promote improvement.
• Complete transition of the Social Services component of CORE to EMR.
• Complete implementation of a CCHHS-wide satisfaction survey for all HIV programs and patients.

Another doctor argued that HIV testing should occur whenever clinics do anything else. CCHHS should also be testing 100% of patients for TB.

Dr. Wakim reported that an all-staff Task Force has been created to consider Provident’s future. The Task Force will check in every two weeks and bring in a proposal whenever it develops one (there is no time-line). Provident’s ER experienced one "sentinel" (problematic) event and will bring the Committee a summary of that once Risk Management approves its description.

The Committee then approved its minutes, approved medical appointments and adjourned.

--Submitted by Kelly Kleiman