CCHHS Quality Assurance and Patient Safety Committee Meeting March 26, 2014

Attending:  Chairman Collens, Directors Lerner, Guggenheim and Hammock; and a new non-Board member of the Committee, Patrick Driscoll.

Cook County's Public Health Department was accredited for the next five years by the Public Health Accreditation Board.

Surveyors from the Joint Commission made a surprise visit to the Ambulatory Care Center and, though the report is not final, issued only 10 citations (of need for correction) out of 1000 standards.  They made a point of telling the staff the visit had been "excellent."

CCHHS Chief Operating Officer Daniels reported on the system's new Capacity Management Project. The Project is focused on four areas: patient flow through the Emergency Department, bed management, the discharge process and patient acuity. The first is most important because CCHHS gets 72% of its patients through the ED, vs. an industry standard of 50-60%. It’s hoped that under the Affordable Care Act fewer patients will use the ED for primary care, but meanwhile the ED divides its patients into 5 levels of acuity, with 1 being the most serious. 1s are seen "within minutes," 2s and 3s are in the ED appropriately, and 4s and 5s should receive urgent care in another setting. For the moment, the ED has created its own "Doctor Quick" section to treat 4s and 5s.

Some internal goals have already been met: a 20% improvement over FY2013 3rd Quarter; only 6% of patients left without being seen; patients are treated and released within 4 hours or treated and admitted within 8 hours. National goals (3%, 3 hours and 6 hours respectively) will now be adopted.

Daniels credited the improvements to collaboration among all the departments, especially nursing initiatives coupledwith IT analysis which identified bottlenecks and administrative fixes which eliminated them. The next step is a "pilot program in Six-Sigma and Lean," two corporate-based programs which use detailed data simulations to map and fix all processes involved in a system (here, a patient’s progress through stages of care). Daniels acknowledged they’ve "hit a plateau and must push through it" to improve further. The goal is to integrate flow in and out of the ED with the System’s overall care strategy. They’ve already decided to create a "Bed Czar" position to improve bed turnover and availability, and are considering a Short Stay and Observation Unit to "decompress the ED."

Chairman Collens urged dissemination of these metrics to all doctors and nurses, and was assured they’d be widely distributed; they’re apparently already displayed at certain nursing stations. Director Lerner congratulation Daniels but urged him to consider using outside advice and to set higher goals "insiders create fewer stretch goals." He added, "Our benchmarks can’t be public hospitals or people will go elsewhere [now that they can]." Collens expressed concern that the Dr. Quick service would encourage patients to continue to receive primary care in the Emergency Department. Stroger’s Dr. Uchowa responded that only by providing patients with a good experience in their new "medical homes" will they be willing to remain in them.

Provident reported that its medical staff had identified patient registration as a bottleneck, so they’re working with Daniels to figure out how to provide bedside registration. Provident’s lab and pathology departments have just been re-accredited for two years. Provident is not in the program of intensive oversight and weekly meetings.

Submitted by Kelly Kleiman