Quality Corner

Recent Highlights, Compiled in November, of Performance Improvement at SHC
- From the SHC Quality Improvement and Patient Safety Committee, chaired by Joseph Hopkins, associate chief of staff

• Perioperative Antibiotic Protocol for Cardiothoracic Surgery

• Protocol standardizes the process and the type of antibiotic (dosage and timing) to be given in the perioperative setting.
• Multidisciplinary protocol team was led by the Infection Control Department in collaboration with cardiovascular surgery chief Bruce A. Reitz and anesthesia chair Ronald G. Pearl. Future protocols for other services will use a similar development process.

• Clinic Collaborative
  [Stanford Breakthrough Collaborative on Operational Excellence in Clinics] project achieved success in its first year in achieving better service and satisfaction for patients and will begin second year with new goals.

• Goals for 2004-2005:
  
  • Each clinic will improve communications with referring physicians.
  • Each clinic will have new patient appointments available within 14 days or will make continuous progress toward that goal.
  • Each clinic will meet measurable goals or at least show measurable improvement in patient satisfaction.


• First year (Oct. '03 to Aug. '04) achievements included:
  
  • The waiting time for a non-urgent, new patient appointment dropped an average of one week (from 26 to 18.9 days).
  • Negative responses dropped 57 percent to the question, "Did you get the appointment as soon as you wanted?" (from 16.2 to 6.9 percent).
  • Negative responses dropped 44 percent to the question, "Was the main reason for your visit addressed to your satisfaction?" (favorable decline from 18 to 10 percent).
  • Only 14.4 percent of patients said they didn't spend as much time as they wanted with the doctor - down from 22 percent the year before.
  • 10 percent fewer patients said they had to wait too long in the exam room before seeing the doctor (25.5 to 21.2 percent).
  • 20 percent fewer patients said they had to wait too long in the waiting room (from 18.1 to 14.4 percent).
  
  
• Some conclusions reached during the first year of the project:
  
  • The established collaborative method of effecting improvement is an effective way to engage multiple teams to produce positive change.
  • Some clinics need more care providers to improve access.
  • More planning is needed to manage seasonal (summer) variations in patient loads.
  • Communications with teams were impeded by the inability of university staff and physicians to access some hospital data and reports.

• Magnet Program in nursing
  Stanford will apply in early 2005 for the rigorously enforced Magnet Facility recognition offered by the American Academy of Nursing.

• University Hospital Consortium Benchmarks

• Trends for community acquired pneumonia (CAP) and acute myocardial infarction (AMI) are at or better than UHC benchmarks. Improvement in CAP pneumovax screening rose from 27 percent in first quarter '04 to 43 percent in the second quarter.
• Core measure improvement - A team is focusing on CHF measures, notably documentation of ACE inhibitors and documentation of discharge instruction for CHF patients.

• NRC Picker (national database)
  Satisfaction - All combined inpatient measures are better than the NRC average, while clinic measurements of satisfaction show both improvement and opportunity for growth.