By Christopher Cheney
The Fountain Valley, California-based MemorialCare health system has made significant progress in decreasing patient harm.
Patient safety has been a pressing issue in healthcare since 1999, with the publication of the landmark report To Err Is Human: Building a Safer Health System. Despite two decades of attention, estimates of annual patient deaths due to medical errors have risen steadily to as many as 440,000 lives, a figure that was reported in the Journal of Patient Safety in 2013.
MemorialCare has been focused on reducing patient harm significantly since 2005, says Helen Macfie, PharmD, chief transformation officer of the health system. “In 2005, we created what we called ‘Bold Goals.’ We have been looking at making significant reductions in patient harm—heading toward zero.”
Since the Bold Goals initiative began, MemorialCare has posted impressive patient safety gains:
- 84% reduction in “harm across the board,” which includes preventable harms such as infections, blood clots, pressure injuries, and falls in the hospital setting
- 10% lower readmissions
- 50% fewer infections
- 71% more patients surviving sepsis
“You need to think about bold goals. You do not aim low and settle for good enough. To me, a bold goal is at least a 50% reduction on your way to zero. Every year, you should make your goals stronger,” Macfie says. “Our board of directors monitor them as well as our executive teams. Our medical staff monitor them, then they cascade out to our nursing staff. We have leadership rounds to go out and talk with the staff and the doctors to look at their accomplishments. We celebrate what is going well, then we ask about what we can do better.”
Reducing hospital readmissions
At MemorialCare, there have been three primary areas where the health system has succeeded in decreasing readmissions, Macfie says.
- “First, you need to make sure there is a safe discharge from the hospital to begin with. If the patient is prepared well for care in the home or another setting, the patient is less likely to be readmitted. The patient or caregiver needs to understand the discharging clinician’s orders. So, discharge education is critical,” she says.
- “Second, you need to follow-up with patients after they have gone home. We do post-discharge phone calls, and we are introducing more extensive outreach to patients’ smartphones,” she says.
- “Third, we have eased access to questions getting answered. We have a navigation center that we created before the coronavirus pandemic, which provides 24/7 advice lines with nurses who can answer questions. We can help patients decide whether they should see their primary care physician, go to urgent care, or come to the emergency room,” she says.
MemorialCare has made progress in limiting hospital-acquired infections such as catheter-associated urinary tract infection (CAUTI), Macfie says.
“When these catheters are inserted, they can become infected. The first way to limit CAUTI is to have strict criteria for when catheters are inserted. The second way to limit CAUTI is to make sure the catheter is inserted no longer than necessary—we conduct rounding and perform checklists to make sure catheters are only in place as long as necessary. Then we have a care bundle that lowers the risk of the catheter getting infected such as placement of the urine bag—if the bag is above the patient, you can get back flow,” she says.
Hand hygiene is a key element of limiting hospital-acquired infections, Macfie says. “We want pristine hand hygiene before and after when care is delivered. Hands are a major source of infection.”
MemorialCare staff have achieved a high degree of hand hygiene compliance, she says. “We are typically at 97% to 99%. Most healthcare organizations are at about 75%. We use hand washing or a gel. We have broad education. We have ‘secret shoppers’ who monitor compliance, and we have data from audits.”
Technology is also playing a role in limiting hospital-acquired infections, Macfie says. “We have UV-light robots that irradiate a room, so once a patient is discharged, we can not only do a deep cleaning of their room but also irradiate the room to kill microorganisms. We have a little army of UV-light robots that cleans patient rooms, bathrooms, and operating rooms.”
No single approach can succeed in reducing infections, she says. “Limiting infections takes all of these things—it’s called whole system thinking. You attack the problem from many angles.”
Lowering sepsis mortality rates also takes a broad approach, Macfie says.
“There are national guidelines called Surviving Sepsis, and we have a best practice team for sepsis that is made up of physicians who work in our emergency departments, medical floors, and ICUs, along with nurses, pharmacists, and other staff members who treat sepsis patients. We have developed best practices—we have order sets and prompts that go into our electronic health record. Then we have protocols that are like a Code Blue for sepsis. We identify a sepsis patient, then we do all the things we need to do to provide timely care. For example, providing fluids and antibiotics early is crucial,” she says.
Community outreach efforts have also helped reduce sepsis mortality rates at MemorialCare, Macfie says. “We have been doing outreach in the community to raise awareness about sepsis. It is like a stroke—the longer you wait to get care, the worse the outcomes. If a sepsis patient does not seek care, it can get worse fast. When our navigation center directs a sepsis patient to the emergency department, it can reduce unnecessary mortality.”
Highlighting areas for improvement
MemorialCare uses “visibility boards” to keep the organization focused on limiting patient harm, Macfie says.
“We have created visibility board slides that have data that show the progression of data over time. The visibility boards also have the key activities that we have put in place and what we are working on next. We use PowerPoint slides because they are easy to create,” she says.
For example, MemorialCare has a visibility board for Cesarean section (C-section) rates, Macfie says.
“We have a visibility board for C-section rates that shows the rates coming down on one side of the board, and we slice the data by race and ethnicity to see if there are any differences. This board also has our plans to address differences by race and ethnicity. Anybody can present that visibility board to a governance body, medical staff, or our leadership teams. Having these visibility boards helps drive culture and the relentless pursuit of reliability and zero harm. The visibility boards also promote conversation.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.