By Jay Kumar
Editor’s note: The third annual PSQH Innovation Awards recognize healthcare organizations who overcame quality improvement challenges. In this article, we highlight the winning submission selected from Jefferson Healthcare in Port Townsend, Washington. Thanks to Barbara J. Youngberg, JD, MSW, BSN, FASHRM, academic director and senior lecturer in residence, Loyola University Chicago, for her help in evaluating the submissions.
A year ago, the COVID-19 pandemic first took hold in the U.S. in Washington state, which forced healthcare organizations there to spring into action against a virus that health experts knew very little about. One such organization, Jefferson Healthcare in Port Townsend, successfully managed to transform its processes and has been selected as the winner of the third annual PSQH Innovation Awards.
In Jefferson Health’s award submission, Brandie Manuel, CPHQ, chief patient safety and quality officer at Jefferson, detailed the steps taken to respond to this crisis.
“In 2020, healthcare organizations across the world were faced with navigating a global pandemic. To complicate this, we are located in Washington state, where the first confirmed case was—and we have patients in our community who had known exposure to those who had tested positive in the skilled nursing facility outbreak in King County,” Manuel wrote. “While every organization responded to this call, I believe that Jefferson Healthcare responded in ways that were truly unique, innovative, and groundbreaking. Jefferson Healthcare is a small, independent critical access hospital, located in a geographically rural area on the Olympic Peninsula. We serve the oldest population in the state, and we are looked to as the safety net organization for our community, and we are not part of a larger corporate team.”
As the pandemic began, Jefferson was faced with a lack of resources.
“The list of people in our county who can respond to a global pandemic begins with us. That being said, resources are limited,” Manuel noted. “Staffing, including a half-time infection preventionist and single employee health nurse, is often stretched thin, and recruitment can be slow. Our ability to make significant technology changes within our electronic health record, which we are contracted to use through another, larger organization, is limited. We do not have unlimited funding or tax revenue to pay for the infrastructure that would become essential.”
Jefferson then created a new healthcare delivery system, Manuel wrote.
“This was accomplished through early recognition and response (we set up our incident command on February 4) and made possible by incredible teamwork, which was led by our physicians,” she added. “Bedside clinicians stepped out of their roles, to serve in incident command seven days a week, with our administrative team. Providers, nurses, therapists all offered to serve in uncommon ways, to include having physical therapists conduct contact tracing, or dental hygienists doing temperature screening. Our teams in facilities, information technology, and clinical informatics were unsung heroes, working long hours behind the scenes to make the magic come alive.”
Technology played a big role in the changes.
“We used data, technology, and innovation to drive our decision-making processes. We organized into Inpatient and Outpatient Operations teams, dividing the work, and staying connected to through our Incident Command structure and technology (dedicated SharePoint sites with the latest information, tools, videos, and resources),” Manuel wrote. “We invited the fire chief, public health, and the Jefferson County EOC to participate in our incident command. Overnight, our data team set up four pages of visualizations, updated every day in our Incident Command SharePoint Site, which has been used to make decisions. These include inventory (testing, swabs, vaccines, Remdesivir, PPE), testing results over time, equipment use (ventilators, NIPPV), volumes, employee absences and testing, and syndromic surveillance data.”
The effort was far-reaching.
“We worked to capture the hearts and minds of our staff members, leaders, providers, and our community through honesty, transparency, and security,” wrote Manuel. “We engaged our front line by creating a PPE Council, when we honestly did not know if we would have enough masks or gloves to keep us safe. This team, made up of the front line, served as ‘PPE Buddies’ for their peers, learned all of the newest information coming out of incident command, and gave feedback to our leadership team as well as taking communication back to our departments—ensuring closed loop communication. We offered daily updates when information was changing quickly and have continued to adjust the flow of information as needed.”
It didn’t take long for Jefferson to see results.
“Within the first two weeks of COVID 19 in our state, we set up our COVID hotline, and alternate care sites, directing all patients with respiratory symptoms to our ‘Respiratory Evaluation Clinic’. Just a couple of weeks later, we set up our testing drive-through,” Manuel wrote. “When Governor Inslee issued a proclamation to stop providing all elective services in person, our teams worked together to implement telemedicine so that our patients would continue to be able to seek care from the safety of their homes.”
As of mid-December 2020, “we have had zero confirmed cases of employees who have contracted COVID 19 due to occupational exposure. Telemedicine is in use across our organization, and we are leveraging technology to stay connected, including using tablets to communicate with inpatients to reduce the use of PPE and still stay connected,” wrote Manuel. “Approximately half of the patients who test positive are confirmed to have out of county exposure. Community rates of positive cases are at 382 per 100,000. Until recently, Jefferson County had 100% recovery (one death reported from a 94-year-old hospice patient who was exposed). Hospitalizations remain low due to COVID-19 and we are actively vaccinating our own employees and the first responders in our community. We have enough supplies, and are connected to the front line healthcare workers who need them. Our staff, providers, and leaders are tired—but excited and proud to be a part of the efforts to keep our entire community safe.”
The following submissions were selected as honorable mentions:
New Hanover Regional Medical Center, Wilmington, NC
New Hanover, an 855-bed trauma II community-based hospital in rural North Carolina, improved quality of care by adopting a perioperative surgical home (PSH) model. This created an all-inclusive approach to quality of patient care and led to the creation of a Surgery Navigation Center that identified patients at great risk for harmful outcomes or readmissions, as well as Enhanced Recovery After Surgery standardization into service line protocols. As a result, in 2018 New Hanover saved $12 million and 2,268 hospital beds, allowing it to provide care for an additional 768 patients.
Mount Sinai Health System, New York, NY
The Mount Sinai Hospital started an initiative to reduce the risk for functional decline in hospitalized patients at an oncology unit in April 2019 and used Activity Measure for Post-Acute Care (AMPAC) scores to quantify mobility. Team-based, multidisciplinary plans of care were created with physical therapy (PT), nursing, and a mobility aide—a medical assistant with rehabilitation training. Patients were mobilized twice per day, seven days per week. The program demonstrated the benefits of early mobilization for hospitalized cancer patients while decreasing the burden of PT and nursing and empowering new leaders in patient safety.