Nadine AllenChief Quality Officer608-274-1820EMAIL: Nadine Allen
Jill LindwallClinical Quality Improvement Advisor608-274-1820EMAIL: Jill Lindwall
It can be challenging to determine what medications a patient takes at home and ensure an up to-date list is kept in the electronic health record. At Children’s Wisconsin, a large multidisciplinary clinical and support team was involved in this project, including medical and surgical providers, nursing staff, pediatric residents, pharmacists, pharmacy leadership, a parent, Information Management Systems, Provider Services, Patient Safety and Performance Improvement.
The Chronic Obstructive Pulmonary Disease (COPD) pathway continues to be successful in reducing COPD 30-day readmissions at Marshfield Medical Center – Park Falls. The pathway was rolled out in January of 2018, and as a result they have seen a sharp decline in readmissions. The pathway follows a patient with mild/moderate or severe COPD symptoms and addresses respiratory treatments, including oxygen use, medications and home regimens, medication transitions, patient activity, smoking cessation, flu vaccinations, discharge information, post-hospital follow up, use of a dyspnea scale and patient education. Marshfield Medical Center- Park Falls is starting to see patients recovering from COVID-19 in the pulmonary rehab department to continue care and reduce the likelihood of a readmission. Many of the recovering patients have COPD and/or other chronic respiratory conditions, so it is helpful to get those patients in to rehab as soon as possible.
With current guidelines emphasizing delivery of intravenous treatment for stroke patients within 60 minutes of hospital arrival, Froedtert and the Medical College of Wisconsin sought to reduce this arrival-to-treatment time to 30 minutes. Through a multidisciplinary team effort, they decreased the average door-to-needle time to less than 30 minutes.
It is well known that early recognition and treatment of sepsis saves lives. To improve outcomes for patients presenting with severe sepsis or septic shock, Marshfield Medical Center has taken a collaborative, multidisciplinary and continuous improvement approach to implement CMS’s evidence-based core measures. A system-wide sepsis improvement team meets monthly, and in collaboration with IT, they ensured sepsis bundle compliance is hardwired into practice. As a result of this teamwork, they have exceeded the state and national averages.
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic. As a result, infants with Neonatal Abstinence Syndrome (NAS), has increased 5-fold in the past 15 years. Traditionally, treatment for these infants has been pharmacologically with additional opioids after being assessed for withdrawal symptoms. The health care team at SSM St. Mary’s Hospital in Madison wanted a model that focused on non-pharmacologic therapies and a simplified evidence-based, family-centered approach to assessment for infants exposed to opioids prenatally. The team created an algorithm and provided education and training to health care team members, families and caregivers on new methods to help console their infants. Since implementation in April 2019, the average length of hospital stay for these infants decreased and the percentage of infants receiving morphine decreased. No infants were readmitted for signs of withdrawal, and no adverse events were reported.
UW Health realized the synergy between staff satisfaction, a culture of safety, and patient experience; therefore, created a cross-functional work group to break down the silos and make improvements. This group played a vital role in educating UW leaders on how to incorporate process improvement into their daily routines. Leaders have now submitted more than 400 projects using the A3 problem solving methodology and are cascading improvement throughout the organization.