In 2011, the Hawaii Medical Service Association (HMSA) launched a partnership with its statewide network of hospitals and Premier, Inc. (NASDAQ:PINC) to improve quality and reduce costs for residents of Hawaii called Advanced Hospital Care. Each hospital installed Premier’s QualityAdvisor™ app which is built on one of the nation’s largest comparative database to analyze and benchmark performance to achieve quality outcomes. Premier provided each participant with a clinical opportunity analysis from the QualityAdvisor data that identified specific areas where participants could make improvements.
In February 2012 Adventist Health’s Castle Medical Center in Kailua, HI, received an opportunity analysis that identified DRG 470 (major joint replacement) as an outlier. Average length of stay (LOS) was 4 days; the 30-day readmission rate average index was 2.44; discharge instructions were not always clear; dressings were not always adequate, and vendors were taking outside equipment into the surgery suite.
The Castle clinical team jumped at the opportunity and put together a team including physicians and clinicians that developed an improvement plan. Interventions included the following:
- Processes for pre-op, education, ordering, equipment setup and post-op discharged were reorganized
- Enforced strict limitations to the OR suite during the surgery
- After study, sutures were changed
- Silver nitrate wound dressings are now being used
- Pharmacists now mix capsule and incision injections
- Physical therapists now see patients the day of surgery
- Surgeons’ post-discharge orders were modified
- Filters in the Surgery suite air handlers were changed
In less than four months, results have been most positive:
- DRG 470 30-day readmissions dropped from a high of 22% in August 2012 to 0% for April through July, 2013.
- The average 30-day readmission observed to expected (O/E) index dropped to less than 1.
- The average length of stay (LOS) dropped from almost 4 days to about 2.5.
- The O/E LOS has dropped to about 0.9.
- The percent of complications dropped from as high at 44% to about 10%; the O/E index is now less than 0.4.