The Institute of Medicine defines healthcare quality as “the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” In addition to quality, keeping patients safe while in the healthcare setting is fundamental to achieving high-quality outcomes. Methodist Healthcare is committed to providing exceptional, world class care for the San Antonio community. Healthcare organizations measure quality in a variety of ways. Methodist Healthcare evaluates quality by looking at outcome measures, process measures, patient satisfaction and quality rankings. Community engagement is also central to improving quality of care.
Methodist Healthcare facilities strive to be in the top 10 percent of performance for all quality measures.
Quality can be measured in various ways, including:
- Outcomes achieved such as mortality rates and surgical infections
- Compliance with evidence-based processes known to enhance care
- Volume of patients with complex diagnoses and procedures successfully treated
- The safety record of each facility
Utilizing the Institute for Healthcare Improvement (IHI) model, Leading a Culture of Safety: A Blueprint for Success, Methodist Healthcare initiatives aim to improve quality and patient safety through strategies focused on hand hygiene and illnesses associated with hand hygiene compliance, prevention of hospital acquired infections (CAUTI, CLABSI, SSI, C. diff)1, Antibiotic Stewardship, Pain Initiatives (Alternatives to Opioids, Drug Take Back), Enhanced Surgical Recovery and Radiation Safety/Dosewatch.
1 Reference: CDC: Types of Healthcare-associated Infections
Catheter-associated Urinary Tract Infections (CAUTI)
Central Line-associated Bloodstream Infection (CLABSI)
Surgical Site Infection (SSI)
Clostridioides difficile Infection (C. diff)
Continuous quality improvement
Hand hygiene is the best way to prevent hospital acquired infections and communicable diseases.
The CDC reports that on average, healthcare providers clean their hands less than half of the times they should. Hand hygiene compliance has been proven to reduce hospital-acquired infections. On any given day, about one in 25 hospital patients has at least one healthcare-associated infection. Healthcare providers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care.
In the community setting, respiratory infections to foodborne illnesses, flu to pink eye, could be avoided if everyone practiced proper handwashing techniques. Up to 80% of communicable diseases are transferred by touch. Although soap and warm water may not be readily available, handwashing gel and sanitary wipes are now easily accessible and can be found in a variety of stores.
Improving hand hygiene compliance is a top priority at Methodist Healthcare. All campuses verify hand hygiene compliance using indirect methods and direct observation. We monitor the consumption of alcohol-based hand sanitizer and soap at the unit and facility level. Trained “secret shoppers” act as direct observers to identify staff who practice hand hygiene, and if correct technique was performed. When staff are non-compliant, ‘just in time’ coaches provide real-time feedback on missed opportunities and seek to understand causes of failure.
Sepsis and sepsis bundle compliance
Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have —in your skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death. Each year in the U.S., more than 1.5 million people develop sepsis, and at least 250,000 Americans die as a result.
In 2017, the CDC urged early recognition and prompt treatment of sepsis and launched Get Ahead of Sepsis, an educational initiative to protect Americans from the devastating effects of sepsis. This initiative emphasizes the importance of early recognition and timely treatment of sepsis.
At Methodist Healthcare, we utilize the Sepsis Bundle for the early identification and rapid implementation of treatment to prevent patients from progressing to septic shock and or to enhance the possibility of survival of this medical emergency.
In May 2019, HCA was the recipient of the Red Hat Innovator of the Year award for our pioneering work in early sepsis detection. The Sepsis Prediction and Optimization of Therapy (SPOT) platform was created to collect and analyze clinical data and signal caregivers to initiate early sepsis care in real time. This platform permitted the detection and identification of sepsis up to 20 hours earlier than traditional screening methods resulting in lives saved.
Methodist Healthcare monitors and measures Sepsis Bundle compliance within 3 hours of presentation to a facility Emergency Department and reports Sepsis Bundle compliance at 70% for 2018 and currently 71.4% through May 2019.
Clostridium difficile (C.diff)
Clostridium difficile (also known as C. diff) is a bacterium that causes diarrhea and colitis (an inflammation of the colon). It’s estimated to cause almost half a million illnesses in the United States each year. About 1 in 5 patients who get C. diff will get it again. Within a month of diagnosis, 1 in 11 people over age 65 died of a healthcare-associated C. diff infection.
C. diff is recognized as the leading cause of gastroenteritis associated death and the most common cause of healthcare associated infections in the United States. Hospital acquired CDI attributes to increase length of hospital stay, 40% higher expenditure for each diagnosed case, higher readmission rate and mortality.
There are other risk factors:
- Advanced age (>64 years)
- Antimicrobial use in past 3 months
- Prolonged hospitalization
- Prior diff diagnosis
- Immunocompromised patient, HIV/AIDS, ongoing chemotherapy
- Concomitant co-morbidities e.g., Inflammatory bowel disease (IBD)
C. diff germs are carried from person to person simply by touching someone or touching surfaces that have been touched by someone infected with the bacteria. In the healthcare setting, a patient with C. diff will be placed in a room that is considered isolation, so as to prevent the spread of C. diff to other patients. All healthcare providers and visitors of the infected patient are required to exercise meticulous hand hygiene using soap and water at any time upon entering or exiting a room of the patient infected with C. diff. Hand hygiene using soap and water is the only way to prevent the spread of C. diff from person to person.
Methodist Healthcare is required to regularly report its C. diff rate to NHSN (National Healthcare Safety Network) a healthcare-associated infection tracking system associated with the CDC. As with other healthcare-associated infections, rates are available to the public. At year end 2018, Methodist Healthcare’s C. diff SIR (Standardized Infection Ratio) was 0.973. For year-to-date 2019, the C. diff SIR is 0.626, a 36% improvement.
Continuous honor roll grades from Leapfrog, a national nonprofit organization driving a movement for giant leaps forward in the quality and safety of American health care. In spring 2019, six Methodist hospitals received an “A” grade, with the remaining qualified hospitals receiving a “B”. Receiving an “A” grade in the Leapfrog Hospital Safety Grades means these hospitals rank among the safest hospitals in the United States. The consistency of the honor roll grades is an incredible feat for any health care system. In 2018, Metropolitan Methodist Hospital was the only San Antonio hospital and one of only three Texas hospitals named “Top General Hospital” by the Leapfrog group. Leapfrog Hospital Safety Grade