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Quality Improvement

Fletcher Allen engages in quality improvement on a continuous basis. Physicians, nurses and staff throughout the organization are involved in projects to improve the quality of care and the services they offer. Fletcher Allen’s James M. Jeffords Institute for Quality and Operational Effectiveness oversees many of these projects. To learn about some of the quality improvement efforts underway, click on the project summaries below:

PROJECT NAME: Critical Access Treatment Support (CATS) Team

TIME FRAME: 2008 – ongoing

DESCRIPTION/PROBLEM: A significant number of critical inpatient events in any hospital setting are preceded by warning signs prior to the event. Early response to changes in a patient’s condition by specially trained individuals may reduce cardiopulmonary arrests, patient morbidity and mortality. 

PROJECT GOALS: To implement a rapid response team to augment the emergency response systems already in place in an academic health care setting.

INTERVENTIONS:

  1. The Fletcher Allen “CATS” team consists of a critical care RN, a Primary Care Internal Medicine hospitalist physician, a respiratory therapist and patient support.
  2. The team is available 24/7 to respond to adult non-ICU inpatients that are deteriorating but have not reached “Code 99” status or acute cardiac/respiratory distress status.
  3. Staff activate the CATS team by dialing “222” if an adult inpatient is showing signs/symptoms of acute clinical deterioration, or when any clinician feels a patient needs prompt bedside assessment.
  4. The patient’s unit nurse stays with the patient throughout the entire CATS activation and continues to support the patient and family.
  5. The patient’s primary care team (attending and residents) are also notified that the CATS Team has been activated.
  6. The CATS nurses continue to educate Fletcher Allen staff about this service to reinforce how best to use it.
  7. As part of our efforts to improve patient safety, we have also implemented the “Call Someone NOW” service. This service is activated by families and patients if they recognize that their loved one requires prompt bedside assessment.

EVALUATION: Fletcher Allen monitors and analyzes the CATS Team calls, and reports them monthly to senior leadership. Analysis of the calls includes monitoring the number of calls, the disposition of patients (whether the patient stays on the unit or is transferred to a higher level of care), interventions with patients and also monitors which units are making the calls.

RESULTS: Since full implementation of the CATS Team, data suggest that there has been a reduction in inpatient cardiac respiratory arrests.  In addition, patients who experienced a rapid deterioration in status have been transferred to the intensive care unit faster than before implementation of the CATS Team. 


PROJECT NAME: Reducing Central Line-Associated Blood Stream Infections

TIME FRAME: December 2008-April 2009

DESCRIPTION/PROBLEM: In 2008, an audit of central venous access catheters showed variable practice. In an effort to reduce the incidence of these serious infections, the organization implemented a project in which central line insertion, care, and maintenance practices were standardized throughout the organization.

PROJECT GOALS: The overall goal of this project is to reduce blood stream infections in central line patients to 0%.

INTERVENTIONS:

Phase One of this project addresses the types of central lines in use, and includes the following interventions:

  1. Decrease the types of central lines in use and standardize kit contents.
  2. Standardize central line insertion to best practice standards.
  3. Standardize documentation forms for central line insertion.
  4. Implement an educational video for nurses and physicians that includes information on best practice for care and maintenance of central lines.
  5. Educate patients regarding the risks and benefits of central lines and the care and maintenance of their central lines. Encourage them to speak up if they notice a break in best practice.

Phase Two of this project addresses the care of the central line, and includes the following interventions:

  1. Standardize care of central lines to ensure that the best practice is used once the lines are reinserted.
  2. Consolidate all policies into two comprehensive policies for insertion, care and maintenance of central lines.
  3. Ensure that best practice is followed for drawing blood from central lines.
  4. Educate all clinicians in established best practices.

EVALUATION: Continue to monitor infection rates, length of stay and cost per case for this patient population.

RESULTS:

  • We have decreased the number of central line kits by 40%
  • All providers that insert central lines now use a standard documentation form that supports best practice.
  • Criteria for changing central lines inserted at other institutions or under emergent conditions has been
  • Our central line infection rates have continued to decrease.


PROJECT NAME: Prevention of Healthcare-Associated Infections

TIME FRAME: October 2008 – ongoing

DESCRIPTION/PROBLEM: Nationally, healthcare-associated infections (HAI) have increased in incidence and gained visibility. Fletcher Allen’s Infection Prevention team has partnered with the James M. Jeffords Institute of Quality and Operational Effectiveness to introduce an organization-wide strategic initiative that includes a multi-faceted program to reduce HAIs.

PROJECT GOALS: The project goal is to reduce specific healthcare-associated infections by 20% during FY ’09 and to move towards zero infections in our organization.

INTERVENTIONS:

  • Improved the tracking and reporting of three specific infections – MRSA, C. difficile and primary bloodstream infections. In addition, a composite measure to track effectiveness of the new initiatives over time has been established.

     

  • Mandatory resident training has been established, to include the microbiology and epidemiology of HAI and multi-drug resistant organisms, data related to HAI at Fletcher Allen, current best practice and strategies to reduce HAI.

     

  • A nurse advocate education program has been introduced: 26 medical and surgical nurses were given 16 hours of infection prevention training, stressing evidence-based practices. Each of these nurses has selected a specific project in their areas that addresses infection prevention.

     

  • Enhanced training and monitoring of Environmental Service workers’ cleaning practices is underway, using florescent marking to monitor the effectiveness of the cleaning process with rapid feedback to staff.

     

  • Two eight-week rapid redesign teams addressed prevention of ventilator-associated pneumonia in ICUs and central line-associated bloodstream infections across the continuum of care.

     

  • Employees will continue to be educated about basic infection prevention, such as good hand hygiene throughout 2009.

EVALUATION: Baseline metrics for this project have been established, with monthly reporting of progress to key stakeholders, senior leadership, and the Board of Trustees.

RESULTS: Our data for this fiscal year shows significant reduction in infection rates:

  • MRSA: 22% reduction
  • C. difficile-associated infection: 6% reduction
  • Primary bloodstream infections: 34% reduction

Contact Information:

For more information about quality improvement at Fletcher Allen:

James M. Jeffords Institute for Quality and Operational Effectiveness
Fletcher Allen
111 Colchester Avenue
Burlington, VT 05401
Phone: (802)847-9795
Fax: (802)847-8959