Closing the Quality Gap Hospitals Team Up With QIOs To Improve Care Quality Improvement Organizations (QIOs) work under contract to the Centers for Medicare and Medicaid Services to bridge the gap between what medical experts say should be standard practice and the care actually provided to Americans. QIOs have had significant success helping providers adopt best practices in hospitals. Below are a few examples categorized by state: Alaska | California | Georgia | Idaho | Iowa | Kansas | Louisiana | Maryland Massachusetts | Michigan | Minnesota | Mississippi | Missouri | Montana | Nebraska Nevada | New Mexico | New York | Oklahoma | Puerto Rico | Tennessee | Virginia West Virginia | Wisconsin | Wyoming Alaska Providence Alaska Medical Center, Anchorage, AK, triples the number of cases between surgical infections during 2002: Providence increased the surgical cases with on-time prophylactic antibiotic administration from 50% to 95%; increased the surgical cases with recommended skin prep and hair removal (no razors) from 46% to 96%; and increased the number of cardiovascular surgical cases with recommended blood glucose levels during surgery from 19% to 62%. “While the numbers are very important, a major part of the results we realized is the enthusiasm for continuing to improve care, and collaboration that has resulted, and the confidence that we can make a difference,” said Betty Gwaltney, Director, Outcome Improvement, Providence Alaska Medical Center. Contact: Evan Stults, Qualis Health at evans@qualishealth.org or call 907-562-2252. Arkansas Sparks Regional Medical Center in Arkansas nearly doubles beta-blocker use for AMI Physicians at Sparks Regional Medical Center in Fort Smith worked with the Arkansas QIO, Arkansas Foundation for Medical Care, to promote facility-wide adherence to evidence-based guidelines. One result: increased use of beta-blockers at admission to treat AMI from 56% in January 2002 to 92% in February 2003. Beta-blockers at discharge increased from 53% to 91% in the same period. Contact Nikki Thornton at nthornton@afmc.org National Park Medical Center (NPMC) has proven its commitment to quality health care by being one of the first hospitals in the state to work on the quality projects and transmit data to the national clinical data warehouse. NPMC is working with the Arkansas Foundation for Medical Care, the Medicare Quality Improvement Organization for Arkansas, to develop, apply and evaluate quality improvement initiatives throughout the hospital, by initiating onsite visits, effectively using improvement tools and willingly sharing successful strategies. At Collaborative Area Learning Sessions conducted in 2004, NPMC staff mentored other hospitals by actively participating and presenting lessons learned, strategies and barriers encountered. NPMC's hard work is resulting in continued improvement in the performance indicators of the national clinical quality improvement projects. In fact, in the first and second quarters of 2004, NPMC scored higher than 90 percent on eight of the reported standards of care, including six acute myocardial infarction (AMI) measures, adult smoking cessation advice and counseling for heart failure (HF), and oxygenation assessment for pneumonia patients. On three of these measures, NPMC scored 100 percent: aspirin prescribed at discharge for AMI, ace inhibitor for a ngiotensin converting enzyme inhibitors ( ACE inhibitors) for left ventricular function assessment, adult smoking cessation advice and counseling for HF. For more information, contact Sally Johnson at Arkansas Foundation for Medical Care: (479) 649-8501 or sjohnson@arqio.sdps.org. California A southern California hospital dramatically improves pneumococcal and influenza vaccination rates: In 2001, Hoag Memorial Hospital in Newport Beach, California, conducted a pilot project with Lumetra, the California QIO, on the National Medicare Pneumonia project. Within three months, pneumococcal and influenza vaccination screening rates went from 5% at baseline to 96%, and from 0% to 100% for vaccine administration. The hospital subsequently rolled out the immunization program to all units with the goal of sustaining rates of 80% for screening and administering influenza and pneumococcal immunizations for appropriate hospitalized patients. Contact: Diana Parker at dlparker@caqio.sdps.org Georgia Gwinnett Hospital System in Lawrenceville, Georgia, performs 478 hysterectomies without a single surgical infection: In 2002, Gwinnett achieved 100% on-time administration of prophylactic antibiotics, 100% of patients with normal body temperature during surgery, and 100% with proper oxygenation during surgery. In 2002-03, Gwinnett performed 81 colon operations without a surgical infection in an eight-month period, and 243 knee/hip arthroplasty cases without a single surgical infection. “It is our goal to spread to all surgical procedures within one year of the completion of this project,” said Gwen Hudson, Surgical Systems Project Operations Manager, Gwinnett Hospital System. Contact: Lee Millman, Manager of Communications, GMCF at lmillman@gmcf.org or call 404-982-0411, ext. 3427. Idaho Results released in November from the Idaho Critical Access Hospital Collaborative showed that the 10-month effort was successful in improving targeted performance measures. The most striking improvements were in rates of smoking cessation counseling. In addition, a November 1 report from the Institute of Medicine (IOM) cited the collaborative as an example of good work by a Medicare Quality Improvement Organization (QIO) to assist rural providers. In partnership with the Idaho Hospital Association and the Idaho State Office of Rural Health and Primary Care, Qualis Health, the QIO for Idaho, worked intensively with 14 small, rural hospitals to improve care for patients with acute myocardial infarction (AMI) and pneumonia (PN). Between January and October 2004, collaborative participants attended four educational sessions and implemented processes to improve care. Documented improvements included the following: he percentage of AMI patients given aspirin early after admission rose from 78 to 92 percent. The percentage of PN patients who received an antibiotic within four hours of arrival at the hospital rose from 78 to 91 percent. The rate of antibiotic selection consistent with current guidelines rose from 90 to 100 percent. The number of patients identified as smokers who received smoking cessation counseling while in the hospital rose from zero to 54 percent among AMI patients and from 9 to 100 percent among PN patients. The new IOM report, titled Quality Through Collaboration: The Future of Rural Health Care, can be accessed at www.iom.edu . For more information, contact Peter Speikers at Qualis Health: (208) 389-5022 or peters@qualishealth.org. Iowa Fort Madison Community Hospital in Iowa makes rapid improvements in heart failure care: Fort Madison, a 50-bed acute care hospital, worked with the Iowa Foundation For Medical Care (the Iowa QIO) to develop a strategy to improve care for heart failure patients. The hospital began by looking at d ischarge instructions provided to heart patients. The facility's rate during 2000-2001 was 50%. Case managers at Fort Madison developed protocols and orders to enhance communication and collaboration among team members, emphasize resource utilization, and emphasize education of the patient and family. Data for 2001-2002 show discharge instructions increased to 95%. In addition, the provision of ACE inhibitors for heart failure improved from 58%-98% from 2000-2001 to 2001-2002. Contact: Sue Nesbit-Fisher snesbit@ifmc.org Kansas Via Christi Regional Medical Center, in Wichita, Kansas, cuts surgical infection rate by two-thirds: Working with Kansas Foundation for Medical Care, Inc., the Kansas QIO, Via Christi Regional Medical Center established a team of quality improvement experts and in-house champions to prevent surgical infections. Via Christi Regional Medical Center dramatically decreased the surgical infection rate; improved on-time administration of prophylactic antibiotics from 34.9% to 85.3% in 12 months; improved the rate of appropriate selection of prophylactic antibiotics from 86.0% to 91.6%; decreased the surgical infection rate from 3.41% to 1.04% (compared to national rate of 2 to 5 percent); and brought community healthcare professionals together to create a community wide standard for surgical infection prevention. Contact: Lisa Williams, Communications Director, Kansas Foundation for Medical Care, Inc at lwilliam@ksqio.sdps.org or call 785-273-2552. Louisiana Eunice Community Medical Center (ECMC), Eunice, Louisiana, achieves a 200% increase in the number of heart failure patients receiving written discharge instructions: Working with Louisiana Health Care Review, the Louisiana QIO, ECMC went from 20 % to 62.5 % of heart failure patients receiving written discharge instructions. Taking advantage of resources offered through the QIO such as pre-existing protocols, and by adopting the philosophy of promoting accountability, the unit managers became responsible for abstracting records and tracking their own progress over time. The team then compared the unit-level results with the data that case managers submitted to JCAHO. This team approach of shared responsibility substantially improved the discharge instruction rate over 6 months during 2002. Contact: Cathy Lewis at clewis@lhcr.org. Working with Louisiana Health Care Review, Inc. (LHCR), the Louisiana QIO, a hospital more than doubles its inpatient pneumococcal immunization rates. Staff at Our Lady of Lourdes Regional Medical Center (OLLRMC) in Lafayette, LA worked with the Louisiana QIO to develop a standing order protocol for inpatient pneumococcal immunizations of adults. To overcome discomfort on the part of registered nurses about adherence to the state's nurse practice act regarding the administration of vaccines without individual patient orders, the hospital obtained approval for the protocol from the Louisiana State Board of Nursing. OLLRMC then conducted in-house nursing education sessions to train hospital staff to implement the protocol. As a result of the cooperative effort, pneumococcal immunization rates for adult inpatients rose from 36.7% at the end of 2003 to 77.1% in mid-2004. Contact: Cathy Lewis at clewis@lhcr.org. Maryland Western Maryland Health System achieves Maryland's highest discharge-instructions rate for congestive heart failure: Working with the Maryland QIO, Delmarva Foundation, the Western Maryland Health System (WMHS) achieved the highest rate in the state on the Maryland hospital report for providing Congestive Heart Failure discharge instructions. CHF care managers at WMHS also improved performance on all CHF quality measures. In 2002-2003, WMHS scored 100% on adult smoking advice and counseling and over 90% in Left Ventricular Function Assessment. Contact: Robin Wolfgang rwolfgang@dfmc.org. Massachusetts Berkshire Medical Center in Massachusetts reaches for perfection in cardiovascular care: Over a period of three years, Berkshire Medical Center, increased aspirin at discharge for cardiac patients from 96% to 100%; smoking cessation counseling from 43% to 100%; ACE-inhibitor use from 67% to 88%; lipid treatment from 59% to 92%; and referral to cardiac rehabilitation from 14% to 98%. These gains resulted from participation in the Get With The Guidelines pilot project conducted by the state's QIO, MassPRO, and the American Heart Association (AHA). Contact: Sue Kelman at MassPRO at skelman@maqio.spds.org. Morton Hospital & Medical Center, Taunton, MA, perfects timely Rx to fight infections Working with the state QIO, MassPRO, in 2004 Morton achieved 100% administration of antibiotics within 1 hour prior to incision, as recommended to prevent surgical site infections. Contact Sue Kelman at skelman@maqio.spds.org. Michigan 33 Michigan hospitals perfect heart care processes: A partnership between the Michigan QIO (MPRO), the American College of Cardiology, two local health coalitions (The Greater Detroit Area Health Council and the Greater Flint Health Coalition), joined with 33 hospitals in three AMI Guidelines Applied in Practice (GAP) projects. Interventions included identification of a hospital physician champion and project leader, structured learning sessions, a collaborative learning environment, focused communications, and regular hospital leader reports. For the University of Michigan Medical Center, a hospital collaborator, quality of care measures at admission showed improvement: aspirin on admission went from 88.98% to 100% and Beta-blocker on admission went from 75% to 100%. Later quality of care measures evaluated at discharge also improved: aspirin at discharge (85.7% vs. 100%); Beta-blocker therapy (60% vs. 100%); dietary counseling 81.8% vs. 96.7%). Contact: Tom Leyden at MPRO, tleyden@mpro.org at 248-465-7388. Minnesota Critical access hospitals in Minnesota collaborate to improve heart care: Ten critical access hospitals in Minnesota worked together in 2001-2002 to improve heart care in conjunction with the state's QIO, Stratis Health, and the Minnesota Department of Health's Office of Rural Health and Primary Care. In the area of heart failure, the participating hospitals showed aggregate improvement in the assessment of left ventricular function (LVF) by 50%; 75% improvement in patient education; and significant improvement in patient discharge follow up. Hospitals also worked on improving care for atrial fibrillation, specifically the administration of warfarin at discharge, which improved from 77% to 85%, and international normalized ratio (INR) monitoring. Fifty percent of the hospitals showed improvement in one or both areas. Each participating hospital team included a physician, a nurse, a pharmacist, and senior management sponsor working together to implement evidence-based strategies utilizing rapid cycle improvement tools and measurement methodologies. The project, which encourages participating teams to learn from each other, is being replicated in 2003-3004 with an additional 22 critical access hospitals across Minnesota. Contact: Jennifer Lundblad at Stratis Health at 952-854-3306 or jlundblad@stratishealth.org . Mississippi Rush Foundation Hospital in Meridian, Mississippi, introduces effective interventions to prevent second heart attacks: Rush Foundation Hospital, a 215-bed acute care facility in Meridian, Mississippi, is working with Information and Quality Healthcare, the Mississippi Quality Improvement Organization, to significantly improve care processes for heart attack patients. Over a one-year period ending in June, 2003, Rush increased administration of beta-blockers at arrival and discharge by approximately 20%, and ACE inhibitors by 100%. Contact: Carole Kelly at IHQ, ckelly@msqio.sdps.org or call 601-957-1575. Mississippi Hospital reduces surgical infection rates by 50 percent Central Mississippi Medical Center (CMMC) in Jackson worked with the state's QIO, Information and Quality Healthcare (IQH), to reduce coronary artery bypass graft surgery and abdominal hysterectomy surgical site infection rates by more than 50 percent. CMMC increased prophylactic antibiotic administration within the hour before surgery from 45.2 percent to 97 percent. Contact Carole Kelly at ckelly@msqio.sdps.org Missouri Three years after they set out to improve the number of acute myocardial infarction patients receiving aspirin at discharge, Truman Medical Centers (TMC) Kansas City, Mo., is in the pink of perfection: 100 percent compliance. Physicians used to treat aspirin-eligible patients on a case-by-case basis, independently making decisions and writing orders. No formal process existed, opening the door for inconsistency. Working alongside Primaris, the Medicare Quality Improvement Organization for Missouri, TMC developed a standardized chest pain order sheet. This form was attached to the charts of every chest pain patient, prompting his/her physician to think about aspirin therapy. An educational campaign directed at emergency department nurses also helped improve care in this busy metropolitan hospital system. For more information, contact Andy Shea at Primaris: (800) 735-6776, ext. 136 or ashea@moqio.sdps.org. Missouri hospitals perfect heart care: Through rapid-cycle improvements conducted between July 2002 and June 2003, Hannibal Regional Hospita l (Hannibal, Missouri) increased the early administration of aspirin— a crucial step in the care of heart attack patients— to 97%. The key to Hannibal's success in aspirin delivery was early identification of AMI patients in the emergency room where nurses and technicians were trained to recognize AMI patients with tools such as chest pain flow sheets. At Jefferson Memorial Hospital, staff recently achieved a 38% increase in “worsening symptoms” instructions at discharge and a 21% increase in monitoring instructions given at discharge. Without this system change, many heart failure patients would not receive vital information needed to help understand their condition and maintain a good state of health. Both hospitals work closely with the state's QIO, MissouriPRO, to improve care in a number of clinical areas. Contact: Deborah Finley at MissouriPRO at 800-735-6776 or dfinley@moqio.sdps.org. Truman Medical Center in Missouri speeds antibiotic administration for pneumonia: Working closely with the state's QIO, Primaris, the emergency department at Truman Medical Center (Kansas City, Missouri) decreased the average amount of time from patient arrival until antibiotic administration for pneumonia from over 7 hours to just under 3 hours, which reduces length of hospital stay for pneumonia patients. The rate of vaccination of Medicare patients at Truman increased from 15% to 45%, with the hospital now striving to vaccinate at least 90% of eligible patients. Contact: Deborah Finley at MissouriPRO at dfinley@moqio.sdps.org. Truman Medical Center in Missouri fights diabetes by lowering patient blood sugar levels: The A1C test measures an individual's average blood sugar level over a three-month period. The recommended A1C level is 8%. At the beginning of 2002, barely one-half of Truman Medical Center's (Kansas City, Missouri) patients were at this level. By August 2003, 100% of the patient population was screened and 80 percent of the patients had lowered their score by 1%. Working with the state's QIO, MissouriPRO, Truman established a diabetes patient registry. A clinical team met on a biweekly basis to discuss diabetes population trends and concerns. A “Diabetes Day” was held allowing patients to obtain necessary diabetes tests and screenings including eye screenings, foot screening, laboratory tests and diabetes education. Each patient was instructed on basic self-management of their disease and encouraged to formulate self-management goals, a technique that proved especially effective. Contact: Deborah Finley at MissiouriPRO at 800-735-6776 or dfinley@moqio.sdps.org . Montana Benefis Healthcare in Great Falls, Montana , reduces surgical site infections by 50 percent: In collaboration with Montana's QIO, Mountain-Pacific Quality Health Foundation MPQHF, Benefis Healthcare was able to successfully cut surgical infection rates in coronary bypass (CABG) surgery by 79 percent, and infection rates in total knee replacements by 57 percent. Working with MPQHF staff, the Benefis team focused on improving timing of prophylactic antibiotics and discontinuation of antibiotics within 24 hours. Benefis also monitored other measures to prevent surgical infection, including normothermia, glucose control, and staff and patient education. The hospital will apply the success of this program to all surgeries. The facility also plans to implement an insulin drip protocol to manage high glucose levels for critically ill patients . Contact: Peg Donahue, Communications Director, Mountain-Pacific Quality Health Foundation at pdonahue@mtqio.sdps.org or call406-443-4020, ext. 145. Nebraska Improving performance and making those improvements “stick” can be challenging. Falling into “the old system” is a challenge for any facility that has implemented a process change. Faith Regional Health System in Norfolk, Neb., uses a variety of methods to sustain improvements. According to Mary Meyer, Quality Director at Faith Regional, sustaining improvements involves senior leadership, the hospital's board of directors, medical staff and hospital staff. Faith Regional Health Services develops internal radar graphs to measure and illustrate improvement. The radar graphs are shared internally to keep staff informed of successes and challenges. Faith Regional Health Services' quality improvement data measures continue to show improvement. In 4 th quarter 2004, improvement was reported in each of the heart failure (HF) core measures. Baseline data for smoking cessation counseling was 20 percent and is currently reported at 83 percent. The left ventrical function assessment baseline data was 77 percent and now is at 100 percent. The ace inhibitor for angiotensin converting enzyme inhibitors (ACE inhibitors) prescribed current data shows 67 percent, from a baseline report of 53 percent. Discharge instructions baseline was 28 percent and currently is at 61 percent. Faith Regional Health Services has continued to demonstrate significant improvement and also recognizes there is always room for continued improvement. Faith Regional recently participated in two quality improvement collaboratives, the Upper Plains Heartcare Collaborative and the Nebraska Surgical Infection Prevention Collaborative. Through collaborative participation, Faith Regional demonstrated improvements in processes and measures, as well as an understanding of the Institute for Healthcare Improvement Model for Improvement. Faith Regional Health Services is always looking for new initiatives to improve care and are willing to partner and share with other hospitals in Nebraska. Sustaining improvements can be difficult, but Faith Regional Health Services has created a menu of interventions to maintain staff motivation, improve communication and demonstrate senior leadership support, making quality improvement a part of the daily work they do in caring for patients. For more information, contact Keri McDermott at CIMRO of Nebraska: (402) 476-1399 or kmcdermott@neqio.sdps.org. Nevada Saint Mary's Regional Medical Center is leading the way to reduce mortality for heart attack patients through a series of interventions developed and implemented by a multidisciplinary team: An active participant in the Hospital Quality Initiative and Get With The Guidelines SM , the hospital-based quality improvement program for the American Heart Association and the American Stroke Association , Saint Mary's has demonstrated its commitment to patient safety in Nevada by attending quality improvement training sessions sponsored by HealthInsight , the Medicare Quality Improvement Organization for Nevada, and applying those principles to improve quality and reduce their acute myocardial infarction (AMI) mortality rate. The multidisciplinary team reviewed the data, analyzed processes to identify existing gaps, and made necessary changes to eliminate those gaps. In addition to investigating the AMI measures for compliance with recommended medications and counseling (aspirin/beta-blocker at arrival and discharge, and ace inhibitor for angiotensin converting enzyme inhibitors [ACE inhibitors] and smoking cessation counseling) critical time increments were measured. For those patients who did not meet the 120-minute target for percutanueous transluminal coronary angioplasty (PTCA), a cardiologist and emergency department physician met to address reasons for this variance. Individual physicians are given data specific to their compliance with the measures and feedback for their performance. The data is regularly reported to the medical staff, hospital staff and board of trustees, in comparison with previous data and state and national results. These interventions have paid off. Between April 2003 and March 2004, Saint Mary's utilized the AMI measures to improve its care processes, resulting in a 50 percent reduction in AMI mortality rate, achieving a level well-below the expected rate of 9-10 percent. Since 2002, significant improvement has also been noted on the other measures including: Aspirin at arrival – improvement from 89 to 100 percent Aspirin prescribed at discharge – improvement from 89 to 99 percent Beta-blocker at arrival – improvement from 64 to 98 percent For more information, contact Kristen Boucher at HealthInsight: (702) 933-7314 or kboucher@healthinsight.org. New Mexico 18 New Mexico hospitals collaborate to improve care for surgical wounds The New Mexico QIO, New Mexico Medical Review Association (NMMRA), brought together teams from 18 hospitals from throughout the state to form the New Mexico Surgical Infection Prevention Collaborative, which was conducted between January and October 2003. The collaborative's overall goal was to reduce infections related to surgery by ensuring that all eligible patients receive appropriate and timely prophylactic antibiotics. Overall results showed significant improvement on three key process indicators: surgical cases with on-time prophylactic antibiotic administration went from 68.4 percent to 80.8 percent; surgical cases with selection of appropriate prophylactic antibiotics improved from 87.3 percent to 95.0 percent; and surgical cases with prophylactic antibiotics discontinued on time increased from 18.5 percent to 76.6 percent. Contact: Carlene Brown at NMMRA at (505) 998-9733 or cbrown@nmqio.sdps.org. New York North Shore Long Island Jewish Health System improves antibiotic administration for surgery patients The Long Island Jewish Health System—a network of 11 acute care facilities—participated in the Surgical Infection Prevention (SIP) collaborative conducted by IPRO, the New York QIO. With the involvement of anesthesia departments, modifications were made to anesthesia records to capture the time that antibiotics were administered, as well as the antibiotic prescribed. The hospitals have demonstrated an administration time of less than one hour in 80 percent of cases and 90 percent compliance with guidelines calling for appropriate choice of antibiotic prescribed. Contact: Spencer Vibbert, IPRO, 516-326-7767 ext. 588 or svibbert@nyqio.sdps.org. Oklahoma Mercy Health Center, Oklahoma City, OK, reduces its surgical site infection rate by 78% in patients receiving cardiac bypass, orthopedic, colon, and hysterectomy surgery: Mercy Health Center went from 100 surgeries between infections to more than 400 at the end of the one-year collaborative; achieved 100% on-time antibiotic administration to the target population; achieved 100% of patients who had prophylactic (preventive) antibiotics discontinued within 24 hours of surgery; achieved 100% of patients with normal body temperature during surgery. “Our longer-term goal is to spread and sustain effective system changes to all surgical procedures within our hospital,” said Ronda Paisley Shaw, RN, Infection Control Practitioner, Mercy Health Center. Contact: Tracie LaGere, Communications Manager, Oklahoma Foundation for Medical Quality at tlagere@okqio.sdps.org or call 405-840-2891, ext. 211. Puerto Rico Dr. Cayetano Coll y Toste hospital in Arecibo, Puerto Rico, triples its rate of early administration of antibiotics for patients arriving with pneumonia: Dr Cayetano Coll y Toste hospital increased initial antibiotic dose administration within 8 hours of hospital arrival for dual Medicare-Medicaid beneficiaries from 33.3% to 100% compliance during an 18 month quality improvement project (2001-2002) undertaken in partnership with QIPRO, the QIO for Puerto Rico. Contact: Janice Hidalgo at jhidalgo@prqio.sdps.org Tennessee University of Tennessee Medical Center revamps process for treating heart patients: The University of Tennessee Medical Center, Knoxville, increased the administration of ACE inhibitors for treatment of heart failure/AMI by 32% and the administration of smoking cessation counseling by 60%. Working with QSource Center for Healthcare Quality, the Tennessee QIO, UT Knoxville developed a clinical pathway, created corresponding standing orders, and instituted a formal smoking cessation education packet. QSource assisted by teaching rapid cycle improvement strategies and holding workshops for sharing innovative ways to encourage process improvements. Contact: Raymond Dawson at rdawson@tnqio.sdps.org. Bradley Memorial Hospital that serves southeast Tennessee participated with Qsource, the Center for Healthcare Quality and Medicare Quality Improvement Organization for Tennessee, in the Innovative Quality (IQ) Series in an effort to improve their patient care processes for heart failure, acute myocardial infarction, and pneumonia (PN) patients. In treating heart patients they were able to improve aspirin at arrival and at discharge by 6 and 50 percent, respectively, along with ace inhibitor for angiotensin converting enzyme inhibitors (ACE inhibitors) use by 35 percent. Now 91 percent of its PN patients get an antibiotic in a timely manner. Bradley Memorial Hospital's performance improvement staff worked diligently with its staff to implement standardized orders and patient education information across all of these clinical conditions. For more information, contact Anthony Culver at Qsource: (800) 528-2655 or aculver@tnqio.sdps.org. Virginia Lewis Gale Medical Center, a large urban hospital in Salem, VA, significantly improves care for heart patients: Working with the Virginia Health Quality Center (VHQC), the Virginia QIO, Lewis Gale Medical Center implemented system changes to increase the early administration of beta blockers by 37%, beta blockers at discharge by 33%, and smoking cessation counseling by 59% over approximately 18 months. The hospital experienced a significant decrease in one-day stays and average-length-of-stay for patients admitted with cardiac diagnoses. Contact: Beth Simos at bsimos@vaqio.sdps.org. At Montgomery Regional Hospital, improving the quality of patient care is the responsibility of every employee. Quality measures are tracked daily and results are communicated regularly to ensure all employees remain involved and committed to improvement. During the first half of 2004, Montgomery Regional achieved 100 percent in its medication administration measures, including beta-blockers at arrival (increased from 83 percent in the 2003 sample), aspirin prescribed at discharge and ace inhibitor for angiotensin converting enzyme inhibitors (ACE inhibitors) for heart failure (HF) (increased from 81 percent in the 2002 sample). The hospital also achieved 100 percent in left ventricular function assessments for HF and was in the national top 10 percentile for pneumonia vaccinations. Teams developed order sets, or protocols, as a guide to steps needed to deliver the right care at the right time. Physicians and nurses were provided with these tools and held accountable for their performance. Physicians received quarterly reports comparing their performance with their peers, and a peer assist program was created to offer guidance and support. Nurses formed an Outcomes Committee to monitor and respond to the measures quarterly. Montgomery Regional is active in the quality improvement community, exchanging insights with other hospitals and leveraging resources from the Virginia Health Quality Center (VHQC), the Medicare Quality Improvement Organization for Virginia. “We are continually amazed by the level of resources the VHQC provides,” said Lori Rakes, Montgomery Regional's Assistant Administrator and former Quality Management director. “We also benefit greatly from the VHQC's collaboratives which allow us to exchange ideas and tools with other hospitals in Virginia.” For more information, contact Tina Perry at Virginia Health Quality Center: (804) 289-5320 or tperry@vaqio.sdps.org. CJW Medical Center, a large urban hospital in Richmond, VA, increases flu screening by 48% in 2000-2001 and pneumococcal screening by 43% in 18 months: With help from VHQC, the Virginia QIO, CJW increased flu screening by 48% and pneumococcal screening by 43% in 18 months. Leading up to the 2001 flu season, CJW began screening all patients—not just high-risk patients—to find those who needed flu and pneumonia vaccines. Contact: Beth Simos at bsimos@vaqio.sdps.org Russell County Medical Center, a small rural hospital in Virginia, increases pneumococcal immunization screening by 56% over 18 months: Russell County Medical Center recognized the need to improve patient screening for flu and pneumococcal immunizations. Data provided by Virginia Health Quality Center (the Virginia QIO) served as an impetus for the hospital to implement system changes to increase assessments for immunizations. The hospital added flu and pneumococcal screens to the nursing admission assessment, implemented physician order sheets and developed a patient consent form used in both outpatient and inpatient clinical settings. Using samples provided by VHQC, the hospital also developed pre-printed clinical protocols to facilitate screening for flu and pneumococcal immunizations. Contact: Beth Simos at bsimos@vaqio.sdps.org West Virginia Working with the West Virginia Medical Institute (WVMI), the West Virginia Quality Improvement Organization, the Ohio Valley Medical Center scored 100 percent on the acute myocardial infarction quality measure of administering aspirin within 24 hours of arrival. The Wheeling, W.Va., hospital achieved this level of patient care during the second and third quarters of 2004 by implementing standardized physician orders and by collaborating with its emergency room physicians, who recognized the importance of this measure. For more information, contact Marc McCombs at WVMI at mmccombs@wvmi.org or 304-346-9864. Wisconsin St. Joseph Regional Medical Center, Milwaukee, WI, went from 19 surgeries between preventable surgical infections to 833 during the 2002 project: The SJRMC team d ecreased the infection rate in C-sections by 100%; decreased the infection rate in colorectal surgeries by 100%; decreased the infection rate in cardiac surgeries by 71%; and decreased the infection rate in vascular surgeries by 65%. “The work of our team is currently being spread to all adult surgical inpatients. This has introduced significant redesign of processes to many areas of the hospital.,” said Barbara Rogness, RN, Patient Care Coordinator, St. Joseph Regional Medical Center. Contact: Kay Simmons, MetaStar, Inc., at ksimmon@metastar.com or call 608-274-1940. Wyoming Campbell County Memorial Hospital in Gillete, Wyoming, revamps care protocols to significantly reduce surgical site infections While volunteering in a project initiated by Wyoming's QIO to reduce surgical site infections, Campbell County restructured procedures to ensure that its pilot patients received the appropriate prophylactic antibiotics 100 percent of the time, that antibiotics were discontinued within 24 hours 100 percent of the time, and surgical sites were clipped rather than shaved 100 percent of the time. To ensure patients were given the proper treatment, staff listed the appropriate antibiotics, along with the recommended dosages, in the standing orders. To ensure antibiotics were discontinued within 24 hours, they changed the orthopedic standing orders protocol. Campbell County plans to apply successful surgical infection prevention techniques to OB/GYN and general surgery patients. Contact: Peg Donahue, Communications Director, Mountain-Pacific Quality Health Foundation at pdonahue@mtqio.sdps.org or call 406-443-4020, ext. 145.