HSMR

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Hospital Standardized Mortality Ratio From
Measurement to Improvement
Hardwiring Patient Safety _at_ Southlake Barbara
Kendrick, Director, Quality Planning
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HSMR From Measurement to Improvement
Our Goal is improvement over time Our Target
for 08/09 Excl. Palliative 90 ? Our Target for
09/10 All Case HSMR 85
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Our Strategies

• Accountability
• Strategic Goal setting at a corporate level
• Program level mortality rate targets using HSMR
  eligible cases
• Regular Reporting and Benchmarking
• Quality Patient Safety Committee (quarterly)
• Board Committee on Quality (quarterly)
• Full Board (annually quarterly via BCQ minutes)
• Community / Public (quarterly website updates
  since April 08)

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Hardwiring Safety in the Strategic Plan Our
Strategic Plan Drives our Safety Plan The key
concepts in each pillar of each pillar show the
emphasis on safety for both staff and patients
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Hardwiring Patient Safety In the Strategic
Plan

• Our brochure is the public face of our strategic
  plan. Distributed to all staff LHIN partners.
  This page focuses on the value of Put Patients
  First and our goals for the Our Patients and
  Community pillar.
• Note the emphasis on safety.

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Transforming to a Regional Health Centre of
Excellence Strategic Pillar Our Patients
Community5 Key Patient Safety Commitments

• Goal Excellent Patient Outcomes
• Reduce Inpatient Mortality
• Champion Safer Healthcare Now! Campaign

• Goal Safe Care Environment
• Improve Culture of Safety
• Decrease Medication Errors
• Decrease Nosocomial Infections

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• Tracking Crude Mortality with HSMR eligible
  cases gives us
• A proxy measure for more timely feedback on
  progress
• Ability to map to our internal portfolio
  structures and create local accountability
• Correlation to HSMR is high at 0.90. Medicines
  crude rate is the most strongly correlated to the
  corporate rate at 0.83

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Creating accountability at a program level
Sept 23, 2008 Portfolio targets have now been
recalculated based on crude mortality, using all
eligible HSMR cases. The targets noted above were
presented to the Quality Patient Safety Committee
for approval.
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Benchmarking

• Quality Patient Safety Committee and Board
  Reports compare Southlakes performance with a
  specific group of peers and the Best in Class
  performances

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Our Strategies

• Patient Safety Culture
• Assessment NRC/ Picker and Accreditation Canada
• Open Forums
• Patient Safety Week events
• Find the Error contest
• SHN other Safety initiative team displays
• Disclosure Rounds
• CNO Forum with Safety Focus
• Integration into Frontline Leaders development
  program
• Quality/ Patient Safety Communiqué
• Good Catch Campaign for Jan 09

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Webshot SRHC Website
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• Our Strategies
• Champion Safer Healthcare Now!
• A series of evidence based interventions proven
  to help reduce inpatient mortality
• Supported by the Canadian Patient Safety
  Institute
• Southlake is an active participant in the
  campaign.
• We have teams in all relevant interventions
• Some are approaching maturity and others are
  still in active implementation

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Our Strategies

• Safer Healthcare Now! Initiatives
• 2 SSI teams (Colorectal and CV Surgery) with
  broad practice spread on antibiotic timing ,
  normothermia and hair removal
• VAP team showing excellent reduction in infection
  rates- best practice spread to CCU and CVICU
• AMI team showing excellent perfect care
  performance

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Our Strategies

• Safer Healthcare Now! Initiatives
• Central Line team showing great improvement in
  compliance with insertion and maintenance bundle
  in the Med/Surg ICU? working on spread with OR,
  Cath Lab, CCU and CVICU.
• RRT reducing codes outside the ICU
• Falls Collaborative (new in 2008) focusing on
  Fall Prevention and Risk reduction in Complex
  Medical Rehab with spread of Risk Assessment and
  Interventions across all units
• Medication Reconciliation- reduction of
  unintentional discrepancies in the Emergency Room

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Southlake SHN Team Performance
Perfect Care AMI Bundle
Central Line Infection Rates
Ventilator Associated Pneumonia Rates
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Our Strategies

• Analysis of Contributing Factors
• Identify potential areas for improvement
• Identify additional clinical best practices to
  reduce inpatient mortality
• Diagnoses/ CMGs with a higher than expected
  mortality
• Higher mortality in a low probability
  Diagnosis/CMGs
• Adverse Event reviews using Global Trigger Tool
  (early implementation)
• ? Sepsis Task Force
• ? Integrated Neurological Unit

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SRHC 07/08 Q1-Q3
SRHC 06/07
What Changed in 07/08? Compared to these
national Top 10 in-hospital mortality diagnoses,
Southlakes 07/ 08 Q1-3 crude mortality rates (in
Red) are lower than national rates. Note this
years decrease in crude mortality for Stroke and
Septicemia at SRHC
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Our Strategies

• Hospitalist Programs
• Cited as effective in reducing inpatient
  mortality Our program is steadily expanding to
  5 FTEs

• Adverse Event Reviews with integration into
  Mortality Review Process (in progress)
• Use a standardized tool consistent reviewers
• To identify preventable adverse events.
• Report to Quality Patient Safety Committee with
  Follow-up on Themes

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Our Results
CIHI will release all eligible Canadian
hospitals HSMR data on December 11, 2008. Our
improvement in 07/08 will be noted as
statistically significant.
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Our Results

• HSMR All Cases
• SRHC Results 07/08
• 419 In-hospital Deaths
• 482 Expected Deaths
• The number of expected deaths is calculated
  specifically for Southlake taking in to account
  their diagnostic mix level of complexity and
  is based on the 04/05 Canadian experience

X 100 87
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Fiscal 07/08 ?For the first time, our Upper
Confidence Limits for HSMR (both excluding
palliative and All Case) are below 100 showing
significant improvement We exceeded our target of
90 for 08/09. For 08/09 Administration has set
the All Cases HSMR target at 85
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HSMR From Measurement to Improvement
Our Goal is improvement over time Our Target
for 08/09 Excl. Palliative 90 ? Our Target for
09/10 All Case HSMR 85