LEAN Six Sigma and Patient Safety

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LEAN Six Sigma and Patient Safety

• Mary Reich Cooper, M.D., J.D
• Chief Quality Officer, Lifespan Corporation
• Edward W. Craven, MBA, CPHQ
• NewYork-Presbyterian Hospital

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WHY?

• Medicare Says It Wont Cover Hospital Errors
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By ROBERT PEAR Published August 19,
2007 WASHINGTON, Aug. 18 In a significant
policy change, Bush administration officials say
that Medicare will no longer pay the extra costs
of treating preventable errors, injuries and
infections that occur in hospitals, a move they
say could save lives and millions of dollars.
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WHY?
For discharges occurring on or after October 1,
2008, the diagnosis-related group to be assigned
shall be a diagnosis-related group that does not
result in a higher payment based on the presence
of a secondary diagnosis code
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No Extra Payment
WHY?

• 1. Serious Preventable Event - Object left in
  surgery
• 2. Serious Preventable Event - Air embolism
• 3. Serious Preventable Event - Blood
  incompatibility
• 4. Catheter Associated UTI
• 5. Pressure Ulcers (Decubitus Ulcers)
• . Vascular Catheter Associated Infection
• 7. Surgical Site Infection - Mediastinitis after
  Coronary Artery Bypass Graft (CABG) surgery
• 8. Falls

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WHY?
Transactional Level of Data Collection Rewards
for Each Time 74 Different Measures
Available Effectiveness and Safety
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Agenda

• WHY do we need to have this discussion?
• WHO are we?
• WHEN did we start?
• HOW have we approached this topic?
• WHAT have we achieved?

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NewYork-Presbyterian Hospital
WHO?
Full asset merger of The New York Hospital,
founded in 1771 and the 2nd oldest hospital in
the US, and The Presbyterian Hospital of New
York, founded in 1868, into one Article 28
corporation which includes

• 2,224 Certified Beds
• 110,000 Discharges
• 11,000 Births
• 88,000 Surgeries
• 1,036,000 Ambulatory Visits
• 17,500 Employees
• 2.8 Billion Operating Budget

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Lifespan Corporation
WHO?
Employees10,941 Affiliated Physicians2,519 Licensed Beds1,174 Total Assets1.77 Billion Patient Discharges52,680 Emergency Department Visits198,447 Outpatient Visits292,029 Net Patient Revenue1.11 Billion   Research Funding66.8 Million   Uncompensated Care at Cost53.207 Million
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Experience in LEAN and Six Sigma
WHEN?

• Designed and implemented NYP plan
• Hired and supervised forty black belts
• Program ongoing since 2002
• 74 million in benefits through June 2007
• National award winners and speakers

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HOW?
Patient Safety Quality Outcomes Define Measure
Report Out GE Healthcare Performance
Solutions December 13, 2004
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Quality Outcomes Pillars for Success
HOW?
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Project Approach
HOW?

• Complete Literature Search
• Identify Best Practices
• Conduct GAP Analysis
• Prioritize GAPS
• Conduct Brainstorming Session to Identify
  Critical Xs
• Decide on DMAIC or Solution/Best Practice
  Implementation
• AIC or Work-Out and Change Acceleration Process
• Monitor progress
• Deliverables Met
• Project Transfer to NYPH
• On-going control

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BSI Site Selection Data
WHY?
90th
50th
Benchmarks from National Nosocomial Infection
Surveillance NNIS Major Teaching Hospital
Med/Surg ICU 50th percentile 4.9, 90th
percentile 7.7
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Blood Stream Infection Project Opportunity
HOW?
Problem Statement The Weill Cornell CCU current
has BSI rate of 8 BSI per 1000 catheter days.
Based on 2003 and 2004 data the BSI rate was as
high as 11 BSIs per 1000 catheter days. The rate
is approaching the National Nosocomial Infection
Surveillance (NNIS) 90th Percentile.
Process
Culture Analyzed BSI Detected
Culture Obtained From Patient
Patient Treated
Infection Removed
Patient Discharged
Tangible Benefits Intangible
Benefits

• Patients and family satisfaction is increased
  with decreased length of stay in ICU
• Increase communication and best practice sharing
  between Epidemiology and Infection Control across
  campuses
• Lowered legal burden from hospital malpractice
  claims and financial settlements/awards

• Decreased length of stay (LOS)
• Increase ICU Capacity
• Reduce IV Antibiotics Usage

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Blood Stream Infection Project Scope/Enablers/Rest
rainers
HOW?
In Scope Weill Cornell CCU SICU Central Line
Catheter Related BSIs. Catheters inserted both
inside outside of CCU SICU
Out of Scope Non central and other BSIs Other
locations Columbia, Allen Pavilion, CHONY and
other Weill Cornell ICUs Days spent elsewhere
within Hospital
Project Enablers
Project Restrainers

• Limited buy in and agreement to participate from
  specific staff.
• This will be mitigated by using CAP tools early
  to communicate the necessity of pursuing this
  project. creating a shared need, shaping a vision
  and mobilizing commitment
• Gaining consensus that there is a true problem
  will be necessary early and throughout the life
  of this project

• Strong history of success in lowering BSI rates
  in ICUs with focus and effort by Epidemiology and
  unit staff
• Causes and drivers of BSI are well established in
  medical literature

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Critical Xs

• Technique
• Training
• Supplies and Kits
• Line Upkeep

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2007 Central Line Infections
WHAT?

• ICUs
• NNIS Data
• Publicly Reported Data
• Mystery Shoppers for Hand Hygiene
• Standardized Protocol for Insertions
• Carts, Barriers, and Kits
• EpiPortal

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BSI ICU Results2007 Months without an Infection
WHAT?
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QUESTIONS?

• mcooper _at_ lifespan.org
• edc9008 _at_ nyp.org