Beebe Healthcare recognized employees and physicians for their dedication and commitment to high-quality patient care during the Eighth Annual Quality and Safety Awards Banquet held Nov. 6 at Kings Creek Country Club in Rehoboth Beach.
The evening represented the culmination of a year’s work by nine teams, made up of 140 Beebe team members. The teams designed and implemented process improvement initiatives to positively impact patient care at Beebe.
Three of the nine teams were presented with awards for their outstanding projects, which solved quality or safety problems identified in healthcare settings.
“Each year, we are thrilled to see the innovative and thoughtful ideas that our team members come up with to improve our internal processes and systems for the benefit of our patients,” said Jeffrey M. Fried, FACHE, president and CEO of Beebe Healthcare. “We especially look for teams that identify problems on their own, and look for data that demonstrates performance improvement. The projects and teams that were recognized this year, as evidenced by the data, demonstrate that we have truly improved the care and outcomes for our patients.”
Stephen Fanto, MD, chairman of the board of directors’ Quality and Safety Committee, introduced the three teams, who then formally presented their project goals, methodologies and solutions.
“It is an honor to work with these teams and see the innovation they bring to the organization each year,” said Fanto. “I and the entire Quality and Safety Committee thank them for their dedication to Beebe and to improving the quality of patient care every day.”
Fanto, together with Fried and David A. Herbert, Beebe board of directors chair, presented the awards. The three award-winning teams were: Implementation of Enhanced Recovery After Surgery, presented by Teresa Hitchens, quality outcomes analyst, MSN, BSN, RN, CNOR, CRNFA(E), CPHQ; Improving the Radiology Order Entry Process, presented by Maurice Winkfield, director of operational improvement, and Dan Mapes, executive director, Diagnostic Imaging and Satellite Services; and Obstetrical Hemorrhage: the Use of the 4 Rs, presented by Bridget Buckaloo, MSN, executive director of Women’s and Children’s Health Services.
After observing longer lengths of stay, and higher readmission and surgical site infection rates than they preferred to see among elective colorectal surgery patients, along with variation in practices among surgeons, the quality team knew a change needed to be made. To implement the Enhanced Recovery After Surgery Program for Elective Colorectal Surgery Patients, a team was assembled. It reviewed evidence-based practices and conducted an analysis to identify gaps between current and evidence-based practices. Team members shared this information with surgeons who perform elective colorectal surgeries, and developed and implemented an education program for staff, surgeons, anesthesiologists and outpatient offices.
The team also developed a new pre-operative booklet with updated surgery preparation information. They also developed a multimodal, opioid-sparing pain management protocol and instituted early mobilization for post-operative patients.
Through the ERAS program, the team reduced the average length of stay by 40 percent and the 30-day readmission rate by 48 percent. They also significantly reduced post-operative opioid usage and surgical site infections.
“The Enhanced Recovery After Surgery program has been an incredible success for our elective colorectal surgery patients,” said Hitchens. “We look forward to expanding the program to other surgeries, including gynecological surgery.”
Patients in need of radiologic testing, such as X-rays or CT scans, were encountering longer-than-necessary wait times and were at risk of harm due to radiology order entry errors, which were magnified by an inefficient registration process.
After receiving several questions, Mapes and Winkfield began researching the issue and collecting data. They developed a standardized training program and order guides for the registration team and implemented an annual retraining program. They also educated radiation technologists, and moved patient history and screening forms away from the registration desk, allowing registrars to focus on registration. By standardizing the order-entry process, the team was able to reduce the error rate from 5.1 percent to 1.5 percent.
“Entering orders accurately and in a streamlined way is critical to the successful treatment of our patients,” Mapes said. “With help from Maurice’s team and by implementing Lean methodology, we were able to significantly improve accuracy and positively impact the patient experience.”
In the United States, obstetrical hemorrhage affects 2-5 percent of all births, and is one of the leading causes of maternal death. The rate of postpartum hemorrhage increased 26 percent between 1994 and 2006, primarily because of increased rates of uterine atony, which is when the uterus fails to contract after birth. This is often due to a long labor or the prolonged use of epidurals and/or Pitocin, which cause the uterine muscle to tire out before it is finished contracting.
Additional contributing factors include failure to recognize excessive blood loss during the birth process and a lack of early interventions. The use of the four Rs: Readiness, Recognition, Response and Reporting, as part of a patient safety bundle, is a way to standardize processes to improve quality of care and patient outcomes.
At Beebe, implementing the four Rs included staff and provider training (including live simulation), deployment of a hemorrhage cart, development of specific protocols, and creation of a dashboard to track obstetrical hemorrhage and transfusion rates.
“Implementing the four Rs has led to a significant increase in the identification of postpartum hemorrhage, which has led to faster response times. This has been the key to improving patient outcomes,” said Buckaloo. “Beebe is thrilled to be participating in a statewide obstetrical hemorrhage initiative and to be leading Delaware hospitals in preparedness and response protocols.”
To sustain improvements over the long term, providers and staff will hold ongoing drills and live simulations with debriefings, and continue to monitor outcome data. The team has also applied for a grant for medical-grade scales to quantify blood loss.