AHRQ Quality Indicators Toolkit Helps Methodist Hospital Health System Save Lives

Methodist Hospital Health System in Houston has expanded the use of the AHRQ Quality Indicators Toolkit to four other facilities after its flagship facility, Houston Methodist Hospital, saw significant results with the use of the toolkit. Among the notable results was a reduction in sepsis mortality from 36 percent in 2009 to 12.2 percent in 2013, which represents 672 lives saved.

Embracing AHRQ's Patient Safety Indicators (PSIs) has helped the Methodist system improve care and become a leader in showing other facilities how to reduce sepsis. In 2012, Methodist Hospital Health System was granted a $14.3 million Center for Medicare & Medicaid Innovations award to identify and treat sepsis before it progresses. Sepsis is the sixth most common reason for hospitalization and typically doubles the average length for patients' hospital stay.

AHRQ's Quality Indicators Toolkit was designed to support hospitals seeking to improve the performance of their Inpatient Quality Indicators and PSIs. The Methodist system implemented the Quality Indicators Toolkit to determine how to bridge the gap between their hospitals' current practices and best practices.

"I really do believe AHRQ has substantially improved our assessments and interventions for PSIs, which translate to a lower burden of illness, reduced mortality, shorter lengths of stay, and decreased costs," says Maureen Disbot, M.S., R.N., C.C.R.N., vice president of quality operations and patient safety for Methodist Hospital Health System. Ms. Disbot says the system has also improved on other PSIs, including postoperative pulmonary embolism, deep vein thrombosis, iatrogenic pneumothorax, and perforations and lacerations.

The PSI measures serve as useful screens to determine whether there is a systemic safety issue in an organization. Ms. Disbot notes, "The ability to benchmark was pretty meaningful for us, but the real imperative to adopt [the toolkit] was that these measures are meaningful to our patients. They trust us with their care and count on us not to place them at risk for preventable complications, like the things the PSIs measure."

One of the resources in the toolkit is a "Gap Analysis Tool," which allows users to set up their own assessment of barriers and best practices. Methodist Hospital Health System used this framework to organize and customize an approach to understanding where issues existed, identify best practices, and determine what could be done about those issues.

"Our gap analysis revealed some deficiencies in the attribution of the PSI, which is an immediate showstopper when trying to promote change and establish accountability," says Ms. Disbot. "We ended up providing data weekly by physician and by service line so we could have current memory of the patient and meaningful responses. This has made the biggest difference in our improvements."

"We have a weekly multidisciplinary meeting that specifically looks at the PSI indicators," Ms. Disbot explains. The weekly meeting is conducted under the auspices of the Houston Methodist Hospital Chief Quality Officer, Stuart Dobbs, M.D. A real benefit to the AHRQ PSIs is that they are in the public domain, and Ms. Disbot adds, "Transparency makes health care better." Without AHRQ's PSIs, she says, "we all would only be looking inward."

In addition to dramatically reducing the incidence of sepsis, implementation of the Quality Indicators Toolkit enabled Methodist Hospital Health System to do the following:

• Recognize that sepsis was a major problem for its patients and devote time to studying the causes and solutions.
• Automate screening procedures and employ nurse practitioners to serve as second-level screeners and initiators of the sepsis protocol.
• Recognize that broader screening efforts save lives.
• Expand screenings to transfer patients and three surgical floors, in addition to the emergency department and intensive care units.

Ms. Disbot recommends that users consider the patient volume within a specific PSI and that the Gap Analysis Tool be reviewed semiannually to determine progress and any need for revision. She notes that the PSIs have become a well-known indicator of potential avoidable complications in her hospital, and they are published widely in the system's quality and service line meetings. She adds, "We have made tremendous improvements in our performance and our ranking. We work tirelessly to keep practice and policy top of mind for the safety of all of our patients."

To learn more about AHRQ's quality indicators, visit http://www.qualityindicators.ahrq.gov/.

The Quality Indicators Toolkit for Hospitals is at: http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html