Otolaryngologists at the University of Cincinnati (UC) Medical Center are focused on achieving high quality care through their morbidity, mortality and improvement conferences by leveraging macro level EMR data while zooming in on a small number of high-yield cases that drive specific performance improvement opportunities.
Ryan Collar, MD, MBA says, “we are beginning to put the electronic medical record to work for us” through new, internal and external data science relationships, including UC Health’s business intelligence program and the national performance improvement data analytics organization, Vizient Inc. The aim, Collar says, is to be “more objective about performance, and to leverage data to do so. If we can’t measure something, we can’t manage it.”
The department now obtains automated, real-time data on the care delivered to each individual post-operative patient in terms of established national metric domains including experience, safety, effectiveness and efficiency. To organize the growing number of established metrics into a more simplified, patient-centric and process-driven approach, the department distills a battery of accepted key indicators into a composite “ideal care” binary outcome for each patient undergoing surgery at UC Medical Center. For example, to achieve a post-operative patient “pass,” he or she would need to have had a top box Press Ganey patient experience score, an appropriate adjusted length of stay, no Agency for Healthcare Research and Quality (AHRQ) patient safety events (PSI) during the admission, and no 30-day unplanned readmissions after discharge.
Over the previous two years, retrospective review shows that on a month-over-month basis, performance ranges between 74% and 94% of patients receiving this ideal care distinction after surgery. The department’s aspirational goal is to achieve 100%. Because the approach is focused on episodes of care for individual patients, it is simple to identify outliers, examine what happened while they were admitted and focus on countermeasures.
While utilizing this approach to maintain a macro-level perspective on the department’s inpatient performance, Dr. Collar explains that the department has evolved its M&M conference to focus on a fewer number of self-reported high-yield cases during department-wide, and sometimes multidisciplinary, monthly sessions.
“We want to improve or solve very specific problems, so we’ve re-named these monthly meetings MM&I (Morbidity, Mortality, and Improvement) conferences,” Collar says. The idea is to select a focused number of cases that allow immediate action and problem solving using frameworks such as TPS (Lean, Toyota Production System) a topic on which the residents receive didactics. The key is that there is follow-up in subsequent sessions wherein groups assigned to take on a specific problem report back to the group with findings, action items and outcomes. For example, a new organizational protocol for patients with complex airways receiving care in endoscopy units has been adopted as a result of the MM&I conference this year that addresses a very specific patient care problem.
Components of the department’s approach to MM&I was presented at the Triological Society’s 2018 Combined Sections Meeting held January 18 – 20 in Scottsdale, Ariz. The American Laryngological, Rhinological and Otological Society, Inc. is known as The Triological Society. As Dr. Collar says, “It’s possible some aspects of this approach could be adapted for use in other service lines at UC Medical Center. Internally we’ll be using this data to explore questions such as how complexity of care interacts with patient outcomes, whether there are systems or services that thrive with different levels of complexity, and the impact of competition and price within healthcare marketplaces.”Leave a reply →