McLeod Regional Medical Center

Founded in 1906, McLeod Health is a not-for-profit organization. McLeod's service area includes 12 counties with a population close to one million. McLeod believes that patient satisfaction is their highest priority. In a recent survey of patients by Professional Research Consultants, an independent national research firm, McLeod ranks higher in patient satisfaction than national averages.

Situation

McLeod Regional Medical Center, a 371-bed tertiary referral center, is one of only seven healthcare organizations in the country selected to lead improvements in healthcare quality as part of “Pursuing Perfection: Raising the Bar for Healthcare Performance” -- a $21 million initiative sponsored by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. The program was developed in response to the Institute of Medicine’s two landmark reports, To Err is Human and Crossing the Quality Chasm. As such, McLeod’s efforts are viewed as a model for delivering higher quality care across the healthcare industry.

Solution

By combining process improvements with information technology (IT) solutions, McLeod has become a national example of how to provide the highest quality, safest care for patients.

When McLeod began the process, its rate of harm (as calculated using industry standard measurements) was well within the average of harmful adverse drug events (ADE) reported in To Err is Human. Harm is defined as medication errors that cause a change in the patient’s condition, either temporary or permanent. The cited average for U.S. hospitals is between two and eight harmful medication events per 1,000 doses -- McLeod’s was 3.5. The goal is to eliminate all harmful medication errors for all patients.

Key to making quality improvements was the implementation of full closed-loop medication processing, using barcode technology for medication administration, a pharmacy IT system, and a computerized physician order entry system (CPOE). These solutions are supporting McLeod’s patient safety goals, and at the same time integrating the electronic health record with sophisticated clinical decision support, lab results, and nursing clinical documentation. In addition, McLeod installed an expanded wireless network to support mobile nurses and physicians, and upgraded the healthcare IT system to included browser technology, handheld PDAs, and an online “dashboard” that provides anytime, anywhere secure access to patient information, schedules, and e-mail.

While technology enabled the implementation of many safety measures, McLeod knew that cultural change was also vital to providing safe medication processes. With the leadership of the medical staff, McLeod has developed numerous evidence-based, data-driven protocols with the goal of reducing variability and improving safety. Having spent years working to change the culture of “blame and shame” through training and education, McLeod also introduced “executive safety rounds,” in which senior hospital leaders regularly visit patient care areas to listen and learn about barriers to safety from front-line staff. At first these rounds were conducted bi-weekly or weekly – now they’re a daily occurrence. As a result, says Isgett, “We got very comfortable talking about our own errors. The number of reported errors began to climb, providing richer opportunities to learn where the system was weak.”

Better Health & Lower Costs

Creating a culture of clinical improvement built on a foundation of clinical and executive leadership, process change, and information technology solutions, McLeod has realized the following results:

• The use of automated medication dispensing combined with electronic bar coding at the bedside has shortened the steps from the physician order to drug administration from 17 steps to seven. And with CPOE it has dropped to five steps.
• All combined processes and system changes have led to a drastic decrease in the rate of harm: a six-month average of 0.52 per 1,000 doses.
• The turnaround time from order entry to medication administration decreased from 92 minutes to eight minutes.
• The patient rate of harm for the neonatal, newborn, and pediatric population is continuously reaching a record-low rate of zero.
• An estimated $6.4 million was saved in key clinical improvement projects with the reduction of 7,700 patient days. This results in a global average length of stay reduction of one day, allowing admission rates to rise by 10 percent.
• An estimated 157 lives were saved.
• Top performer in Premier and the Centers for Medicare and Medicaid Services national quality-improvement project, showing that McLeod Health is leading the way in the care of patients with heart attack, heart failure, pneumonia, open heart surgery and hip and knee-replacement surgery, placing in the top 20 percent and one of two top performers in all of the focus areas