Quovadx, Inc. - CareScience

Using the CareScience process improvement methodology, North Mississippi Medical Center was able to thoroughly investigate their trauma and neurosurgery patient populations, identify root causes and engaged a team of clinicians across departments to improve processes and treatment protocols.

Situation

North Mississippi Medical Center, a 650-bed hospital, is the flagship facility for the third largest rural healthcare system in the country. A CareScience customer for more than seven years, North Mississippi leverages the reporting tools of CareScience Quality Manager for detailed data mining and monitoring of care processes to identify areas for clinical outcomes improvement.

During a review of Medicare data, North Mississippi discovered its craniotomy patients had significant variances in their outcomes. Intrigued by the data and the pending opportunity to improve efficiencies, North Mississippi used CareScience Quality Manager to probe for more detailed information, including outcomes by DRG, diagnoses and procedures. The result, neurosurgery patients were experiencing above average complication rates and longer than expected length of stay. A subsequent investigation of trauma patient outcomes revealed similar outcome patterns among both populations.

Solution

Using the CareScience process improvement methodology, North Mississippi Medical Center was able to thoroughly investigate their trauma and neurosurgery patient populations, identify root causes and engaged a team of clinicians across departments to improve processes and treatment protocols. Evaluating the latest evidence-based practices, the following are a sample of changes implemented:

• Instituting pulmonary consults earlier in the care process
• Elevating the head-of-bed for patients on ventilators
• Performing tracheostomy procedures within 7 days of ventilation if patient determined to need long term ventilation support
• Ensuring patients are fed (enterally via a gastric tube or parenterally) within 3 days of being placed on a ventilator
• Developing a “weaning bundle” to encourage early ventilator weaning

Better Health & Lower Costs

North Mississippi Medical Center partnering with CareScience has validated a care-based cost management philosophy. This partnering has supported North Mississippi in saving lives and saving money. The process improvements implemented resulted in the following:

• tracheostomy ICU patients length of stay decreased from an average of 25.8 days to 17.5 days
• trauma patients length of stay improved to 4.5 days which is 1.1 days better than hospitals in the National Trauma Data Base
• risk-adjusted complications for trauma patients was reduced by 7%
• craniotomy patients length of stay decreased from 9 days to 6.5 days
•  risk-adjusted complications for neurosurgeons have plummeted from 9% to 0.5% above expected, despite increased patient severity

The end results included improved patient outcomes, increased staff satisfaction, reduced length of stay and a savings of over $1.4 million for Medicare patients alone. The team of clinicians who implemented the process improvements also created a cultural change in acceptance and desire for access to risk-adjusted data to improve outcomes.