Questions: AHRQ Quality Indicators (QIs) Case Study: Tampa General Hospital's Adoption of AHRQ Qis Yields Performance Improvements Key Findings - In 2014, Tampa General Hospital began tracking its performance across the full set of AHRQ Patient Safety Indicators, both as a means of improving the quality and safety of patient care, and in response to the incentives underlying CMS' value-based purchasing programs. - Tampa General Hospital substantially reduced its Pressure Ulcer Rate (PSI 03) after implementing a nutrition program aimed at patients whose poor nutrition impacted the healing of skin injuries. - Tampa General Hospital substantially reduced its Deep Vein Thrombosis Rate (PSI 12) after instituting an education campaign aimed at both nurses and patients. Tampa General Hospital: At a Glance - 1000+ bed single facility teaching hospital with an affiliated ambulatory surgery center - 1,500 medical staff members - Affiliated with University of South Florida medical school, and their residency program (750 residents) - Serves as the community hospital referral facility for the Tampa Bay area Urged by its Board of Directors, Tampa General Hospital leadership initially selected the AHRQ Patient Safety Indicators (PSIs) to monitor performance because leadership wanted to improve the hospital's standing under CMS' value-based purchasing and incentive programs. Starting in 2014, Tampa General Hospital analyzed its performance using the full set of AHRQ PSIs. Tampa General also established the position of Chief Quality Officer as a strong signal regarding the hospital's commitment to improving safety and quality of patient care. Laura Haubner, MD, Tampa General Hospital's inaugural and current Chief Quality Officer described the improvement of clinical care experienced by patients of Tampa General Hospital following implementation of the AHRQ PSIs. Focus on Nutrition Lowers Tampa General Hospital's Pressure Ulcer Rate (PSI 03) After comparing its Pressure Ulcer Rate (PSI 03) to that of peer facilities in other parts of the country, Tampa General Hospital committed to substantially reducing its rate of pressure ulcers. The hospital's research identified poor nutrition as a significant contributor to the incidence of pressure ulcers. As a result of this finding, Tampa General Hospital developed a nutrition program targeted to undernourished patients at high risk for pressure ulcers. After implementing the nutrition program, Tampa General Hospital's PSI 03 rate improved significantly, dropping from an observed rate of 518 per 1,000 discharges for the fourth quarter of FY 2015 to zero incidents in the third and fourth quarters of FY 2018. Beverly Hernandez, PhD, RD, LD/N, Director, Clinical Nutrition Services, explained that Tampa General Hospital took a three-pronged approach to addressing malnutrition in these patients. 1. Utilized technology to identify patients at risk for pressure sores, The hospital adopted a computerized malnutrition screen to assist nurses with early identification of patients suffering from malnutrition. 2. Standardized clinical protocols for at-risk patients. The hospital combined early identification of patients at risk for pressure sores with more aggressive protocols for clinical staff, including a requirement that staff must see patients flagged by the malnutrition screen within 24 hours, and an automatic referral to a nutritionist for a poor score on the Braden Scale for Predicting Pressure Ulcer Risk. In addition, at-risk patients are visited by a hospital social worker who helps identify community resources (food banks, meals on wheels) for when patients return home. 3. Increased interdisciplinary collaboration. Tampa General Hospital instituted a Medical Nutrition Committee comprised of physicians, pharmacists, and dietitians. This committee instituted changes that now allow nurses to write nutrition-based orders, instead of waiting for a physician to do so. A Wound Care Committee works aggressively to deter skin wounds during hospital stays, and the Nurse Nutrition Council meets regularly to review cases and identify opportunities for continuous improvement. "The AHRQ PSIs awakened in all of us an awareness that we need to improve the hospital's performance rate of pressure ulcers and that nutrition could be a key means of achieving that," said Ms. Hernandez.

Transcript text: AHRQ Quality Indicators (QIs) Case Study: Tampa General Hospital's Adoption of AHRQ Qis Yields Performance Improvements Key Findings - In 2014, Tampa General Hospital began tracking its performance across the full set of AHRQ Patient Safety Indicators, both as a means of improving the quality and safety of patient care, and in response to the incentives undertying CMS' value-based purchasing programs. - Tampa General Hospital substantially reduced its Pressure Ulcer Rate (PSI 03) after implementing a nutrition program aimed at patients whose poor nutrition impacted the healing of skin injuries. - Tampa General Hospital substantially reduced its Deep Vein Thrombosis Rate (PSI 12) after instituting an education campaign aimed at both nurses and patients. Tampa General Hospital: At a Glance - $1000+ bed single facility teaching hospital with an affiliated ambulatory surgery center - 1,500 medical staff members - Affiliated with University of South Florida medical school, and their residency program (750 residents) - Serves as the community hospital referral facility for the Tampa Bay area Urged by its Board of Directors, Tampa General Hospital leadership initially selected the AHRQ Patient Safety Indicators (PSIs) to monitor performance because leadership wanted to improve the hospital's standing under CMS' value-based purchasing and incentive programs. Starting in 2014, Tampa General Hospital analyzed its performance using the full set of AHRQ PSIs. Tampa General also established the position of Chief Quality Officer as a strong signal regarding the hospital's commitment to improving safety and quality of patient care. Laura Haubner, MD, Tampa General Hospital's inaugural and current Chief Quality Officer described the improvement of clinical care experienced by patients of Tampa General Hospital following implementation of the AHRQ PSIs. Focus on Nutrition Lowers Tampa General Hospital's Pressure Ulcer Rate (PSI 03) After comparing its Pressure Ulcer Rate (PSI 03) to that of peer facilities in other parts of the country, Tampa General Hospital committed to substantially reducing its rate of pressure ulcers. The hospital's research identified poor nutrition as a significant contributor to the incidence of pressure ulcers. As a result of this finding, Tampa General Hospital developed a nutrition program targeted to undernourished patients at high risk for pressure ulcers. After implementing the nutrition program, Tampa General Hospital's PSI 03 rate improved significantly, dropping from an observed rate of 518 per 1,000 discharges for the fourth quarter of FY 2015 to zero incidents in the third and fourth quarters of FY 2018. Beverly Hernandez, PhD, RD, LD/N, Director, Clinical Nutrition Services, explained that Tampa General Hospital took a three-pronged approach to addressing malnutrition in these patients. 1. Utilized technology to identify patients at risk for pressure sores, The hospital adopted a computerized malnutrition screen to assist nurses with early identification of patients suffering from malnutrition. 2. Standardized clinical protocols for at-risk patients. The hospital combined early identification of patients at risk for pressure sores with more aggressive protocols for clinical staff, including a requirement that staff must see patients flagged by the malnutrition screen within 24 hours, and an automatic referral to a nutritionist for a poor score on the Braden Scale for Predicting Pressure Ulcer Risk. In addition, at-risk patients are visited by a hospital social worker who helps identify community resources (food banks, meals on wheels) for when patients return home. 3. Increased interdisciplinary collaboration. Tampa General Hospital instituted a Medical Nutrition Committee comprised of physicians, pharmacists, and dietitians. This committee instituted changes that now allow nurses to write nutrition-based orders, instead of waiting for a physician to do so. A Wound Care Committee works aggressively to deter skin wounds during hospital stays, and the Nurse Nutrition Council meets regularly to review cases and identify opportunities for continuous improvement. "The AHRQ PSIs awakened in all of us an awareness that we need to improve the hospital's performance rate of pressure ulcers and that nutrition could be a key means of achieving that," said Ms. Hernandez.