Quality and Patient Safety

at
Cleveland Clinic

Shannon Connor Phillips, MD, MPH

Patient Safety Officer

J Michael Henderson, MD
Chair, Quality and Patient Safety Institute
Cleveland Clinic: Quality and Patient Safety
What are we doing?

• Quality and Patient Safety Institute – 2006

• Leadership is committed to Quality and Safety as a high

priority.

• Infrastructure development to fulfill Mission and Vision

• Focus Areas
 Quality and Patient Safety Institute
Chairman – J. Michael Henderson, MD
Administrator – Elaine Mead
Departments and Directors

Risk Surveys& Process

Quality Accreditation Data Environment
Management Outcomes Improvement

Jackie Eileen Vicki Eric Stuart Barbara Robert

Matthews Pomiecko Bokar Hixson Kline Ackerman Frye

Physician Leadership:
Shannon Phillips Nick Smedira Chris Hebert George Topalsky
Tom Fraser Ajay Kumar Brian Parker
Quality and Patient Safety Institute

FUNCTIONS:
• Administrative Structure and Authority

• Coordination: All departments contribute to programs for Quality and

Patient Safety.

• Develop a communication structure to clinical departments for

information / education / planning / implementation for Quality and
Patient Safety.

• Connect Quality and Patient Safety to leadership and clinical Institutes

Support Team in the Clinical Institutes

Each Clinical Institute has a Support Team

comprised of experts in:

- Quality
- Safety
- Clinical Risk Management
- Accreditation
- Infection Control
Who “owns” Quality and Patient Safety?

We all do

Balance of Responsibility

Institutes QPSI
What Drives Quality and Patient Safety?
• Regulation: CMS / Joint Commission / ODH

• Required Reporting: CMS: Core Measures / POA / IPPS / OPPS /

PQRI; ODH -2007 legislation for Quality Reports

• Patient Safety: NPSG / IHI / AHRQ – Patient Safety Indicators /

Leapfrog

• Quality Metrics “standard setters”: National Quality Forum / IHI

• Scorecards: US News and World Report / Payors

Focus Area 1: Accreditation & Regulation

• Approach going forward:

- Best Practices / Continuous Readiness
- It really is about the patient.

• QPSI / Institute Team

- Content experts: Communication / education
- Action experts: Institutes / the front line
- Incorporate the standards into daily practice.
Focus Area 2: Quality Data and Reporting

• Align Clinical Outcomes and Process Measures

• Cleveland Clinic Outcomes Books

• Quality Data capture as part of clinical practice (EMR)

Quality Outcomes Reporting:
Aligning Clinical Outcomes and Process Measures

Clinical Outcomes:
- Publications / Outcomes Books
- Mostly High Profile areas
- X percent of CC patients
- Excellent results

Process Measures:
- Publicly reported data
- Drawn from all CC patients
- Opportunity for improvement
Clinical Outcomes: National Quality Datasets
• An Opportunity for the Institutes:
• Recommend to all Institutes
• Quality Improvement and Reporting
• Source data for Outcomes Books

ICU Database:
Critical Outcomes

• What is your
National Surgical Quality
“Best” Database?
Improvement Program
Quality Data capture in Clinical Practice
Electronic
Paper

• Data Management in QPSI:

- Oversight responsibility for quality data collection /abstraction
- Combined forces with ITD and Medical Operations
• Electronic Data Capture:
- Increase “Quality” data capture as we move to Inpatient Epic
- Example: Surgical Episode (NSQIP)
• Data Reporting:
- Keep it Simple (and actionable).
- Scorecards with Medical Operations
Focus Area 3: Patient Safety

• Focus of attention - Cleveland Clinic 2007 factoids:

318
Staph Aureus Overall Surgical
32 Sentinel Site Infection
Events in 2007 Blood stream
infections rate was 7.6%

DVT / PE Rate Decubitus Ulcer rate

• 30 /1000 eligible • 20 / 1000 Eligible

pts Pts

• (Ohio rate – 9) • (Ohio rate -17)

 Patient Safety:
SERS ClinicalReporting
Incident Risk Management
Year 2007
500
Quarter 3
446
Facility Cleveland Clinic 450

400
Events Year 2007
Code Severity Description Total 350Quarter 3

Reported Events
A Category A: Circumstances or events that have the capacity to cause an error 140
300
B Category B: Event occurred, did not reach the patient/person 40 Events Initial Severity Code2
C Category C: Reached the patient/person, did not cause harm 162 250Facility Involved
No Harm Potential or Grand
ActualTotal
Harm
D Category D: Reached patient/person, required monitoring/intervention to confirm no harm 104 200
CC 446 60 506
E Category E: Temporary harm to the patient/person and required intervention 52 EUC 46 163
16 157
62
140
F Category F: Temporary harm to the patient/person and required initial or prolonged hosp 4 150FVW 163 32 195
G Category G: Permanent patient/person harm 1 100
HIL 157 29 186 77
60 67 69
I Category I: Death 3 HUR 67
46 13 80
32 37
Grand Total 506 50LAK 69 16 14 8329 13 14 9 11 14
0LUT 37 9 46
MMT CC 140
EUC 11
FVW 151
HIL HUR LAK LUT MMT SPT
SPT 77 14 91

• SERS: Event reporting Grand Total 1202 198

No Harm

No Harm: Severity Level A through D

1400
Potential or Actual Harm

Potential or Actual Harm: Severity Level E through I

Year 2007
Quarter 3
Facility Cleveland Clinic

• Focus on “Harm” events. Timely investigation & Action Plans

Severity Desc Category E: Temporary harm to the patient/person and required intervention

Events
14
Event Type Total 13
Diagnostic Test 2
Equip / Device 3
Fall 12 13
Infection 1
11
Rx/IV Infiltration 8
Monitoring
Other
10
• Disclosure / apology / early intervention 1
9 9
Reported Events

Skin Breakdown 11
8
Treatment/Proc 4
8

4
4
3
2
2
1 1

0
Diagnostic Test Equip / Device Fall Infection Rx/IV Infiltration Monitoring Other Skin Breakdown Treatment/Proc
Focus Area 4: Metrics

DATA: “If you can’t measure it, you can’t manage it”
Edward Deming

• Scorecards for Quality & Safety

• Data drives improvement
• Work to national standards (NQF / IHI / AHRQ etc)
Focus Area 5: External Reports

Safety

Reputation

Volumes / outcomes / cost / safety

Outcomes New York State

Department of Health
2003 – 2005 HOSPITAL AND SURGEON OUTCOMES
QPSI

Communication,
Performance
Education, Training
Improvement
Quality and Awareness

And

Safety

Monitoring and
Accountability
An Approach to “QUALITY” – Cleveland Clinic
• Leadership: A hospital commitment that Quality & Patient
Safety are important.

• A structure to coordinate “quality” activities

• Build a “TEAM” to develop and support a plan for Quality and

Patient Safety.

• Involve the physicians.

• Embed Quality into daily clinical practice.