GNYHA Foundation: Quality Improvement Initiatives

Grant Date: 10.21.2009
Amount: $265,000

The Fund and Greater New York Hospital Association (GNYHA) plan to enhance the existing quality infrastructure through the following four-pronged strategy:
 

1. Strengthen Clinical Leadership and Education: GNYHA and the Fund will continue two important initiatives involving the training and education of clinicians in quality improvement and patient safety, and in standardizing critical care practices across the region.

• Clinical Quality Fellowship Program – The need for physicians who can lead quality improvement efforts remains acute in hospitals throughout the region. In the coming year, we will initiate the second class of the Clinical Quality Fellowship Program, a 15-month structured program to create the metropolitan region’s next generation of clinical quality leaders. The Fellowship Program teaches physicians skills needed to lead quality improvement and patient safety initiatives. Participants learn from a faculty of local quality improvement leaders and engage in hands-on implementation of quality initiatives at their home facilities.
• Critical Care Education and Training – The Critical Care Leadership Network is a forum for leaders in critical care medicine to improve services by standardizing practices and training across the region. In the coming year, the network will continue to address key issues and develop educational programs to standardize critical care training, including programs on initiating end-of-life discussions with families, burn care, and ultrasound image interpretation. The network expects to initiate specific programs for the early identification and rapid treatment of sepsis, and for the elimination of central line-associated bloodstream infections in pediatric intensive care units.

2. Sustain and Deepen Gains in Infection-Reduction Initiatives: Building upon the highly successful first GNYHA and Fund initiative—which focused on eliminating central line-associated bloodstream infections in intensive care units—fighting other health care-acquired infections remains a top priority through the partnership.

• Health Care-Acquired Infection Reduction Efforts – GNYHA is forming a new Infection Control Steering Committee (with Fund representation) to help hospitals set priorities to reduce health care-acquired infections. This committee will develop a strategy for the next step in reducing central line-associated bloodstream infection rates.
• C. difficile Collaborative – GNYHA and the Fund will continue working to reduce the incidence of C. difficile infections in hospitals. In addition, GNYHA and the Fund will offer educational sessions about infection-fighting strategies to long-term care facilities through GNYHA’s long-term care affiliate, the Continuing Care Leadership Coalition.
• Antimicrobial Stewardship Initiative – As a complement to the C. difficile Collaborative, GNYHA and the Fund will develop a pilot for three hospitals and three long-term care facilities to implement antimicrobial stewardship programs. This pilot will expand to include a larger regional group of health care institutions, aimed at ensuring the appropriate use of antibiotics to reduce antimicrobial resistance, specifically related to C. difficile.

3. Broaden Performance Improvement and Service Redesign Initiatives: GNYHA and the Fund will continue two initiatives to improve performance, specifically in implementing Rapid Response Systems and further enhancing perinatal safety. Another new initiative will also be launched, this one aimed at reducing avoidable and preventable readmissions to promote a more patient-centered model for transitions in care.

• Rapid Response System Collaborative – This collaborative aims to reduce the rates for cardiac arrest codes and mortality in hospitalized patients outside of intensive care settings. Rapid Response Systems rely on interdisciplinary teams of clinicians to identify high risk patients systematically, respond to early signs of acute deterioration, and bring critical care expertise to the bedside before patients decline into a critical state. In the coming year, the steering committee of the Rapid Response System Collaborative will work with the newly formed Pediatric Critical Care Leadership Network to develop a modified Rapid Response System initiative for pediatric settings.
• Perinatal Safety Collaborative – In the coming year, the Perinatal Safety Collaborative will focus on data collection and analysis to assess the impact of elective induction and augmentation protocols, teamwork training, and other steps taken to reduce adverse maternal and child health outcomes. The data will reflect both process and outcome measures. A survey will be conducted in the first quarter of 2010 to identify changes over the past two years in staff perceptions of safety. Standardized data reports will be provided to participating hospitals, starting in 2010.
• Redesign of Care Transition Processes – GNYHA and the Fund will launch an initiative—consistent with a larger goal to promote a patient-centered model for effective care transitions—to reduce avoidable and preventable readmissions. GNYHA and the Fund will aim to improve communication between acute care hospitals, long-term care facilities, and community-based providers by developing a comprehensive care transition process. Standardized tools will be developed to enable providers across the continuum of care to communicate effectively about the needs of patients being served and ensure that appropriate follow-up care is accessible and being delivered. These efforts will complement the Fund’s Next Step in Care Collaborative.

4. Disseminate Results: GNYHA and the Fund will continue to disseminate findings and information about the quality improvement partnership through a quarterly Quality Collaborative newsletter that was created in 2008. GNYHA and the Fund will also continue to submit abstracts and other publications to national organizations to publicize this work.