Implementing an electronic medical record (EMR) turned out to be one of the driving forces that resulted in a New York State hospital being recognized as one of the best in the country. Concurrent monitoring of patient quality measures also propelled the hospital to top status.
The Joint Commission has named South Nassau Communities Hospital in Oceanside a Top Performer on Key Quality Measures for the third consecutive year. South Nassau earned the award for its use of evidence-based clinical processes that are shown to improve care for the following conditions and services: heart attack, heart failure, pneumonia; surgery, children’s asthma, inpatient psychiatric care, venous thromboembolism, stroke, perinatal care, and immunizations.
South Nassau is one of 1,043 hospitals in the U.S. to earn the distinction of Top Performer on Key Quality Measures. The ratings are based on an aggregation of accountability measures data reported to The Joint Commission during the 2014 calendar year. The list of Top Performer organizations represents 31.5% of all Joint Commission-accredited hospitals reporting accountability measure performance data for 2014.
The following accomplishments helped South Nassau earn Top Performer on Key Quality Measures:
- achieved a cumulative performance of 95% or above across all reported accountability measures,
- achieved a performance of 95% or above on every qualifying accountability measure reported, and
- had at least one core measure set that was a composite rate of 95% or above, and (within that measure set) all applicable individual accountability measures had to have a performance rate of 95% or above.
Each accountability measure represents an evidence-based practice such as giving aspirin at arrival for heart attack patients, giving antibiotics one hour before surgery, and providing a home management plan of care for children with asthma.
BETTER MONITORING IMPROVES CARE
Success in those areas was possible because of how the EMR and concurrent monitoring improved the hospital’s ability to get a current and more accurate assessment of quality measures, says Rita Regan, RN, BS, CPHQ, assistant vice president of performance management and care transitions at South Nassau.
“It used to be that after the patient was discharged from the hospital, we would review charts and find the occasional missed opportunity where better care or better documentation could have helped us have better compliance with the best practices,” Regan says. “Since then, we went to concurrent monitoring by being in the electronic record on daily basis, looking for best practices and the right documentation to show that if we didn’t, something there was a very acceptable reason.”
For example, if the EMR shows that a heart attack patient did not receive an aspirin after admission, South Nassau staff look for a legitimate reason documented in the record, such as the aspirin being contraindicated because of bleeding or an allergy.
“When we’re in the chart daily we can find those things, and if documentation is missing we can look into it in real time,” Regan explains. “We will get in touch with the doctor and either have the oversight addressed, or we will have the reason documented. As the EMR developed, we actually put omission orders into the order set to make it very easy for the practitioner to document that and not have to write it in a narrative note.”
South Nassau also emphasizes educating staff on quality measures, both clinical and those related to patient experience. Staff often are more familiar with clinical quality measures and what quality means from their perspective, but they may be less attuned to measures of patient experience, Regan notes.
“We help them understand what quality means to a patient, what makes them want to always come back to us at South Nassau because they received great care and we paid attention to the personal needs of both the patient and the family,” she says. “We incorporate all of these things into every orientation. Every physician, physician’s assistant, and nurse practitioner that is onboarded to our staff meets with some from the Performance Management Department so that they know very clearly what the expectations of the hospital are.”
Clinicians are told that the hospital wants to work in partnership with them to ensure that all patients receive care that meets best practices, and that the hospital is willing do what’s necessary to help the clinicians achieve that. The hospital developed standardized order sets, for instance, and incorporated alerts into the EMR. Regan and her colleagues at South Nassau focus on improving the system so that it is easier to do what’s best for the patient.
The EMR also scores patients on admission for risk of certain complications like a blood clot. If the patient scores high on that risk assessment, the EMR alerts the physician and directs the nurse to confirm that there is an order for the appropriate therapy.
“Its little things like that that help educate and structure the workflow so that you’re set up for meeting best practices,” Regan says.
The aggregation of accountability measures data comes from the scores of quality measures recorded by South Nassau. Regan points out that the high composite scores did not hide lower individual scores.
“With our stroke program, for example, we got 95% on the composite of the stroke core measures, but each individual core measure that makes up that 95% was also at 95%,” she explains. “It’s not that we were 40% in one and 100% in everything else, so it averaged well. You have to 95% on everything in a particular set to get this recognition.”
Patient handoffs have the potential to disrupt the continuation of best practices, so South Nassau emphasizes communication along the continuum of care. Regan says that it is crucial for physicians and staff to document well and have a clear understanding of when certain best practices must take place — on admission, within 12 hours, by day two, or on discharge, for example.
It also is important to have qualified abstracters, Regan notes. South Nassau has RN coordinators who all have expertise in chart abstraction and understanding CMS guidelines. They maintain good relationships with the physicians and other practitioners so that they can reach out to them when needed and work productively, Regan says.
“Our goal is not to be a Joint Commission Top Performer. Our primary goal is to do the very best we can for each individual patient,” Regan says. “If you keep it about the patient in the bed and making sure they get all of the evidence-based care to get optimal outcomes, your compliance, scores, and recognition will follow.”
SOURCE
- Rita Regan, RN, Assistant Vice President, Performance Management and Care Transitions, South Nassau Communities Hospital in Oceanside, NY. Telephone: (516) 632-4993. Email: [email protected].
