Performance Improvement & Analytics. South Shore Hospital Case Study

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Brenda Summers
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1 Performance Improvement & Analytics South Shore Hospital Case Study

2 South Shore Hospital 2

3 South Shore Background Multiple project opportunities Birthing Center was most pressing and would benefit significantly State funding directly related to hospital performance Higher patient satisfaction scores translates to more money for hospital to maintain or improve the patient experience More competitive due to decreases in available funding Among state s highest Cesarean section (C-section) rates Concern for immediate and lasting effects on mother and baby Less profitable than vaginal births 3

4 Environment Obstetrics Unit at South Shore Hospital (Birthing Center) 6-bed Triage area 15 Labor & Delivery (L&D) suites 4 dedicated Operating Rooms (OR) 6-bed Pre-/Post-Anesthesia Care Unit (PACU) 30-bed Mother-Infant Unit (MIU), with nurseries 10-bed Maternal Special Care Unit (MSCU) Neonatal Intensive Care Unit (NICU) Approximately 3700 deliveries per year Staffing Nursing staff employed by hospital Physician staff (MDs & Midwifes) employed by private practice groups Two Laborists employed by hospital MIU MSCU L&D Triage OR PACU NICU 4

5 Objectives Initial goals of the project were to optimize patient flow through the Birthing Center and reduce the C-section rate More specifically, the primary objectives were to: Improve patient throughput Improve staff productivity Improve procedure scheduling Improve mechanisms to reduce the C-section rate 5

Performance Improvement Process Staff interviews and feedback Personal observations Data analysis Process flow maps Value stream mapping session

6 Performance Improvement Process Staff interviews and feedback Personal observations Data analysis Process flow maps Value stream mapping session Focused on identifying constraints and bottlenecks Weekly steering committee meetings Reps from senior leadership, nursing staff, provider groups, and others 6

7 Metrics Metrics were developed in support of the stated objectives, and baseline values were established Additionally, targets were set for each metric These targets represent the expected improvements to be realized over a 12- month period Metric Baseline Value Target (improvement) C-section Rate 42.2% 38.0% (10%) LOS (Vaginal Delivery) 2.68 days 2.55 days (5%) LOS (Delivery via C/S) 4.39 days 4.17 days (5%) C-section On-Time Performance 32.4% 48.6% (50%) Discharge Delay 3.71 hours 2.97 hours (20%) 1 st C-section On-Time Performance 44.4% 66.6% (50%) Discharge by Time Rates n/a * 30%/50%/70% ** Postpartum Recovery Time 5.5 hours 2.75 hours (50%) no data had been collected previously, so no baseline was available ** percent of discharges completed by 11:00 AM, 12:00 PM and 1:00 PM, 7

8 Challenges Reducing the C-section rate is primarily a clinical decision Change had to occur at the provider level Many had been practicing (the same way) for a long time Oftentimes convenience was a factor, due to practice commitments Due to arrangement of provider groups, floor coverage could be an issue Shouldn t plan for chaos but nearly everyone does Approach supported by the fact that, in an emergency, things get done Two sides to every story Root-cause analysis by scenario and/or across units Real skepticism that process changes could impact clinical decisions 8

9 Performance Improvement Initiatives Method Changes C-section rate analysis MIU discharge monitoring Induction management Change Management Provider performance monitoring tool Discharge tracking system

10 C-section Rate Analysis Little visibility into who were the worst offenders Even less accountability for decision to section a patient In non-emergent cases, no second opinion prior to procedure Limited peer review after the fact Generalization by providers that their patient population was unique Data review identified rates for each provider Distinguished scheduled, non-emergent, and emergent cases Distinguished primary and repeat procedures Identified primary indication for sections Provided leadership the information to speak with providers Providers shown their rates for the first time in years Resulted in clinical discussions and self-reflection Several new protocols were initiated as a result of this awareness 10

11 Provider Performance Monitoring Tool Used to give an overview of C-section rates Allows leadership and provider to view relative performance, and changes over time Can drill down to look at specific deliveries Births C-sections Scheduled Non-emergent Emergent Primary Repeat Provider Provider Group Hospital

12 MIU Discharge Monitoring Delays in discharging patients were causing dissatisfaction and boarding in the Birthing Unit Patients scheduled to leave were routinely waiting until late afternoon or early evening before being discharged, despite being clinically ready Conversely, patients wanting to leave were sometimes delayed while waiting for discharge orders MIU staff didn t measure their effectiveness Unsure of how many patients were discharged by designated times Limited data collection regarding reasons for delay By beginning to track these two issues, the MIU staff was able to focus its efforts and saw an immediate improvement in discharges Work is continuing, but trending in the right direction 12

13 Discharge Tracking System MIU Discharges by Time Goal: 70% Goal: 50% Goal: 30% 13

14 Induction Management Staff hypothesized that lengthy/failed inductions were a significant cause of non-emergent C-section Conducted analysis of induction rates, by provider Looked at breakdown of deliveries for induced patients Further analyzed whether failed inductions resulted in emergent or nonemergent sections Analysis of Pitocin start times and delivery times supported the assertion Also showed the impact of cervical ripening Evidence led to rework of hospital induction protocols Updated criteria based on most recent clinical guidance Removed ambiguity from process fixed criteria determine a patient s level, patient s level determines priority for scheduling induction 14

Preliminary Results Again, improvement efforts were designed to realize results over a 12-month period from project inception These results reflect gains that have been observed over 2 to 3 months

15 Preliminary Results Again, improvement efforts were designed to realize results over a 12-month period from project inception These results reflect gains that have been observed over 2 to 3 months since new processes were implemented during the course of the project Results are based on cumulative measurements observed since process implementation Metric Target Latest status (improvement) C-section Rate 38.0% (10%) 37.0% (12.2%) LOS (Vaginal Delivery) 2.55 days (5%) 2.74 days (-2.2%) LOS (Delivery via C/S) 4.17 days (5%) 4.34 days (1.1%) C-section On-Time Performance 48.6% (50%) 45.8% (41.2%) Discharge Delay 2.97 hours (20%) 3.52 hours (5.1%) 1 st C-section On-Time Performance 66.6% (50%) 57.1% (28.6%) Discharge by Time Rates 30%/50%/70% 17%/47%/68% Postpartum Recovery Time 2.75 hours (50%) unknown 15

16 About CTC Enterprise Ventures Corporation

17 Overview EVC is a wholly owned affiliate of CTC Together we provide Applied Research, Development, Professional Services, Consulting and Production services to public sector, healthcare and commercial clients around the world Support numerous Government and industry clients as a Trusted Partner Enable Government and industry clients to reach out and draw the best of breed technology solutions and services Experienced prime contractor and systems developer/integrator across the United States Federal Government Certifications: CMMI Level 3, ISO 9001/14001, and AS9100, VPP Extensive Center of Excellence experience and partnerships with industry, universities, and laboratories 1,300 people across 50 locations 17

18 Consulting Solutions Performance Improvement Strategy BI, Analytics, Big Data Enterprise Content Management Customer Relationship Management Mobile Privacy, Security Business Process Management 18

Welcome to The Mount Sinai Hospital online Maternity tour. The Klingenstein Pavilion is home to the Kravis Women s Center and all childbirth related

Welcome to The Mount Sinai Hospital online Maternity tour. The Klingenstein Pavilion is home to the Kravis Women s Center and all childbirth related services. We are located at 1176 Fifth Avenue between