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Virtua Health

Virtua Health. Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN. TIME IS RUNNING OUT :. ST P THE CLOT!. Virtua Health. Four hospital system in Southern New Jersey Two Long Term Care Facilities Two Home Health Agencies Two Free Standing Surgical Centers (JVs)

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Virtua Health

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  1. Virtua Health Sharon Mindel, Pharm D Terry Rodgers, RN, MSN Jeannie Ritzius, RN

  2. TIME IS RUNNING OUT : ST P THE CLOT!

  3. Virtua Health • Four hospital system in Southern New Jersey • Two Long Term Care Facilities • Two Home Health Agencies • Two Free Standing Surgical Centers (JVs) • Two Medical Staffs (currently merging) • Ambulatory Care - Camden • Fitness Center • 7,100 employees + 2000 physicians • 7,752 deliveries • 8% Operating Margin - #1 in the state of NJ • STAR Culture Virtua receives the JCAHO Gold Seal for:Stroke Center at Memorial,Total Joint Program,and Spine Program

  4. DVT + PE = VTE • 200,000 – 600,00 reports of VTE in the United States annually contribute to 60,000 – 200,000 deaths per year • More deaths than AIDS, breast cancer and highway fatalities combined • VTE is preventable • Many patients at risk do not receive prophylaxis

  5. Risk of VTE in Hospitalized Patients

  6. Project Title: Standard Practice for Venous Thromboembolism (VTE) Prophylaxis Division (s): Marlton Goal/Opportunity/ Description Statement: To increase clinical quality and patient safety and decrease cost associated with VTE Target 90% of patients identified at risk for VTE will be prophylaxed Sponsor (s): Carol Mullin Process Owner (s): Mary Ann Krug, Sharon Mindel, Terry Rodgers, Dee Page, Sabina Zabrodski, Lynn Block Team Members: Sharon Iannece, Mary Saunders, Jennifer Smith Green Belt: Terry Rodgers Master Black Belt: Donna Forrest Black Belt: Jeannie Ritzius Physician Advisor: Dr. Sutherland  

  7. Measure Phase What is the Right Y to Measure? How will it be measured? Prophylaxis of patients assessed for risk of VTE. Discrete data was used to be measured through chart review of discharged patients. What is a Defect? What are the process specifications? Y1 Defect: Not prophylaxing patients identified at risk for VTE USL = none LSL = none Target = 90% based on Sponsor identified CTQ Measurement System Accuracy: An SOP was developed 20 charts were gaged Initial gage revealed 90% agreement Repeat gage after review of SOP revealed 95% correct and agreed upon 20 charts were gaged using hard copy Medical Records This gage also had 95% confidence Data Sources: Medical Records and Net Access 249 Charts manually and electronically

  8. Measure Phase Metrics Initial Z Score for 249 Patients

  9. Pareto Charts for Medical – Surgical Patients

  10. VTE Assessment / Prophylaxis Order Form

  11. Pre - and Post - Pilot Performance Initial Z score for Surgical Patients 8.8% Defects Initial Z score for Medical Patients 57.1% Defects 11.9% Defects from pilot data for Medical Patients

  12. Chi Square Test Results From Pilot • A P-value of • < .05 shows a • statistically • significant • difference Chi Square Test: # Passed-Failed

  13. Project Performance

  14. Accomplishments • Gage completed with 95% confidence • Shared learning with Physicians from Deborah hospital • Piloted electronic chart reviews • Pilot program completed with three Physician groups • Presentations throughout Virtua: • P&T VTE Education with CEU’s • Forms Committee Development of TRIP sheet • Medical Exec for each division Virtua Vine Intranet Education • Quality and Risk Committee Guess the Calf Contest • Quality News letter NEC – MPNEC • Surgical Council Pharmacy Directors • Vendor Expo participation Unit Based Council Education • All day poster presentations on each campus • Individual presentation to physicians / physician groups • Unit Secretary education Dr. Chelemer and Dr. Sutherland worked together with the VTE team to develop the final form for VTE prophylaxis, and presented the form to key committees and departments.

  15. Change Acceleration Process : Leading Change Creating A Shared Need Shaping A Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Monitoring Progress Changing Systems & Structures

  16. Formula for Change Q x A = E Quality X Acceptance = Effectiveness many quality effortsfail due to lack of attention to the cultural and people side of change -- the “A”

  17. Performance after Project implementation to all campuses

  18. Future VTE Measures • VTE prophylaxis addressed in surgical patients with SCIP • Joint Commission/NQF Project – currently testing measures • NQF VTE Steering Committee will recommend specific measures • Anticipate 2008 NQF will endorse measures • No specific plans for implementation

  19. Lessons Learned • System wide focus • Focus on broad range of VOC when dealing with multiple medical staffs • “Over-communicate” • More CAP with physicians: Q X A = SUCCESS • CORE measures can often drive physician compliance • Six Sigma is effective for clinical settings • Development of EMR will improve compliance

  20. Cap – O – Gram C 4/17/07 How likely is this project to be successful ? 100% 90 88 95 C 8/16/06 96 90 80 93 95 88 95 88 92 95 90 75 80 80 90 75 80 80 70 75% 80 75 70 75 75 I 3/17/06 70 70 70 60 65 60 55 A 4/1/06 50% 50 50 45 45 45 M 3/1/05 35 25% 25 D 1/1/05 0 Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Making Change Last Monitoring Progress Changing Systems & Structures

  21. WHAT YOU DON’T KNOW COULD KILL YOU… LEARN WHAT YOU CAN DO TO PREVENT VTE TODAY. Contact Information: smindel@virtua.org – trodgers@virtua.org-jritzius@virtua.org

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