1. SCIP/HF Project Results Primaris June 2, 2011

2. Measures Heart Failure – 3 SCIP-Cardiac - 2 SCIP-Infection - 1 SCIP-Infection - 2 SCIP-Infection - 3 SCIP-Infection - 4 SCIP-Infection - 6 SCIP-VTE - 1 SCIP-VTE - 2

3. Best Practices HF-3: Auto-alerts for continuing ACE/ARBs at hospital DC (for those appropriate patients) has been integrated into hospital’s EHR SCIP-Inf. 1: Considering performance in SCIP metrics in hospital’s credentialing process for physicians SCIP –Card. 2: Implementation of an EHR integrated “flagging tool” to improve compliance Beta blocker use is being flagged, on admission, with protocol to continue post-op, unless physician over-ruled by exception

4. Best Practices SCIP-Inf. 3: Hospital reports implementing auto-stop alerts for prophylactic abxs., and integrating it into their hospital comprehensive EHRs Hospital has implemented a surgical abx. monitoring program that they call “the Antibiotic Stewardship Program.” Process is keyed on an auto-alert type process, using a timing start initiated in hospital E-MAR. Timing process / auto-alert triggers prophylactic abx auto-stop, unless, within 24 hours post; unless over-ridden by the ordering physician.

5. Best Practices VTE-1/2: Using a “rule-out” approach for all admissions Utilizing their EHR with generated alerts, including patient risk-related flags, and VTE prophylaxis start/ timing alerts, in time-frame calculated with EHR Established the 20th hour as “deadline” to implement VTE intervention with process to auto-start at the 20th hour

6. Best Practices VTE-1/2: Implement steps to educate staff on alerts Fully implement a “rule-out” approach to VTE prophylaxis implementation and management for both medical/surgical patients and initiating prophylaxis protocol, unless specifically ordered as contraindication/exception Active support of medical staff and nursing services

7. Teamwork Focused metric review of performance, barriers, and process improvement opportunities Discussed metric performance history with cardiology group and provided ongoing performance feedback Worked closely with nursing leadership and line staff to identify current and potential monitoring/documentation “workarounds” in the hospital’s EHR

8. Teamwork Teamed up with nursing education to correct and resolve documentation problems in EHR Made their medical staff “partners” in the SCIP QI process by providing aggregate, compliance and individual performance reports to staff Conducted ongoing “concurrent review” to identify potential metric outliers Promoted hospital-wide recognition of “DVT Awareness month”

9. Teamwork Recruited orthopedic surgeon as a physician champion member for the SCIP/HF Project Team Broke down measures by physician to identify those that needed reminders and/or official letters Provided physician report cards to show compliance/performance on pertinent measures

10. Teamwork Provided blinded, physician-specific reports at meetings to encourage “friendly competition” with peers Shared unit and/or team specific data to encourage competition and rewards

11. Questions? Visit: www.primaris.org