Baptist Memorial Hospital implements changes to reduce mortality rate
Baptist Memorial Hospital-Union City, a 173-bed hospital in Tennessee’s northwest corner just south of the Kentucky border, is part of Baptist Memorial Health Care, Memphis, TN.
Situation:
Participants in the Premier QUEST collaborative were challenged in the first year to achieve a mortality rate 18 percent less than expected (O/E = 0.82). The Baptist Memorial Hospital – Union City staff responded to the challenge to improve mortality. Data gleaned from ClinicalAdvisor® indicated that many patients who were admitted from area nursing homes died within one to two days of admission.
Solution:
A team conducted an in-depth study to identify opportunities to improve end-of-life care, and an interdisciplinary team including medical staff worked to achieve that goal. The hospital:
- Developed a palliative care treatment plan.
- Educated the community about end-of -life care.
- Partnered with nursing homes to help them to provide hospice care within the facilities and establish processes to identify changes in a patient’s condition earlier.
- Instituted a Medical Response Team to ensure that all codes are in the Coronary Care Unit. (It has been 252 days since a patient coded on a medical-surgical unit.)
- Opened inpatient hospice beds in March 2009.
- Identified opportunities for improved coding of palliative care.
- Instituted IHI’s SBAR technique for communication of critical patient information.
- Implemented a hospitalists’ program.
- Created standing pharmacy orders in conjunction with the medical staff.
Results:
Both the mortality rate and the observed to expected ratio have declined.
- The 2009 mortality rate was 1.72 percent. In 2006 it was 2.49 percent; in 2007, 2.16 percent; in 2008, 1.72 percent
- The O/E ratio is below 0.82, top performer level. Baseline was about 1.75; the ratio went as high as slightly more than 2.O in December 2008 just before implemented changes began to take hold.
"Participation in QUEST led us to look carefully at our mortality rate. Using
ClinicalAdvisor we drilled down into our data to determine the root causes. We
determined that it was related to end-of-life care. We put together a team of
hospital and medical staff to understand the challenge even better. The key to
our success has been much improved communication with hospital staff, medical
staff, our hospice and our community. I’m truly gratified by the way everyone
has pulled together. When a terminally ill patient is admitted today, we first
determine the patient’s wish – to receive further treatment or to opt for
end-of-life care – then our team cares for the patient accordingly."
Teresa Vinson
Director of Quality and Review Services
Baptist Memorial Hospital-Union City
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