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Home My WebLink AboutMINUTES - 06202006 - PR.1 s L Contra TO: BOARD OF SUPERVISORS FROM '� • William Walker, M.D. �� .4 Costa Health Services Director -- -�rti~4 County a------ DATE: June 27, 2006 SUBJECT: Presentation on the 100,000 Lives Campaign SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT presentation to acknowledge the participation of Contra Costa Regional Medical Center in the nationwide 100,000 Lives Campaign sponsored by the Institute for Healthcare Improvement and the designation of the Medical Center as a national Mentor Hospital for Medication Reconciliation. FISCAL IMPACT: None. BACKGROUND: The 100,000 Lives Campaign is an initiative to engage U.S. hospitals in a commitment to implement changes in care that have been shown to improve patient care processes and prevent avoidable deaths. The Campaign is the first national effort to promote saving a specified number of lives by a certain date. That date is June 14, 2006. The quality of health care in the United States varies greatly. A study in 2003 showed that Americans receive "recommended care"just over 50% of the time. In response to growing national consensus among key provider, payer, and employer stakeholders about the inadequate pace of change, the Institute for Healthcare Improvement launched the 100,000 Lives Campaign in December2004. Since then the institute, a not-for-profit organization whose mission is to accelerate the improvement of health care in the US and internationally, has engaged over 3000 US hospitals(representing over 80% of total US hospital discharges) in this national initiative. Contra Costa Regional Medical Center is one of these hospitals. Although saving 100 000 lives is the primary focus, the campaign team has been building a national infrastructure that can support the rapid spread of improvements in health care now and in the future. This infrastructure includes the following methods that are 'new' to health care: CONTINUED ON ATTACHMENT: YES SIGNATURE: / i -f RECOMMENDATION OF COUNTY^ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTJF APPROVE OTHER SIGNATURES ACTION OF BO D N p W APPROVED AS RECOMMENDED V1 O�ER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. UNANIMOUS(ABSENT AYES: NOES: ABSENT: ABSTAIN: Contact: Dorothy Sansoe(5-1009) � � cc: Community Services Department ATTESTED County Administration O N CULL N,CLERK OF THE BOARD OFSUPERVISORS BY: � DEPUTY Page 2 • Learning with other organizations • Rapid Cycle Improvement • Multidisciplinary Teams • Measuring Success (and Failure) • Recognizing Failure as Opportunity • Care Bundles with Opt Out instead of Opt In The 100,000 Lives Campaign chose to focus their efforts on six ways where proven interventions existed that, if implemented on a broad scale, could save lives. These interventions are: • Deploy rapid response teams to patients at risk of cardiac or respiratory arrest • Deliver reliable, evidence based care for acute myocardial infarction • Prevent adverse drug events through drug reconciliation (reliable documentation of changes in drug orders) • Prevent central line infections • Prevent surgical site infections • Prevent ventilator associated pneumonia CCRMC has teams working on all six of these. We have made excellent progress in all areas. Here are some examples: • No Code Blues occurred outside of the ICU/IMCU/ED in the first quarter of 2006. At risk patients were quickly identified and were either stabilized on the med/surg units or transferred to the ICU/IMCU wheremore intensive care was available. • Smoking cessation education for cardiac patients has nearly tripled. • Admissions with fully reconciled medication lists have increased from 53% to 93%. • New protocols have been developed embraced by the medical and infection control staff to prevent central line infections. • Infections of total joint operations have dropped dramatically. • Ventilator associated pneumonias have dropped to near zero (1 in 2005). This did not occur by accident. The hard work of many, many staff of all disciplines are responsible. Our successes have occurred in part because of: • Setting clear aims (including changes to be spread, target level of performance, target population, and time frame) • Identifying, packaging and implementing proven ideas and practices ; and • Establishing a process for refining the plan in response to learning during implementation. ADDENDUM TO ITEM PR.1 June 20, 2006 PR.1 PRESENTATION to acknowledge the participation of Contra Costa Regional Medical Center in the nationwide 100,000 Lives Campaign sponsored by the Institute for Healthcare Improvement, and the designation of the Medical Center as a national Mentor Hospital for Medication Reconciliation. (Steven Tremain,M.D., Health Services Department) (All Districts) Speakers: Rollie Katz,Union Local 1, conveyed his interest and appreciation for the effort the doctors put into the presentation. Jeff Smith, M.D. and Steve Tremain, M.D., made the presentation before the Board on this day. Supervisor Gioia thanked'all of our health care employees for their contribution to the system. Supervisor Uilkema expressed appreciation and requested statistical data from Drs. Smith and Tremain; i.e., number of babies born, number of transplants, and a general break down of data. She feels this would be very helpful for the Board in order to have some idea of the impact on the community. By a unanimous vote with none absent,the Supervisors approved the Presentation 5-0. REQUEST TO SPEAK FORM (THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: Phone: 0� Address: city: Yn&4)tie (Address and phone number are optional; please note that this card will become a public record kept on file with the Clerk of the Board in association with this meeting) I am speaking for myself or organization: LO CHECK ONE: El I wish to speak on Agenda Item # Date: My comments will be: �General 0 For 0 Against 0 1 wish to speak on the subject of: F-1 I do not wish to speak but would like to leave these comment-- for the Board to consi,-,.�i.r- P/ease see reverse for instructions and important information r .. CCRMC Saving L 0 eves . . . . Contra Costa County Board of Supervisors CCRMC, System Redesign June 20, 2006 i'' CCRMC Saving Lives.... ' Contra Costa County Board of Supervisors CCRA-0C.System Redesign June 20.2006 Purpose Provide overview of IHI and 100k lives campaign Discuss role of CCRMC with 100k lives campaign Institute for Health Care Improvement (IHI) 100k lives campaign Some is not a number...Soon is not a.time Berwick,IHI 2004 IHI Non-for-profit organization founded in 1991 Leading the improvement of health care throughout the world Source of energy and support Knowledge Accelerate change Cultivates concepts for improving patient care Turning ideas into action. IFiI will accelerate the measurable and continual progress of health care systems toward; Safety Effectiveness Patient-Centeredness Timeliness Efficiency Equity Institute of Medicine 2001, Crossing the Oualiry Chasm Brutal Facts The IOM estimates that as many as 98,000 people die each year in US hospitals due to medical injuries. The Centers for Disease Control and Prevention estimate that two million patients suffer hospital- acquired infections each year. More Brutal Facts... The US spends the most money on health care of all (advanced) industrialized nations, but it performs more poorly than most on many measures of health care quality Com arisons across nations Female Infant Spend Spend life exp. mort. per cap. per GDP U.S. 79.4 7.1 54373 13.0% Australia 81.8 5.7 52141 8.4% Canada 81.7 5.3 52428 19.2°/ France 82.5 4.3 52226 19.4% Germany 80.7 14.5 $2616 10.7% Japan 84.0 13.4 151852 7.4% Mexico 177..3 25.9 15452 5.4% 100K Lives Campaign Six initiatives Deploy Rapid Response Teams Deliver Reliable,Evidence-Based Care for Acute Myocardial Infarction Prevent Adverse Drug Events(ADEs) Prevent Central Line Infections Prevent Surgical Site Infections Prevent Ventilator-Associated Pneumonia. What has CCRMC done? Executive and clinical leadership endorsement for all six initiatives Sought and attained support from California Blue Shield Foundation and Kaiser Community Benefit Active involvement of employees on IHI teams at every level Collaboration with other hospitals Methodologies Multidisciplinary approach Rapid cycle'improvement Reliability Valuing local knowledge Collaboration Looking to other industries How are we doing? Rapid Response Teams Acute Myocardial Infarction Surgical Site Infection Central Line Infections Ventilator Associated Pneumonia Medication Reconciliation °/Unreconciletl Metllcations on Atlmission (Baseline tlata compared witb goal antl Jmon[h post implementation of l4edication Reconciliation on Admission a.a 0.]5 f 0.3 0.25 0.15 0 Med baseline) Med(post) Surg Surg IPost� IGU�IMGU IGUIIdGU �baseline� (baseline) 1post� Seriest 0.22 0.01 0.]6 '' 0.05 O.t 0.02 Ventilator Associated Pneumonia rate per 1000 ventilator days CCRMC 20032005 zo ,20 i 15 �104,z; 10 , � 5 2003 2004 2005 3103 hospitals participating What about CCRMC? Mentor hospital for medication reconciliation Hosted IHI open office hours twice IHI site visit Here on May 10,2006 What happened? 122,000 deaths avoided nationwide 1 death avoided every 6'h minutes CCRMC estimate of 20 lives saved since July 1,2005 1 CCRMC death avoided every 17 days Next Steps Celebrate and Accelerate Saturate, Spread,&Sustain IMPACT: Perinatal&Amb. Care Patients as partners what would you attempt to do If you knew you could not fail? Schuller CCRMC Saving Lives • C,Mn Cop,Fowl wu.l C,M"M *y Fn,,.Wpa C-1lima,&Cakw.. If1-.r-,-.� �• _ -�_r-• -;...__.fir � t s , J s CCRMC Saving Lives 7