Clinical Quality

Core Measures of Quality
The Joint Commission and Center for Medicare and Medicaid Services (CMS) have developed a core set of research-based quality indicators which are being used across the nation.  They have established standardized measures of quality in selected patient populations including acute myocardial infarction (AMI), community acquired pneumonia (CAP), congestive heart failure (CHF), pregnancy and related conditions and surgical procedures.  Carle is currently participating in AMI, CHF and CAP.

Acute Myocardial Infarction (AMI)
AMI or heart attacks are a leading cause of death and disability in the US. Carle is committed to providing the best care possible to patients who have had or are having a heart attack.  Carle has focused on providing the most up to date treatments in state of the art facilities for many years. In 2004 Carle was designated a Top 100 Cardiac Hospital in the US.  To reach this level of performance Carle has monitored key process in the treatment of AMI and continually strives to improve. One set of data collected and compared to other hospitals is the AMI Core Measure set. This information is reported to The Joint Commission, American Hospital Association and the Centers for Medicare and Medicaid Services in order to compare to other hospitals. The indicators of care monitored were selected by these organizations as having the most impact on improving the care of heart attack patients. They are:

• Smoking cessation counseling
• Aspirin administration  at arrival
• Aspirin administration at discharge
• Beta blocker administration at arrival
• Beta blocker administration at discharge
• Ace inhibitor administration at arrival
• Ace inhibitor administration at discharge
• Statin administration  at discharge

Carle was recently highlighted by the AHA as providing best practices in Beta blocker administration following many quarters in a row with 100% compliance.

Congestive Heart Failure (CHF)
CHF is a leading cause of death and disability in the US.  Carle Foundation Hospital recognizes the significant impact improving the care of patients who have CHF will make not only of each individual but on the community.  In 2004 Carle selected CHF as a Core Measure and began focusing on ways to improve.  This set of quality indicators includes key processes in care of CHF patients and they are:

• Smoking cessation counseling
• Left Ventricular Function testing
• Ace Inhibitor administration at discharge
• Discharge teaching including diet, exercise, symptom management

Community Acquired Pneumonia (CAP)
Many people are susceptible to getting pneumonia due to their age or other health conditions.  Pneumonia  is both preventable and treatable and should not be a significant health concern however across the nation it continues to be a problem leading to many days in the hospital and sometimes death. Carle Foundation Hospital is committed to improving the health of the community and  therefore selected CAP as a Core Measure.  The quality indicators reported to The Joint Commission, AHA and CMS are:

• Pneumonia and influenza screening and vaccination rates
• Antibiotic selection
• Antibiotic timing

Other Clinical Quality Programs and Initiatives

Critical Care Intensivists
Carle is among the 10% of hospitals that meet a national healthcare coalition's patient safety standard for staffing in the intensive care unit (ICU).  Carle has achieved this high standard since 1995, when it formed a critical care team comprised of two critical care surgeons and three internists. Leapfrog, a coalition of more than 150 healthcare benefits providers, recommends that ICUs be staffed by physicians trained to care for critically ill patients.  Having appropriately trained intensivists on staff and practicing under intensive care protocols reduces mortality in the ICU by 40% and lowers morbidity, according to Leapfrog.

Nursing Research
Carle has established a Nursing Research Committee to support, encourage and disseminate nursing research throughout the organization. The chair of the committee is a nationally known nursing researcher and the committee is comprised of staff nurses from various areas, nursing educators, a librarian and a representative from Foundation Quality.  The Nursing Research Committee mission is:  The Research Committee will provide an infrastructure that facilitates the conduct and utilization of research to support delivery of health care that is evidenced-based and quality-outcome driven.

Nursing research Goals:

• Support the advanced preparation and professional development of practicing nurses.
• Advance nursing knowledge and subsequent care delivery.
• Enhance quality of patient outcomes

The Committee is working to:

• Enhance the quality of patient care and promote positive patient outcomes.
• Promote clinical decision-making based on research evidence.
• Promote effective delivery  of health care
• Promote high levels of nursing education and professionalism.

Skin Pressure Ulcers
It is a nursing goal to preserve the integrity of patients’ skin while in our care. Many things are done in the hospital to prevent damage caused by lying in one position or other pressure placed on the skin by equipment and devices needed to care for patients.  Prevention of skin pressure ulcers is directly related to nursing care provided.  Sometimes it is impossible to prevent pressure ulcers because of a patients condition or illness, although this is not frequent. Therefore hospitals who provide excellent nursing care have low numbers of pressure ulcers that develop in the hospital ( called hospital acquired pressure ulcers).  Everyday that a patient is in the hospital is called a “patient day” and the longer a patient is in the hospital the higher the risk of a hospital acquired pressure ulcer. To measure this hospitals track the number of hospital acquired pressure ulcers per 1000 patient days.