Opportunity: 22% of aging veterans return to the ED within 30 days of surgery with 10% getting readmitted.  Average length of stay for readmitted patients is 7 days.

Intervention: Standardized post-operative phone call to occur sooner, redesigned case management rounds and updated contact list for discharging veterans.

Outcome: Time to follow up phone call dropped from 13.3 days to 3.1 days. 

Opportunity: Hospitalized children of parents with limited English proficiency have twice the rate of preventable adverse events. 4% of patients have in-person interpreter during their care.

Intervention: Created process for in-person interpreter availability on morning rounds.

Outcome: 57% increase in the percentage of families receiving in-person interpretation during their hospital stay.

Opportunity: Over 40% of all ICU chest x-rays were ordered through daily standing orders as opposed to as needed, leading to excess harm and cost

Intervention: Removed electronic medical record option for daily CXR ordering

Outcome: Reduced daily CXRs by 90% resulting in more than 13,000 fewer CXRs per year.  Saved nearly $4 million dollars annually.

Spread: Spread across 12 hospital health system.

Opportunity: Late day chemotherapy admissions contribute to continued capacity challenges, leading to inefficient unit flow, patient and provider dissatisfaction, potential increased risk for adverse events, and lost revenue.  

Intervention: Created dedicated patient care areas, eliminated pre-admit outpatient visits and streamlined process for admitting patients earlier in the day.

Outcome: Increased from 4% to 75% of chemotherapy patients being admitted before noon (average now ~10am), reduced hospital LOS by 0.6 days and reduced patients getting pre-admit clinic visit by 75%.

Opportunity: About 30% of PICU patients have a complete and accurate medication reconciliation.

Intervention: Implemented care giver form to document home medications, added med rec tracking in EMR, and added pharmacist responsibility for addressing incomplete med rec.

Outcome: Patients with documented medication reconciliation upon admission increased from 30% to 100%.

Opportunity: Only 80% of dosimeter badges are returned for monitoring resulting in over 3000 badges being unused or unreturned annually.  4% of returned badges have high exposure levels.

Intervention: Changed to less frequent badge returns, streamlined the exchange process and provided participants with access to dose report.

Outcome: Pending

Opportunity: 20% of referrals for orthopedic procedures do not schedule or receive those procedures..

Intervention: Enhanced staffing messaging, surgical scheduling process and standardization of paperwork across multiple clinics  

Outcome: Pending

Opportunity: Reduce inappropriate sedation, allow more interaction with staff and family and accelerate wean from ventilators.  

Intervention: Implemented EHR-based ordered set, scripted rounding template, enhanced view of pain and sedation scores in EHR and educational campaign.

Outcome: 36% reduction in opiate exposure and 18 fewer hours on the ventilator.

Opportunity: 50% of patients with liver failure are not transplant candidates. These patients rarely have palliative care involvement or referral to hospice.

Intervention: Integrated early involvement of palliative care team in transplant evaluation and decision.

Outcome: 100% of patients now receive palliative care consult, 80% within first three days of admission, and 40% of patients deemed not transplant candidates are discharged with home hospice.

Opportunity: Scheduling process allowing for schedules to only be open 31 days in advance causing a referral backup of > 500 patients.

Intervention: Set templates, schedule available 90 days in advance and weekly leadership attention to backlog.

Outcome: 45% increase in number of patients seen; 84% reduction in referral backlog.

Opportunity: Most kids with corrective surgery for single cardiac ventricle do not get recommended care, hastening the need for transplant and significantly shortening their lifespan.

Intervention: Developed multi-disciplinary care approach and pathway to increase number of patients receiving guideline concordant care.

Outcome: 13% increase in number of patients receiving guideline concordant care.

Opportunity: Improve safety of central line placement in pediatric oncology patients. 

Intervention: Streamlined ordering process requiring vital information and dual signature by medical and surgical providers.

Outcomes: Occurrence of central line placement near miss or errors reaching the patient dropped from ~4.5/year to 0/year.

Opportunity: 30% of children with severe abusive head trauma are seen before that visit with potentially identifiable less severe injuries.

Intervention: Implemented nursing screening evaluation for all children < 6 years old. 

Outcome: 83% of patients screened. 3% positive rate with significant referrals to social work and protective services. Minimal impact on provider/staff workflow.

Opportunity: Create telehealth program to provide better access to distant patients. 

Intervention: Implemented clinic-to-home and clinic-to-clinic telehealth program.

Outcome: 469 telehealth patients seen in one year; transfers to inpatient care increased 150% year-over-year.

Opportunity: Patients with late-stage GI cancers spend an inordinate amount of their end-of-life time in the hospital.  

Intervention: Integrated palliative care consultation into care pathway for hospitalized patients.

Outcome: 58% increase in patients referred to ambulatory palliative care; 25% reduction in ED visits at 30 days.Learn more about this project and outcomes here. 

Opportunity: Lack of timely preoperative evaluation leads to frequent cancellations of complex spine surgeries.

Intervention: Creation of risk calculator and lab/imaging protocols; coordinated scheduling of preoperative and spine appointments.

Outcome: 59% fewer cancellations. 4-fold improvement in patients having all labs completed; labs completed 7 days earlier. More than twice as many patients had all imaging completed in timely manner.  

Opportunity: Reduce time patients waited to receive medications.  

Intervention: Optimized the process by using a medication delivery system for all early discharges.

Outcome: Nearly a 60% reduction in total amount of time discharging patients had to wait for medications.

Opportunity: Reduce graft failure of patients ages 13-24 yo. 

Intervention: Developed a program to transition these patients to adult care starting at 14 yo & fully transitioned by 22 yo.

Outcome: Improved making of first appointment in the Adult Kidney Transplant Program from 30% to 70%. 

Opportunity: Improve access to care for pediatric patients with autism. 

Intervention: Shifted tasks to trained nurse to complete initial evaluation.

Outcome: Reduced physician time from 155 to 120 minutes, led to a 55% increase in number of patients seen per physician. 

Opportunity: Decrease length of stay (LOS).

Intervention: Engaged with staff to change culture and treatment of pulmonary hypertension patients.

Outcome: Decreased hospital LOS from 8.2 days to 6.4 days.

Opportunity: Up to 50% of ambulatory antibiotics are inappropriate or unnecessary.

Intervention: Provider education, patient education, and standardized ambulatory antibiotic ordering pathways for common infections.

Outcome: 50% reduction in median duration of antibiotic use for pharyngitis, otitis and COPD exacerbations.

Opportunity: Improving pre- and post-op risk appropriate venous thromboembolism (VTE) prophylaxis.

Intervention: Providers were given training, data, feedback and a financial incentive to improve VTE prophylaxis.

Outcome: Pre-op VTE prophylaxis improved 30%; post-op VTE prophylaxis improved 20%.

Opportunity: Reduce post-operative liver transplant ICU stay.

Intervention: Created intra-operative and PACU care protocols and ICU triage decision tool.

Outcome: Reduced percent of patients requiring ICU stay from 41% to 23%; Saved over $400,000 per year.

Opportunity: Reduce nursing time spent looking for medications.

Intervention: Redesigned Pyxis content and layout.

Outcome: Reduced nursing time to find medication by 21 minutes per nurse per shift. Estimated savings of $76,895 on unit.

Spread: All hospital units: projected benefit of $916,584 per year.

Opportunity: Decrease inappropriate use of IV Levothyroxine among hospitalized adults.

Intervention: Developed an EMR order set that included the appropriate indications for use of IV Levothyroxine.

Outcome: The number of patients receiving inappropriate IV levothyroxine therapy decreased from 79% to 19%.

Opportunity: 90% of Children labeled penicillin-allergic can tolerate penicillin-based drugs.

Intervention: Introduce penicillin pathway and procedures to de-label children at 'no risk'; challenge and de-label those at 'low risk'.

Outcome: 4.2 fold increase in number of children de-labeled from penicillin allergy.

Opportunity: Delays in MRI access result in prolonged length of hospital stay.

Intervention: Streamlined processes for patient screening, transport, and scheduling.

Outcome: 47% reduction in MRI turn-around-time resulting in the equivalent of opening more than 15 available beds per day.  

Opportunity: Poorly coordinated discharge care leads to delays, increased length of stay, and readmissions

Intervention: Creation of multi-disciplinary rounds.

Outcome: 39% increase in patients discharged by noon, 5% reduction in length of stay, and 13% reduction in 30-day readmissions.

Opportunity: Reduce wait time to be seen in clinic.

Intervention: Developed telehealth program, optimized the process for referrals, appointing patients and check in.

Outcome: Reduced wait time for an appointment by 24.1%.

Opportunity: Improve pediatric patients follow up after sleep study showing obstructive sleep apnea.

Intervention: Build and provide scheduler with EMR-derived report and process for follow up visits.

Outcome: Improved time to follow up from 69 to 54 days and follow up appointments from 60% to 87%.

Opportunity: Hemorrhages account for 40% of trauma related deaths.

Intervention: Implemented a resuscitation bundle to improve early treatment of hemorrhagic shock.

Outcome: Appropriate blood product transfusion ratios increased 44%. Trauma mortality improved by 23%.

Opportunity: Reduce length of stay (LOS), improve outcomes in geriatric hip fracture patients.

Intervention: Standardized order set with compliance reporting; cohorted patients on orthopedic unit and service.

Outcome: Reduced LOS by 1 day, decreased readmissions by 16% and reduced 1-year mortality by 48%.

Opportunity: Most children undergoing adenotonsillectomy for obstructive sleep-disordered breathing have an overnight hospital admission for monitoring.

Intervention: Implementation of new perioperative monitoring criteria allowing uncomplicated patients to avoid overnight hospital stay.

Outcome: 31% fewer patients requiring an overnight hospital stay.  No increase in complication rates. Read more here.

Opportunity: Reduce incidence of rescue care associated with operating room pediatric intensive care unit transfers.

Intervention: Standardized order set with compliance reporting.

Outcome: Reduced incidence of rescue care by 43%; projected savings of $403,000 per year.

Opportunity: Improve adherence with well-child care visits in the first year of life. 

Intervention: Development of tracking system, scheduling redesign, patient education, patient incentive, and marketing program.

Outcome: Increased adherence with first five visits in the first year of life from 25% to 78%. Continuity with the same provider improved from < 10% to 74%. Sustained changes for more than 6 years.

Opportunity: Reduce length of stay (LOS) for esophageal surgery patients.

Intervention: Standardized order set with compliance reporting.

Outcome: LOS reduced by 1.1 days and composite harm score reduced by 33%.

Opportunity:  Readmissions are suboptimal for patients and increase costs of care.

Intervention: Created a complex transitions score (CTS) and implemented auto-consulting for high-risk patients.

Outcome: Reduced 7-day readmissions by 32% (7.8% to 5.3%) and 30-day readmissions by 30% (22%  to 15.6%).

Opportunity: Antimicrobial over-utilization results in side effects, excess length of stay (LOS) and avoidable cost.

Intervention: Implemented "handshake stewardship" program.

Outcome: Antibiotic usage reduced by 25%, C. difficile rates by 41%. Reduced LOS for patients on antibiotics by 8% and pharmacy costs by $1-2 million annually.