Quality Initiatives Enabling OMHS to Lower Mortality Ratio

OMHS seeing fewer deaths compared to national average levels of hospital care

OWENSBORO, KY – Figures shared by the Institute for Healthcare Improvement (IHI), a national health care improvement organization, show 2006 patient mortality levels at Owensboro Medical Health System were nearly 20% lower than the 2006 national hospital average, reflecting a continuous reduction in mortality at OMHS since 2001.

OMHS achieved a hospital standardized mortality ratio (HSMR) of 61.59 in 2006. A score of 100 is indicative of the national average performance in 2000, with a lower score indicating better quality of care. Overall, hospital care in the US has improved since 2000, so that the 2006 national average HSMR was 76.43. Owensboro ’s score means that the hospital saw 19.42% fewer deaths than what would have been expected had their patients received national average levels of hospital care.

The 2006 figure also punctuates a five-year stretch that saw OMHS reduce its mortality ratio by nearly half. From 2002-2006, the hospital’s HSMR dropped every year, from a peak of 117.75 in 2002 to the 2006 rate of 61.59.  (Comparative data for 2007 is not yet available.)

The reasons behind the improvements point to high medical staff involvement in quality initiatives that started in 2001, when OMHS began collaborative work with the Institute for Healthcare Improvement. Since that time the hospital has successfully implemented a number of actions to improve care through active participation in IHI’s 100,000 Lives Campaign and its Five Million Lives Campaign, which will conclude in December.

“OMHS has adopted every initiative in the Five Million Lives Campaign, based on the success of the six initiatives in the 100,000 Lives Campaign – all designed to eliminate incidents of harm to patients,” said Vicki Stogsdill, chief nursing officer for OMHS. “Many experienced physicians and clinicians chose to become involved in leading our efforts, and our board of directors established quality as our hospital’s chief strategic initiative. The board also established a board quality and safety committee to oversee and work with other hospital and physician quality teams.”

Jim Conway, senior vice president at IHI noted, “IHI celebrates this accomplishment of OMHS, an organization relentless in its pursuit of the highest level of quality. As active members of the IHI IMPACT network (a national community of organizations seeking transformational improvement) OMHS serves as both teacher and student, always sharing the latest innovations and results with other Impact teams, in a spirit of generosity and shared learning. The OMHS board of directors, administrative, and clinical leadership, maintains a consistent focus on overall outcomes for the organization, grounded in passion for excellence in care and caring and a commitment to serving their patients, families, staff, and community.”

In 2007, OMHS set eight employee-dependent quality goals aimed at improving care and OMHS was successful in meeting each one of them, including initiatives to increase nursing certifications, eliminate patient safety hazards and speed patient admissions.

Heart care at OMHS continues to make improvements, including speeding the time to open blocked arteries for heart attack patients, which has been ongoing the past several years. OMHS is eliminating blockages in an average time of 71 minutes compared to the 90-minute standard established by the American Heart Association and the American College of Cardiology.

“When a heart attack occurs time saved is muscle saved for the patient,” said Christopher Havelda, MD, a cardiologist and chair of a task force at OMHS to improve care for heart attack patients. “We established the task force to implement changes that have shortened response times and saved lives so we can enable our patients to have the best outcomes.”

Other notable quality improvements include the following:

• Mortality for open-heart bypass surgery patients is only one-third of what would be expected. In 2006, OMHS was named CareScience Select Practice National Quality Leader in the category of Cardiac Bypass Surgery, excluding myocardial infarction (heart attack) and valve surgery.
• An estimated 474 pressure ulcers have been prevented over the last four years (a 90 percent reduction since March 2003) due to a multidisciplinary approach to prevent skin breakdown, reducing harm to patients and saving an estimated $1.9 million in treatment costs. This effort was recognized in the September 5, 2007 edition of the Wall Street Journal in an article highlighting hospitals that have significantly reduced the prevalence of pressure ulcers.
• Intensive care nurses and the hospital’s Critical Care Team implemented measures that have nearly eliminated the incidence of ventilator associated pneumonia. Because OMHS is part of IHI’s IMPACT network – hospitals that work to achieve rapid improvement through innovative, breakthrough improvement ideas – hospitals across the country have called OMHS requesting copies of the pneumonia action plan over the last several years.
• Rapid response teams of nurses and respiratory therapists are trained to recognize and respond to patient problems quicker. As a result, the number of emergency, life-threatening situations outside critical care units has fallen by nearly 20 percent since 2005.
• Other care-improving measures include initiatives that have reduced the number of patient falls, eliminated blood stream infections, and lowered the number of medication errors and adverse drug events. OMHS has also reduced IV-catheter infections, fine-tuned glucose levels (which helps speed healing) and increased effective communication among hospital staff through the use of common medical language. OMHS also holds daily meetings at 8:30 a.m. to manage patient flow, and patients are encouraged to become more involved in their own care by asking questions about the treatments they receive.

HSMR Defined

The HSMR is a measure of mortality that is used in both U.S. and international hospitals. It compares the number of actual hospital deaths to the number of “expected” hospital deaths, which is calculated for a patient pool based on each individual patient’s factors, such as age, gender, principal discharge diagnosis, and length of stay. The HSMR also adjusts for community or regional factors that could unfairly sway the results. This process of adjusting a measure based on patient and community factors that might impact that measure is called “risk adjustment,” and is used primarily to ensure that hospitals with different patient illness levels can be compared fairly.  

Owensboro Medical Health System serves an 11-county region in Western Kentucky and Southern Indiana . Our mission is to heal the sick and improve the health of our community. OMHS is a full-service hospital, employing a workforce of over 3,000. In addition to hospital and rehabilitation services, OMHS includes the HealthPark – a medical-based fitness center – home health services, a wound healing center, two outpatient diagnostic centers, the Mitchell Memorial Cancer Center and the McAuley Clinic, which provides health care for the uninsured. OMHS also operates Pennyrile Pulmonary Critical Care, Owensboro ; Western Kentucky Rheumatology Center, Owensboro ; Convenient Care, and MultiCare, Madisonville.