AHRQ Tools Help Wisconsin Hospitals Post Big Quality, Safety Gains

Several AHRQ resources have helped Wisconsin hospitals improve the quality and safety of care for more than 4,400 patients. This resulted in a savings of $45.6 million through 2013, according to the Wisconsin Hospital Association (WHA), which spearheaded the initiatives.

Using "tons" of AHRQ tools and resources, the WHA improved quality and safety in a variety of clinical settings in 108 hospitals, said Kelly Court, WHA's chief quality officer. WHA officials reported that AHRQ tools like Re-engineered Discharge (RED) and Comprehensive Unit-based Safety Program (CUSP) were "extensively" relied on to reduce readmissions and healthcare-associated infections (HAIs). A WHA analysis concluded that the hospital quality and safety initiatives:

• Avoided 30-day readmissions for an estimated 3,556 patients. Quality and safety efforts reduced readmissions by 22 percent in 18 months, saving approximately $34.1 million.
• Prevented HAIs for more than 1,000 patients. The hospitals' efforts included a 42 percent reduction in central line-associated bloodstream infections (CLABSIs) from 2008 to 2013; a 37 percent decrease in surgical site infections from 2012 to 2013; and a 33 percent reduction in catheter-associated urinary tract infections from 2011 to 2013. These HAI successes saved more than $10 million in total.
• The WHA participates in the Federally sponsored Partnership for Patients project, which has a goal of reducing hospital readmissions by 20 percent and hospital-acquired harm by 40 percent. WHA achieved that goal for its work to improve adverse drug events and early elective deliveries. The Association was awarded the 2014 Dick Davidson Quality Milestone Award for Allied Association Leadership for its comprehensive quality portfolio and strong leadership.

AHRQ's CUSP, RED Toolkit, and other resources have helped WHA member hospitals improve hospital safety, prevent falls, and increase patient and family involvement in care. "By making these tools available, accessible, and easy to use, AHRQ has allowed us to do more and do it faster than we otherwise could," Ms. Court said.

WHA helps member hospitals improve quality by providing hospital improvement teams with virtual and in-person project coaching. In 2013, for example, nearly 1,800 improvement teams logged into more than 100 web-based learning events to share best practices and hone their skills.

"All of the CUSP tools are woven into our quality improvement efforts," said Ms. Court. To reduce CLABSI rates, WHA began working with hospitals in 2009 to introduce CUSP, an evidence-based method that helps clinical teams address safety issues by combining clinical best practices and the science of safety. It subsequently helped hospitals use CUSP tools to address other infections.

Along with CUSP, AHRQ's RED Toolkit has helped many hospitals in Wisconsin reduce 30-day readmissions and improve care transitions. RED provides evidence-based tools to help hospitals re-engineer their patient discharge processes, including arranging for follow-up care from a primary care physician or specialist, helping patients anticipate and understand pending lab results, explaining new medications, and making follow-up calls to patients to reinforce discharge plans.

Meanwhile, AHRQ's Preventing Falls in Hospitals Toolkit helped 38 Wisconsin hospitals reduce falls by 26 percent. The toolkit focuses on the challenges hospitals face as they try to develop and sustain falls-prevention programs.

"We also rely heavily on AHRQ survey work," noted Ms. Court. "We include AHRQ's Hospital Survey on Patient Safety Culture for our work in 'just culture,' where frontline personnel feel comfortable disclosing errors, including their own, while maintaining professional accountability.” The survey helps hospitals assess staff perspectives on patient safety issues, medical errors, and event reporting.

More recently, WHA started using other AHRQ tools, including the Guide to Patient and Family Engagement in Hospital Quality and Safety. This guide focuses on four primary strategies to promote patient/family engagement in hospital safety and quality of care.

WHA has long used "SBAR" (Situation-Background-Assessment-Recommendation), a component of the TeamSTEPPS program, but has more recently integrated the evidence-based system into its work with member hospitals.

"AHRQ's ability to continue to do what it does into the future will help us," said Ms. Court. "The AHRQ tools enable our staff to focus our work with hospitals on how to improve in their local settings. The ready-to-use toolkits give us a real head start on what to improve."