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NC hospital dramatically improves quality of care with monitoring tools

As the first Level III Trauma Center in N.C., Cleveland Regional Medical Center (CRMC) in Shelby, part of Carolinas HealthCare System, has always placed a special focus on quality. The 241-bed, not-for-profit hospital employs more than 1,100 people and discharges more than 500 patients a year.

Situation:

Process and outcome data suggested that the medical center was struggling with providing patients reliable systems and processes that delivered evidence-based care, particularly related to the outcomes of care for congestive heart failure (CHF), acute myocardial infarction (AMI) and hip and knee surgical patients.

Solution:

Administration decided action was needed. Performance measurement indicators revealed periods of improvement after process improvements were implemented followed by retreat. Reliable process improvement required more than educating staff about new processes. Concurrent review, intervention and real time results monitoring was necessary.

CRMC joined the Premier/CMS Hospital Quality Incentive Demonstration project. Premier consultants and onsite performance engineers using Premier data to guide them, worked with CRMC administration and medical staff – the Quality Circle – to redesign order sets and protocols. Systems management reorganized processes in the quality management department and created a new vision for concurrent chart review and monitoring

Results:

CRMC improved from lowest to highest deciles in CHF, AMI and hip and knee:

CHF readmission rates dropped 37 percent; discharge instructions improved 73 percent.
In AMI, the mortality rate decreased by 25 percent.
Knee infections have been reduced by 70 percent.
Hip infections, too, have had a 36 percent reduction.

"We think highly of Premier and its tools, and we consider our Premier performance engineers, part of our hospital family, having always felt that they would could support us in achieving our quality goals. The ease of involvement in the HQID pay-for-performance project further assured us that we needed to engage in HQID and use the real time monitoring reports to assist us in our improvement efforts."

John Young
President and CEO
Cleveland Regional Medical Center

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