URMC Wins Quality Awards for Lean, Patient Blood Management and GI Patient Navigation

On April 28, teams from across URMC were honored by the Greater Rochester Quality Council (GRQC) with three awards. Fifteen total awards were presented, covering health care, business and non-profit.

The GRQC, a Greater Rochester Chamber of Commerce affiliate, presents the awards as a way to discover, recognize, and learn from high-performing organizations in the area. Award criteria emphasize results and the effective use of performance improvement tools and practices such as Lean, teamwork, customer focus and project management.

Lean Program: Gold Award

In 2012, there was a renewed effort to incorporate Lean Performance Improvement into the URMC culture. Since then, the strategy has remained in place, and over the last years has evolved to the current model. The approach is showing measurable signs of becoming ingrained in our culture.

At its heart, the strategy means that:

• we incorporate the concepts of Lean into how we do things at URMC, so that it’s not seen as a special initiative, but rather how we function on a day-to-day basis;
• faculty and staff at all levels and in all departments actively identify opportunities to eliminate waste, and leadership supports them along the way to solutions; and
• employees are accountable for continuous improvement, resulting in the superior delivery of the best quality of health care, a consistent patient- and family-centered care experience and satisfied employees.

The Lean core team consists of Sarah Carpino; Tricia Hough; John Lanphere; Sadaf Rauf; Sue Rittenhouse; and Valerie Zacharek.

To demonstrate the implementation of the Lean adoption across URMC, three projects were highlighted in the application:

• Cytology turnaround time project. Recognizing the challenge Cytology had with consistently meeting turnaround time goals for cytology specimens, the department applied Lean techniques, dramatically improving their results. Through this project the team surpassed their targets, increasing capacity while lowering costs. Brendan Boyce, M.B.Ch.B.; Deborah Congdon; Dawn Costello; Mike Facik; Michelle Fuller; Kim Handley; Nathan Loria; Marilyn Menegus, Ph.D.; John Plavnicky; Tamera Pulver; Maimoona Ramaswamy; Robyn Sage; Nicole Truax; Vicki VanDeWalle; Tonya Wyatt; and David Zhou, B.Med., Ph.D., contributed to the Cytology initiative.
• Air handler filter inspection and replacement project. Incorporating a data-driven workflow reduced the direct cost and associated labor costs of maintaining the hundreds of filters used across the institution. Reduced energy costs alone accounted for over $137,000 in savings. D. Antonetty; J. Capellupo; D. Coleman; B. Hamm; J. Hinkel; K. Honan; D. Miles; B. Morey; A. Smith; D. Steedman; S. Teugeman; and J. Wasielewski from Facilities led this project.
• Reducing catheter-associated urinary tract infections (CAUTI) in an ICU setting. Stemming from a concern for patient safety and a desire to improve patient outcomes, this multi-disciplinary task force focused on staff education, alternative and standardized supplies and improved processes to cut the CAUTI rate. Melissa Bronstein, R.N., M.P.A., C.I.C. (Infection Prevention); Ann Marie Pettis, R.N., B.S.N., C.I.C. (Infection Prevention); Marcy Metroyanis, R.N., M.S.N. (Nursing); David Kaufman, M.D. (Medicine); Paritosh Prasad, M.D. (Medicine); Vicki Vandewalle (Lab); and many others participated in this effort.

Patient Blood Management Program: Silver Award

In July 2014, the institution began work to establish a Patient Blood Management (PBM) program. Its goal was to implement scientifically based transfusion practices across the entire Medical Center.

The program combines education, a strong evidence base, data collection and analysis and communication, which has culminated in tighter management of UR Medicine blood transfusions. Through relentless education and auditing, the PBM program has cut out unnecessary transfusions and reduced complications (and their associated costs).

In one year, there was a 22 percent decrease in utilization, which translates to direct purchase cost savings of over $1.1 million and an estimated 199 fewer complications. This reduction in complications translates to reduction in patient days, fewer nursing hours and ultimately reduced mortality rate for patients.

Department of Pathology Transfusion Medicine—Patient Blood Management Program core team members are William Andrews; Neil Blumberg, M.D.; Christine Cahill, M.S., R.N.; Amy Kievitt, M.T.; Scott Kirkley, M.D.; Debra Masel, M.T.; Majed Refaai, M.D.; Amy Schmidt, M.D., Ph.D.; Pathology residents; and blood bank technologists.

GI Patient Navigator: Bronze Award

Over the past few years, no-shows for colonoscopies were becoming an issue for UR Medicine’s Gastroenterology and Hepatology (GI) division. The test is a minimally invasive procedure that screens for colon cancer, and it involves a very particular preparatory diet starting three days before the visit. Early detection of colon cancer is imperative to allow for multiple treatment options, and with increasing demand for the test since the Affordable Care Act in 2010 mandated full coverage of the screening by insurance plans, the GI department had to rethink their daily business processes.

Why the former 14 percent no-show rate? There were a handful of reasons, a major one being a gap in pre-procedure patient education. Patients weren’t being reminded of their appointment and the details of the steps they needed to take to prepare for it more than three days in advance. With the creation of the new GI patient navigator position, patients are now called 5-7 days before they’re due in, with an appointment reminder and in-depth review of prep. GI patient navigators also try to uncover and resolve any possible barriers to the patient making it in.

The no-show rate now holds at 4 percent, yielding healthier patients and providers whose time is better spent with appointments going as planned.

Natalie Appleton; Marcia Fowler, M.S., FNP-C; and Sadaf Rauf, MSHA undertook this task.

“URMC has always been focused on delivering high-quality health care and the best patient and family experiences,” says John Lanphere, director, Performance Improvement. “Lean principles give us another set of tools to improve the way we achieve those goals. With so much changing in the delivery and business of health care, it’s great to see the quality work of our teams recognized in the region. It helps to inspire others to learn and look for ways to improve even more.”

The Greater Rochester Quality Council is a collaborative network of organizations and individuals whose expertise is quality and performance excellence. Its purpose is to stimulate and foster excellence in the products, services, and processes of all organizations and businesses in the community so that the Greater Rochester area continues to grow economically and attract new business. They promote sharing of resources, learning and expertise in quality principles and practices.The Greater Rochester Chamber of Commerce serves, promotes and advocates for its members in order to secure economic prosperity for our region.