St. Luke's Magic Valley Medical Center in Twin Falls, Idaho, hasn't always had the best Leapfrog Group safety grades. The 213-bed acute care hospital up until 2016 pulled in B's, and in one particularly bad year, D's.
Hospital leadership took a hard look at each measure, and they went to work. Five years in a row, they've received an "A."
"You get ranked by Leapfrog, Healthgrades, IBM Watson, CMS, all these external organizations, and you need to understand why you score the way you do," said Dr. Bart Hill, vice president and chief quality officer of St. Luke's Health System.
This year, 33% of 2,700 hospitals received an 'A' from healthcare watchdog Leapfrog Group. The Leapfrog Group scored 24% of hospitals with a "B," 35% received a "C," 7% received a "D" and 1% received an "F." The group uses up to 27 performance measures to grade how safe a hospital is.
The state of Idaho had the second highest percentage of hospitals graded with an "A" following behind Massachusetts.
The two states couldn't be much different: Idaho ranked second to last in the country for the number of physicians per capita in 2018, according to the Association of American Medical Colleges. Massachusetts, meanwhile, came in first.
"Those disparities in resources makes it (the state score) surprising," said Dr. Joshua Kern, chief medical officer at St. Luke's Magic Valley. "But this just shows, if you put an emphasis on results, even if you don't have resources, you can make the make the needle move."
Some of the raise in Magic Valley's scores were from investing in technology, like an EHR that was implemented in 2016 that enabled computerized prescription order entry. They also targeted surgical site infections, which were high. Almita Nunnelee, who was the the senior quality director for Magic Valley at that time, helped collaborate with surgeons to figure out that the problem was generating from colon surgeries, where some portion of the colon would be removed and two ends are graphed together. Without the perfect seal, bowel material can leak into the stomach and cause sepsis.
"With physician engagement, we leveraged infrared technology to take a look at that joint junction after they've repaired it," Nunnelee said. "The physicians were hungry for that information. They wanted to know how they were performing, they're very competitive, nevermind wanting to do the right thing."
The hospital implemented team training that's resulted in fewer errors and higher employee engagement. Physicians in the emergency department call out orders to other staff, which are then verbally repeated back to ensure accuracy. They've also used a manual tool to track handwashing, another measure from Leapfrog. Employees take five observations each week of whether doctors and others wash hands before interacting with patients, a lower-cost solution than investing in sink technology.
Most organizations have noted that it's more efficient and less costly when quality is made a priority, both for the organization and for the payers, Hill said.
"That being said, you can go bankrupt trying to drive quality with everything," Hill said. "Nurses and doctors typically are showing up trying to do the right things, it's just different pressures or different emphasis being placed on them that that keeps them from doing the right thing."
About three hours east of Magic Valley is Portneuf Medical Center in Pocatello, Idaho. The 205-bed acute care hospital has received two 'B's in a row this year and for last fall, followed by almost four years of 'C's.
They focused on improving their lowest measures, which included prescription barcode administration. Every time a nurse gives a patient medication, they now have to scan the barcode into the EHR.
"It's definitely a safety issue. Let's say the patient was on an order of 10 mg, but you give them 100 mg without doing the scanning, you end up giving the wrong amount," which can lead to bad outcomes, said Jordan Herget, Portneuf CEO.
Portneuf tied the barcode scan into nurses' annual performance reviews, and the hospital went from 30% of medications being scanned to close to 100%. Herget also said they targeted bad outcomes with central line associated blood stream infections, and catheter-associated urinary tract infections by using checklists of around 30 things nurses and doctors needed to do to prevent infections. Without the checklist, care can get missed. The whole endeavor has taken buy-in from all clinical staff, but also from leadership.
"Leadership also has to invest resources and put the tools in place that allow improvements to be sustained," Herget said, and added that they're using a new EHR that will enable computerized physician order entries, another Leapfrog measurement.