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September 2018
In This Issue
Sepsis Awareness Month
HIIN Updates
Safety & Preparedness Updates
Quality Reporting News
Upcoming Events
2018 Dick Davidson Quality Milestone Award for Allied Association Leadership
Taking a broad approach to improving the quality of Missouri hospitals has led to MHA being awarded the American Hospital Association's 2018 Dick Davidson Quality Milestone Award for Allied Association Leadership on your behalf. As always, thank you for the continued progress towards achieving the Triple Aim. Listen to Jeff Johnston, Board Chair; Herb Kuhn, President and CEO; and Leslie Porth, Senior Vice President of Strategic Quality Initiatives discuss the quality efforts that lead to this award.
 Dick Davidson Award Video
Sepsis Awareness MonthAccording to, someone dies from sepsis in the U.S. every two minutes. September is Sepsis Awareness Month, and it’s about time.

Time is crucial in identifying and treating this disease. You can help by learning about sepsis and taking action in your organization and community to spread the word.

To help raise sepsis awareness among your colleagues, friends, family and community, take a look at the toolkit that includes infographics, flyers and social media postings.

Role of EMS in Sepsis Care
To help expedite the identification and treatment of sepsis, you are encouraged to engage your EMS providers in sepsis care. Recently, education has been released to help EMS workers identify sepsis in the field and initiate treatment before the patient comes to the ED. To learn more about “Sepsis: First Response,” read the press release, and watch the 15 minute video and 60 minute education module.
Preventing Pressure Injuries in Septic Patients
Sepsis care in the ICU involves major body systems. A prospective study involving 243 ICU patients evaluated the effectiveness of decreasing pressure injuries with a prophylactic sacral dressing in high-risk patients. A checklist is available to help prevent pressure injuries in septic patients.
Early Lactates Improve Outcomes
A recent study showed that sepsis patients who received early lactate measurements had improved outcomes, and that patients in the emergency department had timely lactate measurements 79 percent of the time, while those who developed sepsis as an inpatient had timely lactates only 29 percent of the time. Timely lactate measurements promote rapid interventions and treatment. The full study can be found online.
Best Practice Tip:  Use your clinical decision support tools or care pathways to bundle a lactate draw with blood culture orders!
Did You Know...?
  • A new study offers evidence-based guidelines for appropriate urinary catheter use in common surgeries to prevent complications.
  • Annals for Hospitalists Inpatient Notes — Bedrest is Toxic — Why Mobility Matters in the Hospital was published by the Annals of Internal Medicine as a web exclusive. This article supports the use of Get Up as a cross-cutting strategy to reduce multiple harms and improve patient outcomes.
  • The CLABSI Change Package has been updated for 2018 and offers a menu of strategies, change concepts, and specific, actionable items that any hospital can implement to reduce CLABSIs.
HIIN Updates
HIIN Contract Extension
Thank you for your hard work in submitting data and improving care in your organizations! The HIIN team is reviewing data submission and improvements for the two-year HIIN project. Milestone stipends will be sent to all qualifying hospitals soon. Please check with your hospital improvement advisor for additional information.

The MHA HIIN team is excited to announce that the Centers for Medicare & Medicaid Services currently is considering requests for proposal that would add a six-month extension to the existing HIIN contract. If awarded, the original HIIN contract work would be extended from Sept. 28, 2018, through March 28, 2019.

CMS indicates that the possible extension would expand the focus of, and increase attention on, opioid stewardship. Current improvement work to reduce all cause harm, readmissions and disparities, and to increase patient and family engagement, will remain continued goals in the extension. The MHA HIIN team will keep you updated on the status of the contract as we learn more.

The 2018 HIIN will continue to focus on the overarching topics of high reliability, the UP Campaign, patient and family engagement, and culture of safety development. MHA’s HIIN team will continue to provide a variety of resources through multiple platforms to support participants.

LEAN Six Sigma Green Belt
Coming Soon! Pending contract finalizations, MHA is pleased to announce the second cohort of the Lean Six Sigma Green Belt Program. This program is offered exclusively to the Hospital Improvement Innovation Network participating hospitals. The program is slated to kick off January 2019 with recruitment during the months of October and November 2018. Lean Six Sigma is a performance improvement platform with roots originating in the production and manufacturing industry. Its methodology builds upon a five-step process — Define-Measure-Analyze-Improve-Control — with an intense focus on the removal of errors, defects or “waste,” which is described as any step, motion or resource that does not add value to the process. There will be a broad range of topics to choose from for an improvement project. Begin to consider potential projects and candidates for this exclusive opportunity.
AHRQ ICU Project
In August, MHA welcomed 14 ICUs from nine different hospital organizations into the AHRQ Comprehensive Unit-based Safety Program (CUSP). During this project, units work to improve infection prevention practices, prevent CLABSI and CAUTI, and improve outcomes for their patients. We are proud of these organizations for being committed to patient safety.
  • Boone Hospital Center
  • Mercy Joplin
  • Missouri Baptist Medical Center
  • North Kansas City Hospital
  • Research Medical Center
  • Southeast HEALTH
  • SSM Health St. Mary’s Jefferson City
  • St. Anthony’s | Mercy
  • St. Luke’s Hospital Chesterfield
UPing the Ante
Missouri Hospitals drive improvements UP by taking strides to reduce harms through improvement sprints. Improvement sprints are simple, low-cost ways to apply concentrated efforts toward generating improvement over a short time period. Throughout these MHA Improvement Sprints, each UP component will be broken down to support hospitals in policy development, compliance review, and technical and educational resources. Building the three foundational UP questions into the culture of daily practice will simplify safe care, streamline interventions and reduce multiple forms of harm. The UP intervention is a simple, easy-to-accomplish activity for all staff to use with every patient to create highly reliable care.
UP consists of four components.UP Components
  • Wake UP promotes prevention of over-sedation.
  • Get UP promotes mobilization of patients.
  • Soap UP promotes hardwiring hand hygiene.
  • Script UP promotes the optimization of inpatient medications.
The UP Sprints will begin at the end of October 2018 and continue through March 2019. Hospitals may sign up for the UP Sprints individually, so improvements may be aligned with the current goals of your organization.
While emergency care is important in all hospitals, the emergency department is particularly important in critical access hospitals where the distance to urban tertiary care centers makes the effective triage, stabilization and transfer of patients with the necessary and appropriate information of life or death importance. ED transfer communication measures allow the acute care safety net facilities to show how well they carry out their important stabilize-and-transfer role for rural residents. This measure is required of hospitals participating in the FLEX MBQIP program in Missouri and across the nation.

As of the second quarter of 2018, the following CAHs achieved 100 percent compliance in all EDTC composite scores, putting them in the top performers list of CAHs in Missouri and the nation.

  1. Carroll County Memorial Hospital
  2. Lafayette Regional Health Center
  3. Perry County Memorial Hospital
  4. Iron County Hospital
  5. Ellett Memorial Hospital
  6. Excelsior Springs Hospital
  7. Cox Monett Hospital
  8. Putnam County Memorial Hospital
  9. Harrison County Community Hospital
The graph below shows the ranking of each participating CAH based on the most current 2Q2018 data.
Safety & Preparedness Updates
Sierra Leone Reports New Ebola Species
A recently published article announced the government of Sierra Leone has discovered a new species of Ebola in bats. Even though there is no evidence the new virus has infected people, the EcoHealth Alliance, an environmental nonprofit group involved in the discovery, says it has the potential to infect human cells. Studies continue to understand the pathogen and provide information about how to better protect people.
To Address School Shootings, U.S. Wants Students to Learn Bleeding-Control Techniques
The New York Times recently published an article regarding the Department of Homeland Security grant opportunity to create a program to teach high school students proper bleeding-control techniques.
Aim for Excellence Report 2018
This report summarizes the progress and trends of specific quality measures related to infections, patient safety and readmissions.
CPHQ Review Course Success
MHA hosted a CPHQ review course in July, and more than 30 individuals completed the course. Of those, more than one-third have successfully passed the CPHQ certification exam to date. Congratulations to those who have passed the exam!
Hep C ECHO Begins New Session this Fall
The Hep C ECHO kicked off on Friday, Sept. 7, with new topics that were inspired by the participants.
  • “Roadmap to Screening, Testing, Diagnosis, Treatment, Surveillance and Follow-Up”
  • “Chronic Hepatitis C: Pearls of Diagnosis”
  • “Hepatitis C Updates — Are There Any New Drugs Coming?”
For a complete list of didactic topics, please visit the website. The Hep C ECHO meets the first and third Friday of the month from noon to 1 p.m. Registration for the Show-Me ECHO is required.
HIDI Introduces the ED Super-utilizer Alert
The HIDI Advantage® Alerts and Notification service is designed to provide actionable insights at the right time and in the right place to facilitate transformation of care. Now available through our HIDI Advantage notification portal, participating hospitals will receive alerts regarding emergency department super-utilizers.

The Emergency Department Super-utilizer Alert is created when a patient arrives in the ED who is at high risk for having 10 or more ED or inpatient stays within a 12-month period. This predictive alert is based on the model detailed in the November 2017 HIDI HealthStats. In addition, MHA’s December 2017 Trajectories includes strategies to address the challenges presented by super-utilizers.

If your organization is not already taking advantage of HIDI’s ED Super-utilizer Alert service, contact HIDI to learn how you can get connected to HIDI Advantage.
MHA Publications
MHA has released two new practitioner-focused resources to treat patients with Opioid Use Disorder. The September issue of Trajectories focuses on the medication first model – initiating buprenorphine treatment in emergency departments with community-based treatment supported by peer recovery coaches. This program is a cornerstone of the Missouri Department of Mental Health’s Missouri Opioid State Targeted Response Grant led by the University of Missouri–St. Louis, Missouri Institute of Mental Health. Launched in St. Louis, the medication first model is gaining momentum across Missouri.

In addition, a Quality Issue Brief focused on documentation of Neonatal Abstinence Syndrome care was released as a supplement to the Trajectories publication.

Quality Works® Expands Services
Quality Works® expanded its services to include expertise in facilitating and leading clinical quality, population health, safety collaborations and performance improvement education. These offerings include the following.
To learn how our experts may assist your facility, contact Sherry Buschjost at
CMS Releases HSRs For FY 2019 Readmissions Reduction Program
Read more.
CMS Updates eCQM Value Sets for 2019 Reporting
Read more.
CMS Selects Hospitals for eCQM Validation
Read more.
PSVA Tool Accepting QRDA Files for HWR Measure
Read more.
TJC Releases Specifications Manual Version 2018B
Read more.

More news can be found in MHA Today.

Upcoming Events
Excellence in Clinical Care Series - 
Quality Improvement, Infection Prevention
8 a.m. - 4:30 p.m.
Wednesday, Sept. 26 - Friday, Sept. 28
Camden on the Lake
Lake Ozark, Mo.

2018 Annual Emergency Preparedness
and Safety Conference: Creating Safe
Environments to Give and
Receive Quality Care
Thursday, Oct. 18 - Friday, Oct. 19
Tan-Tar-A Resort
Osage Beach, Mo.

Upcoming Virtual Events
NHSN AUR Reporting:
An Overview and Lessons
for the Antimicrobial
Stewardship Program
11 a.m. - Noon
Friday, Sept. 14
Quality Works Medical Group
Leadership Series:
Provider Recruitment & Retention
Noon - 1 p.m.
Tuesday, Sept. 25
Safe Sleep Webinar
10 - 11:30 a.m.
Thursday, Oct.. 4
For additional MHA events, visit the MHA calendar.

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