COVID-19 Update

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As the coronavirus spread throughout the U.S. between late January and early March, large-scale testing of people who might have been infected did not happen because of technical flaws and regulatory hurdles, which squandered the country’s best chance of containing the virus’s spread. While this continues to be a national challenge, Missouri has added confusion due to varied information about capacity based on equipment and supplies. It is imperative that diagnostic testing support patient care and surveillance in both health care facilities and community settings going forward.

Early on, initial Missouri testing criteria issued by the director of the Missouri Department of Health and Senior Services were restricted to specific patients and health care workers with known exposure and symptoms. As COVID-19 spread, testing criteria gradually relaxed, and broad diagnostic testing was encouraged with the inclusion of asymptomatic individuals without known exposure for general surveillance analysis. As Missouri’s stay-at-home order sunsets and hospitals begin to resume emergent elective procedures, the need for testing supplies to meet full capacity and demand is critical.

The estimated need for diagnostic testing for patient care, protection of health care workforce, and surveillance – based on national models (Harvard, University of Washington) and corroborated by Dr. George Turbelize of DHSS – project a much higher demand for testing than current status. Based on local and national models, 13,000 tests per day throughout the state is required to meet our current testing need. This likely will expand in the fall as influenza season gets underway.

While emergency care is important in all hospitals, the emergency department particularly is important in critical access hospitals where the distance to urban tertiary care centers makes the effective triage, stabilization and transfer of patients an area of focus. ED transfer communication measures allow CAHs 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 first quarter of 2020, the following CAHs achieved 100% compliance in the ALL EDTC composite score, putting them in the top performers list of CAHs in Missouri and the nation.

1. Carroll County Memorial Hospital
2. Cass Regional Medical Center
3. Cox Barton County Hospital
4. Cedar County Memorial Hospital
5. Excelsior Springs Medical Center
6. Harrison County Community Hospital
7. Iron County Hospital
8. Mercy St. Francis Hospital
9. Mosaic Medical Center - Albany
   
10. Perry County Memorial Hospital
11. Putnam County Memorial Hospital
12. Ste. Genevieve County Memorial Hospital

The HIIN Project ended a couple of months ago. For those facilities who earned a stipend, checks were sent to CEOs and final HIIN reports were sent to HIIN leads in early May. Our nationwide network consisted of approximately 1,600 hospitals, 34 states, regional and local hospital associations, and six Quality Innovation Network – Quality Improvement Organizations (QIN-QIOs). It was among the largest unified endeavors to reduce all-cause preventable harm by 20% and readmissions by 12%. As we often were reminded throughout this project, “Aims create systems, and systems generate results.” Overall, this work contributed significant results in improved patient care nationwide. Since 2016, your involvement in our network has contributed to:

• 16,075 lives saved
• 151,734 fewer patient harms, and
• $1.233 billion in cost savings.

Severe Hypertension in Pregnancy AIM Collaborative

In November 2019, 34 of Missouri’s birthing units, emergency departments and provider clinics joined together to begin Changing Missouri’s Birth Story. Through this collaborative, these organizations initiated implementation of evidence-based guidelines and safety bundles developed by the Alliance for Innovation of Maternal Health to create safe health care for every woman. The focus of this maternal collaborative is to recognize and treat maternal hypertension and preeclampsia to reduce the incidence of stroke and cardiovascular health issues. The need for such implementation comes at a critical time: Missouri’s maternal mortality ranks 44th in the nation – 40.7 deaths per 100,000 live births.

The collaborative completed its first quarter and made some significant impacts in working to Change Missouri’s Birth Story. Fifteen hospitals submitted survey results for the first quarter, with results as follows.

• 80% of units completed a maternal safety drill
• 53% of submitting units had 50% or greater physician and midwife education completed on Severe HTN/Preeclampsia
• 87% of submitting units had 80% or greater nursing education completed on Severe HTN/Preeclampsia
• 11 out of 15 reporting birthing and ED/nonbirthing facility units reported >50% of patients who had a diagnosis of hypertension, preeclampsia or eclampsia were scheduled for a follow-up visit within 7-14 days of discharge

“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.” – William Foster

With the onset of COVID-19 came the need to quickly adapt to changing circumstances and develop innovative strategies to protect our communities, inspire our workforce and safely care for the populations we serve. This innovation and effort helps us slowly mitigate the repercussions of COVID-19 and demonstrate our resolve as a health care community.

Despite COVID-19, the MoAHQ board continued to meet at regular intervals and members have been brainstorming how to support our quality community throughout the state. Having the ability to network with our peers is arguably one of the greatest assets of being a member of a Professional Membership Group. The MoAHQ website is password-protected, but a benefit to membership is having the ability to make connections with other health care providers that share the same fervor and passion for improving the quality of health care. Our members offer decades of knowledge from an array of backgrounds, which can be a great resource for any scenario. If you have not done so already, I encourage you to visit our website at www.MoAHQ.org and get connected.

One membership goal is to provide a platform to recognize outstanding practice and innovative quality improvement ideas. More information will be shared in future editions of the MHA Quality and Safety Update, but we have been planning a few events that we would like to extend to you.

• Poster Presentations – In June, we will solicit a call for poster presentation abstracts to be shared at the MoAHQ Luncheon at MHA’s Annual Convention & Trade Show in November. Ten poster abstracts will be chosen, and topics may be from an array of quality initiatives, including COVID-19 innovative practices. This opportunity is extended to quality professionals and college students actively enrolled in a health care-related field. We acknowledge that budget constraints may pose a barrier to attend the convention in person; therefore, we hope to facilitate remote options, such as Zoom, to share your project with the MoAHQ community.
• Zoom Learning Event – Aligning with our poster presentation call for abstracts, we have all learned lessons in response to COVID-19. In preparing for a potential second surge, we plan to develop a Zoom networking opportunity in early fall to share best practices and lessons learned related to COVID-19.
• Distinguished Quality Professional – For the past several years, we have recognized an individual that has demonstrated great contributions and accomplishments in quality improvement. The nominee application will be published this summer with the award recipient being named in early fall. The recipient will be recognized at the MHA Convention.
• MoAHQ Recruitment – Many of our members have mentioned that attending the MHA Convention is cost-prohibitive, so MoAHQ is offering a scholarship to cover the cost of registration and the MoAHQ Luncheon. Scholarships are based on member activity and recruitment efforts. Please contact me or Jessica Stultz for more information regarding this opportunity.