Through NJHA’s Health Research and Educational Trust of New Jersey (HRET), innovative collaboratives encourage providers to take leadership on issues of quality and safety, and learn from each other in the process. Improvements made through these collaboratives save lives, reduce costs of care and distribute best practices across the state. Here are some of the initiatives NJHA and its members are carrying out:
The New Jersey Antimicrobial Stewardship Learning Action Collaborative promotes the use of the appropriate type, dose, duration and delivery of antibiotics to improve quality of care and safety while reducing costs attributable to inappropriate antimicrobial use.
Antibiotics are some of the most widely prescribed drugs in medical practice, yet, according the Centers for Disease Control and Prevention, up to 50 percent of all antibiotics prescribed are either not necessary or are not effective as prescribed; this has become widely recognized as a top public health priority, with overuse of antibiotics one of the key factors contributing to the rise in antibiotic-related illnesses.
The collaborative’s work has already reduced the rate of antibiotic-resistant C. difficile infections – a type of intestinal infection – in just its first year.
Hospital Improvement Innovation Network
In 2016, HRET was selected as one of 16 organizations nationwide to continue efforts in reducing preventable hospital-acquired conditions and readmissions.
These Hospital Improvement Innovation Networks (HIIN), a project of the Centers for Medicare and Medicaid Services, work to reduce patient harm and readmissions. From 2012 through 2016, the initial work under this national effort helped New Jersey’s healthcare community prevent 77,342 cases of harm and avoid $641 million in unnecessary healthcare costs.
Through 2019, HRET and the other HIINs will work to achieve a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions.
Collaborative work done through the HIIN addresses common healthcare-associated harms, like infections from catheters, ventilator-associated pneumonia, preventable injuries from falls and sores that can develop from constant pressure on the skin called pressure injuries.
The HIIN uses webinars, interactive trainings and peer-to-peer learning to encourage best practices for avoiding patient harm and improving safety. Data sharing and analysis is also a critical component.
More information on the core improvement areas and how New Jersey’s providers are responding can be found at www.njha.com/PFP/NJTools.
Diabetes Prevention Program
Through a partnership with the NJ Department of Health, NJHA’s HRET serves as a Diabetes Resource Coordination Center, working with hospitals, community health centers, community-based organizations and other provider and community stakeholders to maximize participation in diabetes education programs.
High Reliability Organizations
NJHA’s newest collaborative is focused on taking lessons learned in high-risk fields like aviation and nuclear energy and applying these safety innovations to the healthcare community. Leadership teams from hospitals and health systems are engaged in the High Reliability Organization Collaborative, learning how to create an organizational structure and teamwork-based safety culture that ensures inevitable human mistakes do not lead to patient harm.
Patient and Family Engagement
Studies suggest that patients and families who feel part of the care team tend to be happier with their care and ultimately have better medical results. They are more likely to comply with their treatment and prevention plans, less likely to engage in unhealthy behaviors and have fewer emergency department visits and hospitalizations.
Through the New Jersey Patient and Family Engagement Collaborative webinar series, hospitals and health systems focus on patient and family advisory councils, education and maximizing diversity in both the patient and family-centered care work. It has been well documented that diverse patient and family advisory councils support organizational improvement that delivers high-quality, culturally appropriate healthcare and disparities in healthcare and health outcomes.
Perinatal Quality Collaborative
The New Jersey Perinatal Quality Collaborative is one of 13 state organizations awarded funding from the Centers for Disease Control and Prevention to improve the quality of care for new moms and babies throughout the state. The Perinatal Quality Collaborative is working to reduce early deliveries, severe complications such as infection and hemorrhaging, ethnic and racial disparities in birth outcomes and the number of cesarean sections for low-risk, first-time mothers.
The Perinatal Quality Collaborative has already worked to cut the early-elective delivery rate in the state in half, and birthing hospitals around the state reduced adverse obstetric events by 34 percent, saving the state more than $34 million from 2012 to 2016.
Safe CT Imaging
Medical professionals worry that overuse of CT, or computed tomography, scans for head injuries are exposing kids to a new risk – an increased potential for cancer due to radiation. Minor head injuries occur commonly in children and adolescents, and approximately 50 percent of children who visit hospital emergency departments with a head injury are given a CT scan. Research shows CT scans are not necessary in the immediate evaluation of minor head injuries. By utilizing clinical observation and the Pediatric Emergency Care Applied Research Network (PECARN) criteria, physicians can determine whether imaging is appropriate, reducing unnecessary exposure to radiation.
The #SCANSMART program, developed and promoted by the Safe CT Imaging Collaborative, educates parents, coaches and physicians on the PECARN criteria to determine if a CT scan is appropriate. Within the first year of the collaborative, 47 hospitals signed on to reduce children’s exposure to radiation from unnecessary CT scans.
Through the Sepsis Learning and Action Collaborative, hospitals across New Jersey implemented life-saving sepsis detection and care tools, resulting in nearly 400 lives saved in one year of targeted action.
Sepsis is a life-threatening reaction by the body to infection. Because symptoms resemble the flu or other common illnesses, sepsis is difficult to detect and difficult to treat in advanced stages. Sepsis is among the top four most expensive conditions for hospitals, according to research from the Healthcare Cost and Utilization Project and the Agency for Healthcare Research and Quality. More than 1.1 million people in the United States were diagnosed with sepsis in 2008.
Beginning in late 2014, member hospitals voluntarily reported sepsis data to NJHA, as well as participated in peer-to-peer learning through webinars, in-person sessions and expert presentations. They also adopted standardized screening tools and a “bundle” of treatments as best practices in their facilities. By the end of the first year of work, the rate of sepsis mortality decreased 10.76 percent. The collaborative has extended its work to specify best practices for neonatal intensive care units, maternal sepsis care and how emergency personnel have a role in preventing sepsis.
By innovating together to focus on specific areas of patient safety, New Jersey’s healthcare community embraces quality improvement as part of its culture.