The DVT team has earned the clinical iCARE award for November for excellence in quality, in recognition of the team’s tremendous improvement in VTE (Venous Thromboembolism), which includes Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Core Measures hospital wide, and for decreasing the length of stay for our DVT patients.
The non-clinical award for November went to the Clinical Documentation Improvement (CDI) Team for excellence in quality, in recognition of its improvements in clinical documentation.
The CDI team makes a significant impact behind the scenes at Stony Brook Medicine by helping to support the organization and the physician staff through facilitation of accurate documentation of patients’ clinical status. This team works diligently to assist the medical staff in clearly documenting the clinical truth of the patient’s illness, which is the first step in accurately portraying Stony Brook’s quality of care and acuity of our patients. Over the past three years, this small team has made measurable improvements in the hospital’s Case Mix Index, Mortality Index and Severity of Illness scores, which has contributed to the financial health of Stony Brook and resulted in improved Quality report card issued by Medicare, as well as other agencies.
• 12 percent Increase in Case Mix Index (CMI) • 27 percent Decrease in Observed to Expected (O to E) Mortality Rate • 40 percent Increase in Severity of Illness Index (SOI)
The CDI Team, under the direction of Karen Chase, Associate Director, is an integral division of the Revenue Integrity Department. The dedication of Karen and her team has put Stony Brook on the map as a leader of CDI. In the past three years they have had four speakers and two poster presentations at the national conference. They founded and lead the Long Island Chapter of ACDIS to promote best practices. They are truly a team of talented individuals.
The DVT team has worked tirelessly to improve Core Measures related to the lifesaving care of VTE, DVT and PE patients, as well as improve patient care and satisfaction under the Big Q initiative.
The hospital-wide inpatient core measures for VTE are:
• VTE 1- Venous Thromboembolism Prophylaxis • VTE 2- Intensive Care Unit Venous Thromboembolism Prophylaxis • VTE 3- Anticoagulation Overlap Therapy (for IV/ SQ to warfarin) • VTE 5- Venous Thromboembolism Discharge Instructions for Warfarin • VTE 6- Hospital Acquired Potentially-Preventable Venous Thromboembolism
(Note: VTE 4- Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram, was retired.)
VTE made one of the biggest improvements on the United Healthsystem Consortium (UHC) Quality & Accountability report this past year. Stony Brook’s composite VTE score (combining VTE measures 1-6) for Q1 for Years 2013-2015 improved as follows:
• 2013: 69.5 percent • 2014: 82.3 percent • 2015: 94.2 percent That’s a 26.2 percent increase in just two years!
The DVT team collaborated with multiple disciplines to improve patient care and safety. Interventions included:
• Numerous EMR implementations to improve documentation for nursing and ordering for practitioners • Increased amount of equipment needed for mechanical prophylaxis • Utilization of floor appointed dyads and pharmacists to assist with parenteral to warfarin overlap • Increased education provided to nursing; started training new employees on Sequential Compression Device (SCD) machine in orientation • Creation of a Crystal report that runs twice a day to flag patients that do not have the appropriate prophylaxis and are reviewed by floor appointed RN • Ongoing resource and support from the VTE team daily to hospital practitioners
Aside from improving core measures, the team has also been instrumental in decreasing length of stay (LOS) and cost while increasing patient safety and satisfaction. In comparing two six-month periods in 2014 and 2015:
• Inpatient hospital days for DVT decreased by 45 percent • ED admissions for DVT decreased by 32 percent
Some interventions were:
• Establishing a procedure for discharging patients right from the ED • Addition of a NP and a phlebology fellow to the service • Ongoing education for practitioners on the new American College of Chest Physicians (ACCP) guidelines regarding outpatient treatment of DVTs
Congratulations to the VTE and CDI teams for their contributions to quality at Stony Brook Medicine.
Left to right, DVT Team members Kristan Probeck, ANP-C, and Antonios Gasparis, MD, with Carol Gomes, Chief Operating Officer. Not pictured are Pamela Kim, MD, and Doreen Elitharp, ANP-C.
Clinical Documentation Improvement Team