Much to be proud of, but more work to do on YNHH's quest for quality and safety

Neurosciences ICU staff members review safety procedures to prevent CAUTIs. From left are Alyssa Yardis, RN, service line educator; Cynthia Umpierre, patient care associate; Sylvia Tang, RN; and Brianna Sowell, RN.

There’s a calendar hanging in the Neurosciences Intensive Care Unit (NICU) conference room with several colored stickers indicating the days a fall or hospital-acquired infection occurred.

Staff notice when a new sticker is added – red for patient falls, yellow for catheter-associated urinary tract infections (CAUTIs) and blue for central line-associated bloodstream infections (CLABSIs).

“They really take it to heart,” said Kelly Poskus, RN, patient service manager. “It just makes everyone more determined to prevent future events.”

There has been great progress. Several years ago, there would have been more stickers. The number of CAUTIs that occurred in the NICU dropped significantly over the past few years – from 19, to nine, to only three this past year.

In many ways, the NICU’s experience mirrors that of the entire hospital, where staff, along with physicians, are making substantial progress in improving quality and safety, but constantly strive to do better.

“Everyone knows there’s a patient behind each of our safety and quality numbers,” said Thomas Balcezak, MD, Yale New Haven Health chief medical officer. “The stakes are enormously high, which is why our goals are so ambitious. But people should know that their work is already having a significant impact.”

These improvements were made possible due to Yale New Haven Health System’s high reliability organization (HRO) journey, which started in 2014. Since that time YNHHS has trained more than 30,000 staff and physicians, including 22,000 at YNHH, in HRO “CHAMP” behaviors. Now HRO training is part of new employee orientation and the physician credentialing process, so everyone joining the organization is familiar with CHAMP safety behaviors.

“Contractors working at the hospital have requested training, even though they’re not required to take it,” said Katie O’Leary, RN, executive director, Safety and Quality, YNHHS.

YNHH has seen a more than 80 percent reduction in events of patient harm – from a high of 95 events to a record low of 12. Numerous departments and units throughout the hospital have gone a year or more without a significant event of harm.

At the same time, safety event reporting – especially of near-miss events – continues to rise.

“The increase in near-miss event reporting indicates a growing and healthy culture of safety,” O’Leary said. “Staff are more comfortable reporting safety concerns because they want to find and fix problems before harm reaches patients.”

Other examples of progress: One of YNNH’s quality and safety goals is reducing the number of readmissions for heart attack patients. The stretch goal for 2018 was 64 readmissions; the hospital ended the year with only 34. A recent study showed that between 2017 and 2018, YNHH improved significantly in several measures, including safety, efficiency and patient-centeredness.

“These are incremental – but critical – wins in our quest to get to zero events of harm and meet our ultimate safety and quality goals,” said Steven Choi, MD, chief quality officer, Yale New Haven Health and Yale Medicine. “We have much to be proud of, but more work to do. We will get there.”

There have been other wins in the ongoing quest for safe, high-quality care. For the first time, the hospital received approximately $6 million from the federal Centers for Medicare and Medicaid Services as part of its value-based programs, which reward healthcare providers for the quality of care provided to Medicare patients. YNHH was recognized for reducing hospital-acquired infections.

As Poskus said, “We’re proud of our successes, but we never let ourselves get comfortable. We practice constant, constant vigilance.”