The Quality Expo is an opportunity for improvement projects created by employees to be shared as part of the Henry Ford Health culture of continuous process improvement.
For more information, visit https://onehenry.hfhs.org/departments/qualityandsafety/Pages/Quality-Expo.aspx
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Project #01: Insulin Prescribing and Glycemic Control in Response to a Steroid-Induced Hyperglycemia Best Practice Alert
Nicole Bullock, Anna Eursiriwan, and Kevin Szyskowski
Background: The American Diabetes Association (ADA) recommends intermediate-acting insulin NPH or longacting insulin glargine for steroid-induced hyperglycemia in patients with diabetes mellitus (DM). At Henry Ford Jackson Hospital (HFJH), methylprednisolone is associated with a high incidence of hyperglycemia. HFHS implemented a Steroid-Induced Hyperglycemia Best Practice Alert (BPA) to prompt insulin prescribing (NPH or glargine) in patients with recent hyperglycemia (BG >200 within 24 hours) and a new steroid order.... Read More
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Project #03: Global Patient Navigator Initiative: Optimizing Services for International Patients at Henry Ford Health
Jamie Vollenweider
In 2016, after identifying opportunities to improve the international patient experience, International Patient Services (IPS) was developed as a division of Henry Ford Health International. Since its inception, IPS has collaborated with various departments throughout the system to develop processes and policies specific to our international patient population. The goal was to create a standard process for registration, appointment scheduling, cost estimates, and payment collection all while providing world-class... Read More
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Project #04: I-C-U Continuing Antipsychotics at Discharge
Joseph A. Gregor, Angela Nguyen, Cassandra Falk, and Vince Procopio
Antipsychotics are often utilized in the intensive care unit (ICU) for acute delirium. These agents are often continued after delirium resolution upon a patient’s transfer to general medicine units or hospital discharge. Unnecessary continuation increases risk of QTc prolongation, anticholinergic side effects, and mortality in elderly patients with dementia. The Confusion Assessment Method for the ICU (CAM-ICU) can be performed periodically to help determine if antipsychotics are still warranted... Read More
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Project #05: Evaluation of Half-Dose Prothrombin Complex Concentrate in Cardiac Surgery
Dalia Kassabieh, Jessica E. Obioma, Long To, Joe Younan, Jennifer Brown, and Benjamin August
Background: Cardiac surgery inflicts multiple stressors on the coagulation system, sometimes leading to excessive bleeding post-cardiac surgery and requiring blood component transfusions. Pre-incision treatment with full-dose four-factor prothrombin complex concentrate (4F-PCC) (25 units/kg) has been used satisfactorily in reversing acute periprocedural bleeding time, volume, and associated costs. 4F-PCC poses a substantial cost burden on medical centers, with a cost of approximately $1085 per 500-unit range vial. Purpose: To evaluate... Read More
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Project #06: Lung Cancer Screening in Patients Prescribed Smoking Cessation Therapy at an Integrated Health System
Paige T. Stratton, Jewel Konja, Brooke Putrus, Katelyn Patterson, Amber L. Martirosov, and Nancy MacDonald
Smoking is one of the leading causes of lung cancer and, per the CDC, within 10 to 15 years after quitting smoking, the risk of lung cancer decreases by 50%. The National Comprehensive Cancer Network (NCCN) guidelines recommend that high risk patients be screened for lung cancer with low-dose CT after shared patient and provider decision making. The Centers for Medicare and Medicaid Services recommends annual screening for lung... Read More
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Project #07: MSQC Abdominal Hernia Project
Miranda Adams
Aim: To improve the care of patients undergoing an abdominal hernia surgery. Project goal is to improve multidisciplinary discussions, standardize & improve documentation and implement best practices, therefore improving patient care. Physician driven, smart phrase templet, was developed to standardize documentation preoperatively, intraoperatively and postoperatively. Improve postoperative patient outcomes starting in 2021 and continuing into 2024 by encouraging patient to make healthy lifestyle choices and help prevent complications.
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Project #08: Stewardship Opportunities for a Hospital Philanthropic Fund for Patient Medication Access
Stormmy R. Boettcher, Jeremiah J. Jean, Nisha Patel, Caren El-Khoury, Kristin M. Griebe, and Nancy MacDonald
Introduction: Barriers to medication access contribute to excess morbidity, mortality, and unnecessary use of healthcare resources. Hospital philanthropic funds assist patients in covering the cost of essential medical needs, which may otherwise be uncovered or unaffordable. Pharmacists have a vital role in ensuring access to medications, however, they are not involved in the fund distribution process. Fund utilization patterns for discharge medications have not yet been evaluated. Objectives: Characterize... Read More
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Project #09: Potential Cost Savings in the Reversal of DOAC Associated Bleeding
Carolina Orzol, Lindon Nikolaj, Vince Procopio, and Norm Buss
Background: Direct oral anticoagulants (DOACs) are a cornerstone of therapy in treatment and prevention of deep vein thrombosis, pulmonary embolism and other thromboembolic disorders. Despite their favorable safety profile, patients are still at an increased risk of intracranial hemorrhages (ICH), gastrointestinal (GI) and/or fatal bleeding. Two agents commonly used in DOAC associated bleeding include andexanet-alfa and four factor prothrombin concentrate complex (4F-PCC). Reversal agent selection is determined by clinical... Read More
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Project #10: Less Chaff, More Wheat: Clinical Decision Support Governance
David Allard, Donna S. Summers, Brian M. Church, Lori Doyle, Michael Eichenhorn, Pam Ferguson, Matt George, Christopher Gortat, Mary Griffin, Salim Hamadeh, John Joseph, Tanya Larocque, Ronnel G. Miranda, Rajika L. Munasinghe, Lance K. Podsiad, Martin Ratusznik, Ilan Rubinfeld, Jonathan Sykes, Glenn Tokarski, Rachel Tshiamala, Cynthia Valerio, Adrienne Vaught, and Linda Vergilio-Panek
Aim: Use governance structures to establish guidelines for effective use, oversight, approval and post-implementation assessment of clinical decision support tools Improve the sophistication of team in designing and implementing effective decision support. Use five rights of decision support (the right information, to the right person, in the right format, through the right channel, at the right time in the workflow) as guiding framework for design and review. Minimize impact... Read More
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Project #11: Clinical Evaluation and Cost Impact of Sugammadex Utilization at Henry Ford Health Hospitals
Fatimah Cheaito, Petar Puskar, Frank Julian, Raymond Yost, and Gladys Dabaja
Introduction: Sugammadex is a widely adopted neuromuscular reversal agent (NMBA) for rocuronium and vecuronium-induced paralysis. There is mixed evidence regarding the impact of sugammadex on PACU length of stay and time from NMBA reversal to operating room exit. Concerns excess usage could lead to higher overall costs with negligible benefits led to an exploration of use at Henry Ford Health (HFH). HFH policy indicates neostigmine/glycopyrrolate is the cost-effective standard... Read More
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Project #13: Developing and implementing an Agitation Response Team (Code ART) in an urban academic emergency department
Leslie Strugnell, Namita Jayaprakash, Michelle Slezak, Sudhir Baliga, Kamal Sayej, Casey L. Boyer, Hilja Compian, Caroline Dowers, Justin Bright, Rebecca Lenz, Elizabeth Gonzalez, Michelle Thompson, Ronald Franco, and Jennifer Peltzer-Jones
Problem Statement: The acute presentation of patients with psychiatric emergencies, altered mental status, substance use, and cognitive delays creates a safety risk to employees working in the triage area. A lack of standardized responses impacts response time and increase risk of injury to employees. Project Goal: Implementing multidisciplinary agitation response team to provide safer care for the acutely agitated patient, promote a safer environment for ED staff, and promote... Read More
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Project #14: Septic Shock Mortality and Sepsis Readmission Reduction
Allison Wilcox, Colleen A. Drolett, and Stacy Sparks
The aim of this project is to reduce septic shock mortality rates to 28.55% and sepsis hospital readmissions to 13.75% through calendar year 2023, due to finishing above goal for both of these outcome metrics in calendar year 2022, for our sepsis patient population.
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Project #15: A Tale of Two Nasal Swabs: Impact of Process Improvement in Testing for MRSA Pneumonia
Sura Mulugeta, Shaina Vincent, Vince Procopio, Amy Beaulac, Erin Eriksson, Christen Arena, Nisha Patel, Shivani Kantharia, Andrew Mannino, Wasym Mando, Michael Veve, Rachel Kenney, Sarah McKay, Bob McCollum, Marty Ratusznik, Robert Tibbetts, Linoj Samuel, Kathy Callahan, Anita B. Shallal, Nasir Husain, Najia Huda, and Megan M. Cahill
Pneumonia (PNA) is a leading cause of infectious-related hospitalization in United States. Close to a third of patients receive inappropriate anti-methicillin-resistant Staphylococcus aureus (MRSA) coverage for pneumonia. This can increase length of stay, health care cost, and cause harm to patients. MRSA nasal swab (via MRSA culture or PCR) can aid in ruling out MRSA pneumonia, facilitating the reduction of anti-MRSA treatment. In 2018, via delegated authority, pharmacists were... Read More
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Project #16: Identifying Common Factors of Those on the Open Encounters List
Lisa MacLean, Michael Nauss, Lana Abdole, Kathleen Yaremchuk, Eva Alsheik, and Sunita Ghosh
More and more organizations are recognizing the electronic medical record (EMR) as one driver that contributes to burnout. This study aimed to understand the reasons why some providers have delayed completion of documentation while others do not, and to use these results to create interventions so that providers can complete documentation within the Open Encounter Policy guidelines. This was done by looking for differences among providers on the open... Read More
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Project #17: Addressing Safety Issues with Direct Oral Anticoagulants
Stacy Ellsworth, Noelle Ryan, Beverly Stallings, Mary Ann Misiak, Helen Gikas, Stephanie Watts, Gregory Krol, and Scott Kaatz
Problem: Over the past decade, direct oral anticoagulants (DOACs) have become the medication of choice for treatment of atrial fibrillation, thrombosis, and some coronary artery disease states. Prescribing these medications is often associated with inaccurate dosing leading to increased risk of bleeding and clotting events. Events related to DOAC medications have led the Joint Commission to create a National Patient Safety Goal as of July 2019, aiming to reduce... Read More
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Project #18: Improving Early Detection of Clostridioides difficile Infections Through Electronic Reports
Hannah M. Musgrove, Abigail Ruby, Princetta Morales, Yolanda Thompson, Eman Chami, Arielle H. Gupta, Geehan Suleyman, Gwen Gnam, and Edward Pollak
Clostridioides difficile (C. difficile) is a serious infection, causing life-threatening diarrhea. Patients with C. difficile will have liquid, loose, mucous-like, or non-formed stools. The financial burden of C. difficile infection (CDI) is substantial, increasing costs up to an additional $32,000 during hospitalization. These patients can have complications leading to surgical intervention, longer length of stay, and are at risk for recurrent infection, which further adds to healthcare cost. Each... Read More
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Project #19: Using Interprofessional Collaboration to Reduce Reported Rates of Central Line-Associated Bloodstream Infection in an Intensive Care Setting
Hannah M. Musgrove, Abigail Ruby, Yolanda Thompson, Eman Chami, Gwen Gnam, Edward Pollak, Geehan Suleyman, and Arielle H. Gupta
Central line-associated bloodstream infections (CLABSIs) are preventable healthcare-associated infections (HAIs) associated with increased morbidity, mortality, and prolonged hospital stay. Additionally, CLABSIs are the most expensive HAIs with an estimated cost of $46,000 per case.
Problem Statement: The surgical intensive care unit (SICU) at Henry Ford Hospital experience high rates of CLABSI in 2019 and 2020. Improvement Statement: By end 2022, the goal was to reduce the CLABSI rate per... Read More
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Project #21: Leveraging stewardship to promote ceftriaxone use in severe infections with low- and no-risk AmpC Enterobacterales
Megan Hardy, Rachel Kenney, Amy Beaulac, Tricia Stein, Erin Eriksson, Vivek Kak, Asgar Boxwalla, Shaina Vincent, Nasir Husain, Anita B. Shallal, Robert Tibbetts, Kathy Callahan, Allison Weinmann, Geehan Suleyman, and Michael Veve
Aim: To implement and evaluate the impact of a stewardship intervention on the antibiotic treatment of severe infections due to low- and no-risk Enterobacterales. The historical standard of care for the treatment of infections due to these organisms was broad-spectrum intravenous antibiotic therapy with cefepime or a carbapenem such as ertapenem or meropenem. More recent evidence suggests that ceftriaxone, a narrower spectrum antibiotic, is an appropriate choice. Therefore, we... Read More
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Project #22: Observation of Anti-Infective Use in Esophageal Perforations
Emma Kabalka, Courtney Hooten, Allison Bouwma, Kristin Griebe, and Carloyn Martz
Introduction: Esophageal perforations (EPs) are a tear of the esophageal mucosal and muscle layers, posing infection risks, due to gastric contents in the thoracic space. This rare disease state has many causes and has a mortality rate of 13.3%. Diagnosis is challenging due to vague symptoms, leading to delayed treatment Prognosis worsening significantly after 24 hours. Treatment involves surgery, endoscopy, and antibiotics. There is no standardized institutional or national... Read More
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Project #23: Healing the Devices that Heal
Ali Youssef, Jeff Phillips, and Dennis Calopisis
Aim: Establish effective governance over medical device cybersecurity and lifecycle management. Identify and manage vulnerable medical devices. Manage medical device security risks including establishing an iterative process aligned with PDCA cycle of performing security risk assessment, risk mitigation and monitoring. Identify and respond to medical device security incidents in a manner that minimizes adverse impact, restores operations and prevents reoccurrence. Implement a training and awareness program to educate HFH... Read More
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Project #24: Reducing Blood Culture Contamination Rates in the Emergency Department
Kelly Ashcraft and Marlene Derbyshire-Green
Sepsis and Septic Shock is one of the leading causes of death in the United States. Blood cultures are an important diagnostic tool for identifying pathogens responsible for infection. Blood culture contamination is a significant problem which can result in unnecessary antibiotic exposure, extended length of stay, and increased hospital expense. Recent studies associate 1 false positive blood culture with $4,162 avoidable cost and 3.7 extended hospital days1. A... Read More
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Project #25: Putting a CAP on Discharge Antimicrobial Therapy: Evaluation of a Transitions of Care Process Through an Electronic Scoring System for Patients with Community-Acquired Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD)
Ana Christine O. Belza-Mai, Jessica Efta, Rachel Kenney, Nancy MacDonald, John Stine, Robert McCollom, Martin Ratusznik, and Nisha Patel
Problem: Less than 1 in 5 hospitals with monitor antibiotic use at hospital discharge, leading to antibiotic overuse. Antimicrobial Stewardship Program Transition of Care (ASP TOC) is a standard of care pharmacist-driven intervention: pharmacists pend discharge antimicrobial orders and write progress notes for patients with uncomplicated infections being discharged on antibiotics. Identification of ASP TOC opportunities through an electronic scoring system the electronic health record (EHR) may allow for... Read More
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Project #28: DOES ANYONE REALLY KNOW WHAT TIME IT IS?
Christian Keller, Amanda Poxon, Suzanne Celmer-Harter, Frank Morden, Jacob Potterpin, and Jessica A. Burke
Problem Statement: Due to the increased amount of QuantiFERON®-TB Gold Plus testing, the number of timers alarming in the lab is disruptive to accessioning and leaves room for errors. Specimens are being pulled too early or left in the incubator for too long, which invalidates the testing, resulting in patients having to be called back. Improvement (Goal) Statement: Since QuantiFERON®-TB Gold Plus specimens can incubate at 37°C for anywhere... Read More
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Project #30: Reduction in use of CXR for Children with Asthma, Bronchiolitis, and Croup
Elizabeth Plemmons, Trisha Ribitch, Zoe Kaps, and Asma Engelbrecht
Problem Statement: Respiratory illnesses particularly asthma, bronchiolitis and croup are among the top diagnoses for which children visit the emergency department. Chest x-rays are frequently used by emergency providers in children presenting with these conditions, yet they rarely reveal information that contribute to changes in management and can lead to excess cost, radiation exposure, & overtreatment with antibiotics.
Improvement (Goal) Statement: Reduce the use of chest x-rays in children... Read More
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Project #31: Reducing Greenhouse Gas Emissions in Jackson: A CQI Story about the Triumphs of Science and Collaboration in Changing Clinical Operations
Joshua Goldblatt, Kimberly Finch, Terry A. Ellis, and Kannan Suri-Mohanram
The climate change crisis threatens human health by adversely affecting the spread of infectious disease, malnutrition, mental health, and the displacement of people or communities. The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) is a project of the Multicenter Perioperative Outcomes Group (MPOG) Collaborative Quality Initiative (CQI). Their sustainability goal is to help reduce greenhouse gas emissions from anesthesia waste used in the US by optimizing environmentally-safer anesthesia agents... Read More
