Thank you all for the

excellent application

submissions

This truly reflects the

innovation in quality, safety

and experience throughout

Providence Health Care

Application

Summaries

2019 Patient Experience &

Quality Innovators Award

Dinner

Sponsored by the

PHC Community Ministry Board

October 28, 2019

PHC Community Ministry

Board

2019

Patient Experience & Quality Innovators

Award

You are Providence.

You are what people see when they arrive here

Yours are the eyes they look into when they’re

frightened and lonely

You are the voice people hear when they ride the

elevators and when they try to sleep and when they try to

forget their problems

You are what they hear on their way to the appointments

that could affect their destinies And what they hear after

they leave those appointments

Yours are the comments people hear when you think they

can’t

Yours is the intelligence and caring that people hope they’ll

find here. All they can know is what they see and hear and

experience

If you are indifferent, so is Providence. If you are a good

steward, so is Providence. If you are compassionate,

respectful, just and excellent, so is Providence. Together, we

are the people of Providence

And so we have a stake in your attitude and in the collective

attitudes of everyone who works at the hospital. We are

judged by your performance. We are the care you give, the

attention you pay, and courtesies you extend.

Thank you for all you are doing

The PHC board, through its quality committee, is responsible for ensuring that PHC management and staffs achieve an unprecedented level of ex-cellence in service of providing the highest quality, experience and safest care to the communities of Eastern Washington. Underlying this goal are two realizations: innovation is necessary for continued improvement, and PHC staff are excellent sources of that innovation. In order to support those two realizations, the board proposed to recognize and reward those members of the PHC staff who have contributed the most to achieving the highest quality, experience and safest care in the region. The PHC Quality Innovators & Experience Awards acknowledges this achievement.

Top projects will be chosen to receive the PHC Quality and Experience Awards. The winners and applicants have been invited to attend this gath-ering to recognize and celebrate the achievements of their innovative pro-jects. Two members from the winning teams will be eligible to attend the IHI annual quality meeting in December.

The PHC board has a strong interest in promoting the spread and adop-tion of innovative approaches that improve quality, safety, experience and encourage management to pursue adoption and expansion of the award winning ideas to units both within PHC and elsewhere within PSJH. In addition the board will ask for a one year follow up report on the award winning projects in order to ascertain whether their impact had spread.

Thank you all for your excellent submissions this year. The summaries of the applications are included here.

Larry Peg

Larry Soehren Peg Currie

Providence Health Care Providence Health Care

Ministry Board Chair Elect Chief Operating Officer

Quality

Innovation

Applications

Outpatient Therapy Services for Urgent Care Referrals

Team Members:

Lucy Brown; Greg Carter, MD; Amanda Johnson; Heidi Moser; Michael Ravelo, MD; Randall Volk, MD; Aimee Wallace

Organizations Participating:

St. Luke’s Rehabilitation Institute, Providence Urgent Care

Application Primary Contact:

Aimee Wallace

Executive Sponsor:

Heidi Moser

Executive Summary

St. Luke’s Rehabilitation Institute was receiving 50-60 referrals per month (600-720/year) from Providence Urgent Care locations converting an average of only 1-2% to outpatient therapy. The barrier was that few patients had a pri-mary care provider to sign off on a therapy plan of care which is required by insurance. The Urgent care providers did not have the bandwidth to assume this role. The solution was to identify an Urgent Care physician champion who would agree to review and sign the plan of care recommendations from thera-py services for the initial 90 days which would expedite care for the patient. During this initial phase of therapy, the patient would have time to seek out a primary care provider who could monitor progress and continue oversight should the patient require >90 days of outpatient therapy. Results from this project were improved outpatient therapy access, patient satisfaction, and out-comes by increasing conversion of referral to actual patient care trending as high as 50% 2019 YTD.

St. Luke’s Ventilator Initiative

Team Members:

CMO; Case Management; Infection Control; Inpatient Therapy Managers; Nurse Managers; Respiratory Therapy; Pulmonary

Organization Participating:

St. Luke ’s Rehabilitation Institute

Application Primary Contact:

Darrell Bryant

Executive Sponsors:

Heidi Moser, Nancy Webster

Executive Summary

As a Level 1 Trauma designation for rehabilitation hospitals we strive to ensure a safe and successful transition from rehabilita-tion to the community for patients requiring ventilator assistance. In 2017 The Ventilator Initiative Committee was established with interdisciplinary membership which includes the Medical Director, Physiatrist, Managers of Respiratory, Nursing and Therapy.

The committee identified areas of need and systematically put a plan in place to address each need, including identifying needed policies and procedures, facility needs and caregiver training and education.

Since the program was reinstituted, 4 patients have been admit-ted on a ventilator and successfully discharged to the community.

• 3 returned home on a ventilator 24/7 or just at night

• 1 was weaned from the ventilator and eventually decannulated prior to discharge to home with family.

Bridging Critical Thinking with Technology—PSHMC 7th Floor Quality Improvement Project

Team Members:

Shelley Berdar; Caitie Blanksma; Carrie Campbell; Rick Olson, Joe Siers; Kimberly Trower; Mary Willard

Organization Participating:

Providence Sacred Heart Medical Center —7N Pulmonology and 7S Medical Oncology Departments

Application Primary Contact:

Rick Olson

Executive Sponsor:

Neil Christopher Apeles

Executive Summary

This project initiated an early intervention for prevention methodology by bridging critical thinking with technology (EPIC). The problem occurring was nursing would assess their assigned patients and receive scoring for skin risk and fall risk. These scores were not consistently utilized to initiate interven-tions. This instilled a reactive action to address areas after an event had oc-curred. These units (7N & 7S) have many new graduate nurses developing their skill set, care routines, and critical thinking. The solution included devel-opment of a report from EPIC that would highlight the quality indicators for patient safety. The charge nurse interacts with the caregivers to focus atten-tion on patient care quality needs by asking questions to foster critical think-ing. As a result of this project, over the last year we have seen a decrease in patient falls, hospital acquired pressure injury (HAPI) events, catheter associ-ated urinary tract infections (CAUTI), and central line associated blood stream infection (CLABSI) events. We now have caregivers providing information to the charge nurse prior to being asked. This work has provided the methodolo-gy of bridging critical thinking with technology to deliver early intervention for prevention improving our patient quality outcomes.

“United We Stand”: Contrast Reaction Manage-ment Training for Outpatient Imaging Centers with Emphasis on Teamwork

Team Members:

Natalie Crawford, MD; Robin Hines, MD; Julie Kaczmark, MD; Dwayne Marsh; Marjan Milani, PharmD, BCPS, BCCCP; David Reisberg; Wade Scoles; Trisha Sumner; Shannon Tripp; Faith Washington, RN; Sadaf Zaidi, MD

Organizations Participating:

Inland Imaging, Providence Sacred Heart Medical Center Radiology and Radiology Residency Departments, Washington State University Medical School

Application Primary Contact:

Natalie Crawford, MD

Executive Sponsor:

Dean Martz, MD

Executive Summary

The impetus for our project was a Serious Safety Event, a “near miss”: a po-tentially life-threatening IV contrast reaction in a young adult patient in one of our outpatient imaging centers.

This lead to a root cause analysis which revealed major deficiencies in our radiology practice’s contrast reaction management preparedness.

In response, we developed a robust 3-phase plan:

1. Standardization – design identical emergency equipment (contrast reaction boxes) and replace the old ones at each site – see Figure 1.

2. Education – educate all members of the team - radiologists, residents, radi-ology technologists, radiology nurses, and patient care assistants - about con-trast reactions and how to manage them using multiple educational tools which we developed:

Project “TP” Throughput

Team Members:

Jenelle Anderson; Pamela Fugitt; Julie Gibbons; Pam Gilroy; Ed Johnson, MD; Micah Kaluzny; Naydu Lucas; Rachael Magruder; Mary Beth Smyth

Organization Participating:

Providence Mount Carmel Hospital

Application Primary Contact:

Micah Kaluzny

Executive Sponsor:

Naydu Lucas

Executive Summary

We are a critical access hospital (CAH) with 10,000+ Emergency Department (ED) visits per year and do not have sufficient patient volume to support dedi-cated triage/first nurse. Time to be seen (i.e. triage) is one of the major players in patient engagement and satisfaction within the overall ED experience. With a door to triage time of greater than 10 minutes, we were not meeting best practice standards regarding arrival, triage and initiation of care. Over the course of this project we developed a team based approach including frontline caregivers/providers to help with work flow and process. We started using a new analytic dashboard to collect and provide real-time data (Multiscale EDQ) to track progress and continue process improvement. For 12 consecutive months, ending in March 2019, we had a door to triage time below the 10 mi-nute goal and we improved our overall rating of care based on Press Ganey HCAHPS scoring.

Discharge Lobby Throughput Service Project

Team Members:

Marlo Andreoli; Neil Christopher Apeles; Johanna Bakker; Ed Ehrhart; Meredith Ellis; Danny Garner; Christy Gilbert; Debra Gil-lette; Kim Grippi; Matt Hopkins; Holly Jarman; Heidi Keplinger; Kathy Melvin; Michael Nafzgar; Sherry Nash; Rick Olson; Eric Reimer; Kelli Rinas; Susan Scott; Tonia Wells; Pride—Throughput Committee

Organization Participating:

Providence Sacred Heart Medical Center & Children ’s Hospital

Application Primary Contact:

Susan Scott

Executive Sponsors:

Jim Bradley, Susan Stacey

Executive Summary

Problem: Capacity management at SHMC has become increasingly more complicated. Patients are often waiting in the ED or PACU for inpatient beds. In- patients often times are ready for discharge but may not have a ride home, family members may be delayed or prescriptions must be filled in the pharma-cy before departure. Caregivers expressed apprehension about discharging patients early without a secure area to wait for loved ones.

Solution: A Discharge Lobby was developed to expedite the discharge pro-cess for inpatients, provide a comfortable space for patients to wait for their ride or wait for prescriptions, freeing up inpatient beds for other patients. Fami-lies have a more efficient drive through pick up process without parking. Pa-tients are more satisfied when there is a plan in place as they discharge. Caregivers are more satisfied when discharges occur throughout the day ra-ther than all at one time.

Results: Greater than 20% of discharged patients left by 11:00AM. Greater than 20% of all discharged patients exited via the Discharge Lobby. Greater than 1000 hours of patient care time was saved by all inpatient units over 6 months.

a) Didactic Online Course

b) Hands-On Workshop in medication and emergency equipment handling

c) Training videos demonstrating optimal medication/equipment handling and emergency response in a variety of contrast reaction scenarios

3. Practice – 2-hour Simulation Lab workshops in managing contrast reactions in small teams utilizing an interactive robotic patient in our own Simulation Lab at SHMC.

We measured knowledge about contrast reactions and their management pri-or to and following each phase of training for all participants. A significant im-provement in knowledge and skill was demonstrated – see Table 1. Partici-pants also expressed increased confidence and success in treatment of con-trast reactions after completion of training.

Expansion of the Psychiatric Emergency Department Improves Patient Care

Team Members:

Ana Bernal; Chelsea Little; Adrianne Loetscher; Heather Striker; Psych ED UBC

Organization Participating:

Providence Sacred Heart Medical Center

Application Primary Contact:

Adrianne Loetscher

Executive Sponsor:

Tamara Sheehan

Executive Summary

As with most emergency departments (ED) throughout the na-tion, our organization was overwhelmed with the challenge of caring for the large number of psychiatric patients boarding in our ED while waiting for psychiatric services. This issue has an assortment of staff and patient safety issues, as well as, quality concerns for both the psychiatric patients and those who are in the ED receiving acute medical care. In order for us to address some of these issues, we were able to expand our current psy-chiatric emergency department. In doing so, we were able to de-crease the variation in patient cases, provide more standardized care, reduce expenses, increase safety and improve the overall quality and value of the care provided to our psychiatric patients.

Days in the Phase

Team Members:

Samer BaniHani, MD; Okechukwu Ojogho, MD; The Kidney & Pancreas Transplant Team

Organization Participating:

Providence Sacred Heart Medical Center Kidney & Transplant Program

Application Primary Contact:

Brenda Fairman

Executive Sponsor:

Dean Martz, MD

Executive Summary

The problem we faced was extraordinary time our patients spent in the trans-plant referral and evaluation phases that led to patient, referring provider, and dialysis unit dissatisfaction. This resulted in lost referrals to other transplant programs.

We performed a gap analysis with the newly acquired data we obtained through Phoenix (the EPIC transplant module we went live with in August 2016). This newly acquired data provided insight into our trouble areas within the pre-transplant patient throughput process. As a team, we process mapped our workflows for the various stages in pre-transplant throughput. This work led us to identify the need to standardize our workflows and processes as well as identify opportunities to reduce waste. We established goals for different time points in the process and monitored progress on a quarterly basis. We also elicited feedback from referring providers and dialysis units on how to better serve them and their patients and put that feedback into action.

The process improvement work we did has resulted in increased pre-transplant visits, as well as an increase in projected wait list additions for 2019. Overall, we have achieved increased patient, referring provider, and dialysis unit satisfaction through this work.

A tele-sitter tech monitors up to 9 patients at a time. They are able to spea through the camera in several languages. This allows them to communicate directly with the patient. This is an additional resource for nurses and pa-tients.

Results: Reduced average sitter usage went in half from 56 FTE’s 1st half of

2018 to an average of 28 FTEs 1st half 2019. Savings for RN wages for the

first half = $476,382. Whereas savings for NAC wages = 463,621. This trans-lates into a projected annualized savings of over 1.4 million dollars*. *This does not include reduction of overtime for premiums each unit are charged. Reduction of overtime in all nursing departments. Nurse sensitive quality indi-cators did not see an increase in adverse events related to decrease in sitters.

Long Length of Stay- Social Workers

Team Members:

Kimber Bowen; Patty Ferguson; Cathy McInroe; Yolanda Pfaff

Organizations Participating:

Providence Sacred Heart Medical Center and Providence Holy Family Hospital—Social Work Departments

Application Primary Contact:

Cathy McInroe

Executive Sponsor:

Shelby Stokoe

Executive Summary

Problem: There has been an alarmingly increasing pattern of patients pre-senting to our ED who do not meet medical criteria for hospitalization but are unable to be discharged because of the lack of a safe discharge plan. This a multifactorial issue, often stemming from difficult behaviors or a need for a high level of unskilled care. This leaves the hospital caring for these patients in the hospital setting which is the most expensive level of care. Additionally, it creates throughput issues which prevent patients needing the acute medical bed boarding in the ED or diverted out of their community for care.

Historically there have not been enough social work resources to commit the time and expertise to discharging these patients in a timely manner, as they are extremely time-consuming.

Solution: To conduct a pilot where a dedicated social worker with a de-creased caseload was hired to focus only on planning safe discharges for these LLOS patients.

Results: The initial pilot showed great success, prompting the addition of a second LLOS dedicated Social Worker. These two additional Social Workers have decreased the number of patients who are in the LLOS category, plus have decrease the length of stay of these patients, as evidenced by the graphs we have provided.

Providence Medical Group - MA Apprentice

Program

Team Members:

Michelle Bourcy; Erica Brunett; Bryan Fix; Angela Harvey; LaRae Long; Julie Orchard; Kathy Tarcon, RN, MBA

Organizations Participating:

Washington Association for Community Health, NEWTech, Spokane Valley Tech

Application Primary Contacts:

Bryan Fix, Julie Orchard

Executive Sponsor:

Kathy Tarcon, RN, MBA

Executive Summary

PMG has grown to over 2,000 caregivers and over 350 Medical Assistants, which are now required in Spokane area clinics to ensure physician productivity and patient access to service. Due to the extreme shortage of qualified candidates in the market, PMG needed to explore new ways of recruiting.

In 2006, we partnered with The Washington Association for Community Health to help us offer a DOL - accredited MA Apprentice program that provides 2,000 hours of on-the-job training, 410 hours of education with collegiate credits and testing for national certification. This program was brought to local high schools in alternative educational formats: NEWTech Skills Center (Spokane - District 81) and Spokane Valley Tech (SVT). NEW-Tech programs included a Medical Assistant class, a Nursing Assistant class while SVT offered a Biotech, EMT and Sports Medicine program. Working closely with educators at both of these institutions, we were able to engage poor and vulnerable students who are not on a college-prep track and encourage them to apply to our program. We began in July 2017, with an inaugural cohort of 8 students.

Building a Culture for Sitter Reduction through Nursing Practice

Team Members:

Marlo Andreoli, MSML, BSN, RN; Leah Edwards; Yvette Moulton; Tonia Wells, MSN, RN

Organizations Participating:

Providence Sacred Heart Medical Center & Children’s Hospital

Application Primary Contacts:

Marlo Andreoli, MSML, BSN, RN; Tonia Wells, MSN, RN

Executive Sponsor:

Susan Stacey, MBA, NEA-BC, FACHE, RN, CNO

Executive Summary

Problem: Sitter usage at Providence Sacred Heart Medical Center in 2018 hit an all-time high and had been increasing for the last 5 years. The hospital was deploying over 25 sitters per shift on average with an annual cost for sit-ters of approximately 4.7 million dollars. This was double the budgeted amount. Overtime in the sitter cost center was greater than 22%. Overtime can cost more than financial. Studies have shown long shifts can lead to burn out and medical errors. Physical sitters were used for multiple reasons includ-ing impulsive behaviors, risk for falls, potential self-harm behaviors and de-mentia. In the past, all these behaviors were managed by nursing. Nurses believed that sitters would prevent falls and ensure patient/staff safety. Basics of nursing practice continue to be fundamental to patient outcomes and sitters were requested vs. using evidence based nursing protocols.

Solution: Re-education to staff and management related to the policy and criteria for sitters. Attendant ticket was developed to request a sitter and was based on policy/criteria. Management presence at bed board to review at-tendant tickets and charting in EMR. Basics of nursing practice encouraged and includes: moving patient closer to nurse’s station, bed/chair alarms, pur-poseful rounding, care planning, engaging family, and diversion activities. Increase use of tele-sitter program for shared responsibility of direct observa-tion of potential behaviors. A tele-sitter is a camera placed in the patient room to monitor patients that are high risk for falls, elopement risk, or self-injury.

Patient and Caregiver Concierge Program

Team Members:

Anthony Balzarini; Rob Beaton; Kimber Bowen; Jeff Davis; Leah Edwards; Kay Gorka; Chris Hadorn; Holly Jarman; Kathy Melvin; Deb Morris; Marisela Revuelta-Cervantes; Adam Richards; Pride—Patient Experience Committee

Organizations Participating:

Providence Sacred Heart Medical Center & Children ’s Hospital

Application Primary Contact:

Deb Morris

Executive Sponsor:

Jim Bradley

Executive Summary

Problem: SHMC patients and guests are frustrated by not being able to find information/departments/providers they need, unnecessary and unexplained delays in service, difficulty with way finding, and other gaps in basic patient/guest needs. Redundancies in service and out of date/inaccurate information add to their frustrations. Consequently all caregivers at SHMC play a part in helping solve these challenges – this in turn takes caregivers away from pa-tient care and increases workload for many caregivers.

Solution: A concierge service provides immediate service response and in-formation, way finding assistance, advocating for and solving patient/guest service delays and researching and connecting patients/guests with the infor-mation or services they need. This would greatly improve the patient experi-ence and allow clinical caregivers to focus on patient care.

Results: Since program inception, concierge “patient touches” exceed 2,400 each month. Clinical concierges (in the ED) have positively affected Press Ganey outcomes for: first person interaction, delays in service, comfort of waiting area and how family and friends are treated. Service concierges in the main tower were piloted on the 6

th floor. Positive increases in, overall food,

courtesy of food server, courtesy of housekeeper and cleanliness of room have all increased, some significantly, in the first quarterly outcomes.

As of September 2019, we have graduated 27 students with only one student leaving the program. Clinics who train Apprentices generally convert them to regular employment and find they do not need to rely on the MA Float pool for coverage. MA Coaches in our clinics have become more engaged by having the opportunity to pass on their knowledge. Most importantly, we have young adults who have been able to move out of their parents or guardians homes and start a life of their own in a job that they may have never thought possible with a livable wage and a healthcare career. The MA Apprentice program is the first step in a lifelong healthcare career, with endless possibilities.

No Wrong Door: Increasing Access in Urgent Care for Behavioral Health Patients

Team Members:

Lucy Brown; Therese Etherton; Deborah Hjortedal; Denny Lordan; Sheryl Romaniuk; Tamara Sheehan; Jo Ellen Thorne; Randall Volk, MD

Organizations Participating:

Providence Sacred Heart Medical Center & Children ’s Hospital, Providence Medical Group Urgent Care Sites

Application Primary Contact:

Tamara Sheehan

Executive Sponsor:

Tamara Sheehan

Executive Summary

Problem: Patients are often referred to our Providence emergency depart-ments (ED) from urgent care (UC) clinics for mental health risk assessments in response to a patient experiencing severe depression, extreme anxiety and suicidal ideation. These patients often spend an average of eight hours in the ED to be assessed, with more than 70% discharged immediately after the assessment with outpatient resource information. This unnecessary process increases the cost of health care where patients are seen at the highest level of care for lower level care needs. Additionally, this inefficiency delays care by decreasing UC and hospital ED throughput, and exasperates hospital ED be-havioral health boarding issues.

Solution: In January 2019 we initiated an on-demand telehealth program in our first Providence Medical Group (PMG) UC where experienced mental health professionals conducted risk assessments via telehealth. The target patient population were those the UC providers would have normally sent to the ED for a risk assessment for reasons mentioned above. In April 2019 the 2

nd PMG UC started, with the last Spokane PMG UC starting in late June

2019.

Outcome: This on-demand Telehealth risk assessment program was utilized and did decrease the overall cost of care for the patient, their insurance carri-er, and our organization.

Patient

Experience

Applications

“Yes, I can hear you.” Promising Results of Rural Telepsychiatry between Spokane and Stevens County

Team Members:

Amy Burns, MD; Peter Edminster, MD; Caleb Holtzer, MD, MPH; Tanya Keeble, MD; Erik Loraas, MD; Denny Lordan

Organizations Participating:

Providence Psychiatry Residency Spokane, Family Medicine Residency Spokane—Colville Track, Stevens County Primary Care, Providence St. Joseph Telemedicine

Application Primary Contact:

Tanya Keeble, MD

Executive Sponsor:

Kathy Tarcon, RN, MBA

Executive Summary

This pilot was implemented to #1 address economic and healthcare disparities in rural Steven ’s county, and #2 create an educational paradigm in which to teach psychiatry and family medicine residents in an emerging healthcare paradigm. We de-veloped a telepsychiatry program between Psychiatry Residency Spokane and Colville Family Medicine Residency to provide spe-cialty care to patients with Medicare insurance, who were either part of our existing collaborative care consultation program, or who had diagnoses that were outside the scope of typical primary care treatment e.g schizophrenia, bipolar disorder. Over the course of 6 months we identified the key stakeholders in the pro-ject and met twice monthly to shape program goals, and measur-able objectives, and develop all the structural components need-ed to provide this care. Over the next 6-9 months we had en-couraging results in the 4 main areas for measurement: patient attendance, symptom improvement and satisfaction; in PCP re-ferrals and satisfaction with the service, in resident learning over the course of the rotation, and in economic impact for patients - money saved in travel gas, time saved off work. In 2018 we add-ed another ½ day per week and in 2019 we plan to expand to pa-tients with Medicaid insurance.

Improving Processes for Admission and Safe Administration of Chemotherapy

Team Members:

Neil Christopher Apeles; Shawna Beese; Shelley Berdar; Caitie Blanksma; Karen Byrd; Meegan Carpenter; Stacy Dale; Vicki Dodson; Anna Franklin; Robert Gersh, MD; Rebekah Hart; Tracy Hinz; Tina Hunter; Justin Hurtubise; Laurie Loe; Sean Hurley, MD; Tyler Moosman; Tara Neumann; Rick Olson; Matthew Ortiz; Tammi Port; Gianna Rowse; Susan Scott; Kathy Smith; Kim Ward; Donovan West; Jennifer Zimmerman

Organizations Participating:

Providence Sacred Heart Medical Center and Providence Holy Family Hospital

Application Primary Contacts:

Justin Hurtubise, Matthew Ortiz

Executive Sponsors:

Neil Christopher Apeles, Kathy Smith

Executive Summary

Problem: A significant number of oncology admissions are pre -scheduled inpatient chemotherapy administration patients. On the day of admission they often did not have pre -authorization, admit or-ders, history and physical (H&P) or chemotherapy orders. This result-ed in a significant delay in treatment. The time from admission to first chemotherapy averaged 13.3 hours with delays up to 49.3 hours. This negatively impacted patient satisfaction and increased overall length of stay. Reimbursement was also impacted due to lack of pre -authorization.

Solution: At the time of scheduling, the change was made for the provider’s office to provide a diagnosis, authorization number, and type of chemothera-py. The patient was to be scheduled at least 72 hours in advance. An H&P, admit order, and the chemotherapy plan had to be entered into EPIC by 2:00pm the day prior to the scheduled admission. Any admission deemed ur-gent/emergent by the provider required documentation supporting the urgency along with a clinical review by the Medical Director of utilization management.

Result: Once implemented, this change resulted in an over 50% reduction in the time from admission to first chemotherapy administration. The average time decrease from 13.3 hours to 5.7 hours. Additionally, increased patient and caregiver satisfaction was achieved.

Appropriate Setting and Utilization of Rituximab Biotherapies

Team Members:

Brent Albertson; Neil Christopher Apeles; Shawna Beese; Shelley Berdar; Caitie Blanksma; Karen Byrd; Meegan Carpenter; Stacy Dale; Vicki Dodson; Robert Gersh, MD; Rebekah Hart; Tracy Hinz; Tina Hunter; Justin Hurtubise; Laurie Loe; Duane Lutz; Sean Hurley, MD; Marjan Milani, PharmD, BCPS, BCCCP; Tyler Moosman; Tara Neumann; Rick Olson; Matthew Ortiz; Tammi Port; Gianna Rowse; Paula Sayegh, PharmD; Susan Scott; Todd Seiger; Kathy Smith; Michelle Sodorff; Kim Ward; Donovan West; Jennifer Zimmerman

Organizations Participating:

Providence Sacred Heart Medical Center and Providence Holy Family Hospital

Application Primary Contacts:

Justin Hurtubise, Marjan Milani, PharmD, BCPS, BCCCP; Matthew Ortiz

Executive Sponsors:

Brent Albertson, Neil Christopher Apeles, Kathy Smith

Executive Summary

Problem: Rituximab is a medication used to treat certain types of cancer and autoimmune diseases. The unit price of Rituximab is $939 per unit in the in-patient setting, but can be purchased under outpatient 340B for $280 per unit. In 2018 Sacred Heart Medical Center and Holy Family Hospital spent over $1.5 Million in inpatient Rituximab. Additionally, inpatient use of Rituximab is a financial burden due to diagnosis dependent reimbursement and the inability to bill for medication waste. It is also a capacity burden with long infusion times occupying inpatient beds.

Solution: The purpose of this project was to optimize hospital resources and improve patient satisfaction by transitioning inpatient Rituximab associated with chemotherapy regimens to the outpatient setting. By transitioning Rituxi-mab regimens to the outpatient setting the inpatient cost burden could be re-duced.

Result: These infusions are now given one day prior to admit at the oncology clinics or day after discharge at our outpatient infusion centers. This project has resulted in an overall 80% reduction in Rituximab inpatient spend. The shift to hospital based outpatient infusion centers has been associated with positive net revenue.

Stroke Integrated Practice Unit (IPU)

Team Members:

Neil Christopher Apeles; Craig Bakker; Silvia Bowker; Chris Clutter; Mark Eide; Anna Franklin; Dan Getz, MD; Debra Gillette; Julie Haines; Louise Harder MD; Justin Hurtubise; Ken Isaacs, MD; Kris Knight; Rebecca Mallo, MD; Mary Jo Moore; Cynthia Murphy, MD; Sherry Nash; Harry Owen; Beth Perkins; Elizabeth Walz, MD; Dawn Wright

Organizations Participating:

Providence Sacred Heart Medical Center, Neuroscience Institute, St. Luke’s Rehabilitation Hospital, and Providence Medical Group

Application Primary Contact:

Justin Hurtubise

Executive Sponsors:

Craig Bakker, Ken Isaacs, MD

Executive Summary

The Sacred Heart Medical Center Stroke program is one of the best programs in the Providence St. Joseph Health System. It has consistently received the highest recognition from Get With The Guidelines and The Joint Commission. In the spirit of excellence and continuous improvement, the stroke program decided to take initiative to improve upon its already outstanding track record. To accomplish this goal, we decided to build an Integrated Practice Unit (IPU). The IPU model is built upon the desire to become more patient centered, overcome profession boundaries, and reduce waste in the delivery of care. It looks at care delivery not as individual silo sites of care, but rather one contin-uous delivery organized around a specific disease. Since organizing care into an IPU, the stroke program received recognition from The Joint Commission as a Thrombectomy Capable Stroke Center, increased provider engagement around the full continuum of care, decreased Case Mix Index (CMI) adjusted length of stay (LOS), and improved the door-to-groin puncture times for endo-vascular care.

RCPT: Right Care/Place/Time

Team Members:

Tammy Arndt; Pam Currier; Marc Harger; Michael Jacobsen; Denny Lordan

Organizations Participating:

NW TeleHealth, Providence Healthcare TeleHealth, Providence Medical Group Clinics, and the Spokane Teaching Health Clinic (STHC) Psych Residency

Application Primary Contact:

Tammy Arndt

Executive Sponsor:

Andrea Fleming

Executive Summary

Project: Leverage telecommunications technology to expand access to care at the right time and place, improving outcomes and easing the way of pa-tients and caregivers.

Identified Problem(s): Expand access to specialty care for rural patients re-quiring follow-up visits to improve continuity of care and health outcomes.

Provide behavioral health assessment at PMG clinics to reduce unnecessary emergency department admissions

Solution: Establish telemedicine program utilizing Zoom software to deliver covered services to patients at a distance (clinic/home).

Results:

Improved access: Peds Endocrinology: on-demand nurse triage service for newly diagnosed rural patients requiring education and support for insulin pumps; Cystic Fibrosis: medication review and dietary oversight for patients who struggle to come into the clinic.

Improved clinical experience: Urgent Care Psych Triage—reduce unneces-sary ED visits; STHC Psych Residents—conduct behavioral health assess-ment in Stevens County; Single Ventricle—nurse triage support for rural fami-lies to reduce unnecessary transport (Life Flight)

Eased the way of patients and caregivers: Caregivers able to use MyChart to schedule and deliver services via video; Patients able to use personal device (desktop, laptop, tablet or mobile) to receive services from home.

Economic Stewardship: Cost effective delivery of care.

Providence Stevens County Opioid Crisis Response

Team Members:

Amelia Alberts; Kim Crawford; Jim Divis; Crystal Ellsworth; Megan Fowler; Joel Herman; Michelle Hinds; Caleb Holtzer, MD, MPH; Jon Howes; Kerry Michaelis; Kathy Pinnell; Jamie Stolp; Leslie Waters; Lisa Wolfe

Organization Participating:

Providence Northeast Washington Medical Group

Application Primary Contact:

Caleb Holtzer, MD, MPH

Executive Sponsor:

Ron Rehn, Chief Administrative Officer

Executive Summary

The opioid epidemic impacts communities throughout Northeast-ern Washington. The crisis was initiated by high rates of opioid prescribing and was later fueled by cheap and abundant supplies of heroin and fentanyl. Data shows that decreasing the prescrib-ing rates of opioids paradoxically leads to increased rates of overdose deaths as patients move from prescriptions to more dangerous drugs. Stevens County suffers known rural health dis-parities including a high burden of opioid use disorder (OUD) and limited treatment resources.

Providence Northeast Washington Medical Group (PNEWMG) addressed this crisis with a two pronged strategy:

1.) Implementation of a comprehensive clinic wide Opioid Improvement Pro-ject (OIP) to refine opioid prescribing practices.

2.) Securing Washington State Health Care Authority (HCA) funding, creating the Tricounty Opioid Treatment Network (TCOTN) to aggressively treat opioid use disorder with medication assisted treatment (MAT).

These two programs working in concert, changed our clinic culture, produced comprehensive opioid policies, improved clinician’s knowledge and skills, de-creased access to prescription narcotics, improved mental health screening rates, and increased access to naloxone and MAT prescriptions. Simultane-ously we built a wide community coalition that is raising public awareness, lowering stigma and providing comprehensive wraparound treatment for opi-oid use disorder.