Quality and Patient Safety Annual Report 2009

QUALITY AND PATIENT SAFETYANNUAL REPORT 2009

Accelerating Transformation

Robert J. Laskowski, M.D., MBAPresident and Chief Executive Officer

Health care has never had more scrutiny. Increased oversight from the private

sector, government and consumers has led to demands for greater transparency

and challenged us to rethink how we deliver care. The good news is that

Christiana Care has accepted the challenge and we are transforming how we

deliver care.

This past year, teams throughout Christiana Care have focused their collective

energy and creativity to make dramatic improvements in quality, safety and

enhancing the value of what we do for the communities we serve.

This report details some of our most successful Focus on Excellence initiatives

of the past year. As you will read, the key areas of focus for Christiana Care are

improving quality and safety, decreasing costs and building our financial strength

to reinvest in our mission of care and service.

FOCUS ON EXCELLENCE � AWARDS , ACH I EVEMENTS AND RECOGNIT ION 1

Level-4 Trauma CenterWilmington Hospital is a participatingtrauma center (Level-4) in the Delaware

Trauma System. The last site survey wasconducted by the State of Delaware Office ofEmergency Medical Center on March 17, 2009.

Awards, Achievements and RecognitionWith its focus on developing and maintaining a safe culture groundedin achieving high reliability processes and leveraging technology,Christiana Care continues to be honored as a leader in patient safetyand quality of care.

FOCUS ON EXCELLENCE

2009 AccreditationsBone MarrowThe three-year reaccreditation by theFoundation for the Accreditation ofCellular Therapy (FACT) attests thatChristiana Care’s program continues tomeet FACT’s rigorous standards for

collecting, processing and transplantingbone marrow and stem cells. Started in1991, the Christiana Care programremains the only FACT accredited programin Delaware and one of only 169 in theU.S. and Canada.

Bone Marrow Transplant Program team members, are (top row, from left), Patricia Strusowski, RN, MS,Kathy Hinckle, RN, Tina Scherer, RN, MSN, OCN, Yong Zhao, M.D., Betty Stone, RN, Courtney Crannell,RN. (Front row, from left) Dawn Henry, MT, Frank Beardell, M.D., Shirley Amato, RN, Liz West, RN, andDanielle Brown, MSW. Missing from photo is Stem Cell Transplant Coordinator Mary Sheridan, RN.

U.S. News and World Reports“America’s Best Hospitals 2008”U.S. News and World Report ranks ChristianaCare in the top 50 hospitals in the UnitedStates in three specialties: ear, nose andthroat (46); endocrinology (37); and gastro-enterology (40).

Thomson Reuters 100 TopHospitals PerformanceImprovement LeaderFor the second consecutive year, ThomsonReuters, a nationally-known provider ofhealth care information, puts ChristianaCare among the top 100 U.S. hospitals –and among the top 15 major teaching hospitals– for the fastest, most consistent performanceimprovement over five consecutive years.

Thomson ReutersHealthcare AwardChristiana Care won a 2009 ThomsonReuters Healthcare Advantage Awardfor its “extraordinary improvement” inclinical performance – in reducing lengthof stay for patients with heart failure, syn-cope, pneumonia and cellulitis; decreasingpractice variations among these populations;and improving compliance with heart failureand pneumonia core measure sets.

2 FOCUS ON EXCELLENCE � AWARDS , ACH I EVEMENTS AND RECOGNIT ION

THOMSON REUTERSHealthcare Advantage Award

American Association of Critical-CareNurses Beacon Award, Spring 2009The Medical Intensive Care Unit earned theprestigious Beacon Award, which goes to unitsthat exhibit “high-quality standards andexceptional care of patients and patients’families.” Christiana Hospital is one of only35 hospitals nationwide to receive this award.

In the Spotlight Nationally


Nursing Professionals’“Top 100 Hospitals to Work for2009”

Nursing Professionals ranked Christiana Caretenth on its list of the best hospitals in thenation to work for 2009.

In the Spotlight Regionally

Christiana Care hosted the regional American Heart Association “Pursuit ofClinical Excellence” workshop in April 2009. Timothy Gardner, M.D., MedicalDirector of the Center for Heart & Vascular Health and President of the AmericanHeart Association, opened the conference.

National Research CorporationConsumer Choice AwardFor the 13th consecutive year,Christiana Care earned the ConsumerChoice Award as the top hospital inthe Delaware region.

Christiana Care will be featured in the AHA “Get with the Guidelines”advertisement in U. S. News and World Reports July 2009 Best Hospitals issue.

American Hospital AssociationsHospitals in Pursuit of Excellence:A Guide to Superior PerformanceImprovement,May 2009Christiana Care’s “Automated PatientTracking in the ED” is one of only 30 case

studies from hospitals nationwide includedin the AHA’s new guide to help hospitalsreduce health care acquired infections andimprove patient safety, patient flow andmedication management.

American Heart Association (AHA)“Get with the Guidelines” AwardsThe AHA awarded Christiana Care an AHAGold Award for achievement in myocardialinfarction care and an AHA Silver Award forachievement in heart failure care.


In the Spotlight at Christiana CareChristiana Care’s annual Focus on Excellence Awards exemplify ourcommitment to improving the health of all those we serve. This year,19 of 75 outstanding team entries were recognized for their creativityand ongoing commitment to improving the safety and quality of carefor our patients. At the award ceremony, Michael O’Neil, founderand Chief Executive Officer of GetWellNetwork, Inc., spoke about theimportance of transforming the patient bedside experience toimprove costs and quality of care.

President’s AwardVigilant Advocacy to Prevent HospitalAcquired Infections: VAP Eradication.The Medical Intensive Care Unit (MICU) had azero Ventilator Associated Pneumonia (VAP)rate for nine of 10 months. The quarterly VAPrate the MICU fell below the National HealthSafety Network mean rate for similar units,reaching zero. Compliance with head-of-bed ele-vation improved to 100%.

Clinical Excellence – Gold Award.Strengthening Trauma Care: Implementationof INR Point of Care Testing.International Normalized Ratio (INR) Point ofCare Testing (POCT) saves at least 30 minutesfrom an INR lab sample. Less venous blood isrequired for INR POCT, and the process givesnurses the autonomy to draw blood samples fromtrauma code patients when they arrive.

Clinical Excellence – Silver Award.Prewarming the Perioperative Patient.The temperature of patients wearing Bear Pawsgowns was more than three times more likely toincrease than that of patients receiving traditionalpre-warming techniques.

Clinical Excellence – Bronze Award.5ACare Improvement Pilot.Amultidisciplinary team rounds used a PatientCare Worksheet to track outstanding issues, pri-oritize the workload and predict which patientswere likely to be discharged within the next 24hours. The pilot met its goals within 3 months:reduced length of stay by 0.5 days, increasedpatient turnover by 5%, reduced third-party-payer denied days by 28%, and improved patientsatisfaction scores by 25%.

Safety First – Gold Award.Looking for Mr. Good Bar Code.Pharmacy developed a quality assurance process tovalidate and certify medication bar codes and toprovide a highly reliable scan rate. In two months,Wilmington Hospital administered more than165,000 doses, with fewer than 20 failures. Thissuccess rate of more than 99.99% exceeds the teamgoal of 99.5% and approaches Six Sigma level.

Safety First – Silver Award.Reduction in Inpatient DVT Rate at CCHSUtilizing aMultidisciplinary PI Approach.As a result of focusing on prevention and riskassessment for surgical patients, the deep-veinthrombosis (DVT) rate decreased by about 40%.Availability of pneumatic compression boots inthe Christiana Hospital post anesthesia care unit(PACU) increased from 10% to 100%, and avail-ability of boots in surgical inpatient units im-proved from 50% to 90%. A system-wide DVT-reduction steering committee is being formed.

Safety First – Bronze Award.Tissue Tracking: Accountability for TissueSurgically Implanted Into Our Patients.Bar coding technology increased the accuracy oftissue tracking to 100%. The system also sup-ports tracing tissue involved in recalls, assuringpatients that all tissue is safe for implantation.

Safety First – HonorableMentionAward.Implementation of a Team TrainingProgram for Trauma Care.More than 350 trauma clinicians were trained inteam concepts and standardized processes.Positive perceptions of teamwork increasedsignificantly, and preliminary data show adecrease in the length of stay for trauma patientsadmitted after the training.


Great Place toWork Award.Got Verbal Orders? Sign Online!Amultidisciplinary team developed technologythat enables physicians to sign off on verbaland phone orders online. Four months after theonline system was implemented, 90% of 62,800verbal or phone orders were signed, comparedto 3% at baseline, and 80% met the 48-hoursignature standard.

Think of Yourself as a PatientAward.Pharmacy Addresses the Needs of GlutenAllergic Patients.Pharmacy software systems do not detectconflicts between medication and food allergies,including gluten which is used as filler in somemedications. Pharmacy established a process toforce manual filling of orders for gluten allergicpatients. Post implementation, Pharmacydispensed six medications with gluten but theallergy was identified in all cases and none ofthe medications were given.

Financial Strength Award.Orthopedic Implants Supply CostInitiative.To save money without limiting surgeons’ choices,the team secured five vendors who agreed toformulary pricing for total joint implants. Farexceeding its $600,000 savings goal, the teamsaved $1,500,000.

Nursing Excellence Award.Preparation of Elective Joint ReplacementPatients.Because nurses at the Center for Advanced JointReplacement empower and support patients,92% of patients are discharged within the three-day goal, and 85% are discharged to their homes,with home or outpatient therapy. The readmis-sion rate is less than 2%, and patient satisfactionscores are in the 97th percentile.

Nursing Excellence – HonorableMention Award.Implementation of a Constipation Protocol.Within eight months, the Constipation CareManagement Guideline team achieved a 52%increase in documenting bowel movements and a25% decrease in patients with no BM for four ormore days. The percentage of patients who had aBM within one to three days increased 18%.

Learning Excellence Award.Perioperative Documentation Education.Within six months (3 months ahead of sched-ule), 100% of the 900+ perioperative staffmembers were trained on new perioperativeon-line documentation. Within five days oftraining, staff operated independently.

Learning Excellence – HonorableMention Award.Achieving Competency Today: AnInnovative Learning.Funding from the Robert Wood Johnson Foun-dation has enabled 53 interdisciplinary learnersto complete the 12-week ACT curriculum.Seventeen performance improvement projectsdeveloping from the course are underway.

Resident’s Award.What Search Engine? Improving anUnderutilized and Inaccurate Resource.The implementation of the IS Sharepoint Searchincreased the percentage of successful searchesfrom 51% to 89%, and the number of searchesrequired dropped more than 50%.

Operational Improvement Award.Emergency Department – Front EndRedesign.The front-end redesign of the EmergencyDepartment decreased the Super-Trackpatients’ median length-of-stay by 70 minutes,the rate of patients who left without treatmentdropped 73%, and patient satisfaction scoresreached the 99th percentile.

Excellence in Community HealthAward.Promoting Clinical Outcomes andOperational Efficiency.Streamlined billing reduced the number of billholds, the days to request for anticipated pay-ment and cancelled requests for anticipatedpayment. Clinical Outcomes & Reimbursementalso decreased the number of days to payment.

People’s Choice Award.Simulated Code Blue Practice forRadiology.After training, 40 radiologic technologist andtechnical assistants reported their comfort levelin a Code Blue situation increased by 56% andtheir ability to locate emergency equipmentincreased by 54%.


Publications“Cancer Stem Cells: A Step toward theCure,” in Journal of Clinical Oncology, 26 (17).

“Change Management at the HospitalFront Door: Integrating Automatic PatientTracking in a High-Volume EmergencyDepartment and Level-1 Trauma Center,”in Nurse Leader, 6 (2).

“Christiana Care Health System: SafetyMentor Program,” in the Agency forHealthcare Research and Quality four-vol-ume Advances in Patient Safety: NewDirections and Alternative Approaches.

“Favorable Toxicity and BiochemicalControl Using Real-Time InverseOptimization Technique for ProstateBrachytherapy,” in Brachytherapy, February11, 2009.

“Five Minute Consult – Safety MentorProgram,” inMedia HealthLeaders,May 2009.

“Free Them Up…Effective Patient Safetyand Quality Improvement Require SkillDevelopment,” in the American Journal ofMedical Quality, 2008 (23).

“Implementation of a Team TrainingProgram for Trauma Care: The BETTER(Bringing Enhanced Team Training to theEmergency Room) Initiative,” in Annals ofEmergency Medicine, 52 (4).

“Improving Handoff Communication,”in Nursing, February 2009.

“Integrating Hospital-Based Pharmacistsin a Private Medical Oncology Office,”Oncology Issues, 2009.

“Integrating Team Training Strategies intoObstetrical Emergency SimulationTraining,” in Journal of Healthcare Quality,scheduled September/October 2009.

Sharing What We LearnIn the past year, Christiana Care nurses, physicians and staffpublished more than 50 articles in nationally-recognized venuesand gave more than 100 invited presentations at national andinternational conferences. Here are some recent accomplishments.


PresentationsThe Agency for Healthcare Research andQuality's Health Care InnovationsExchange featured Christiana Care’s PatientSafety Mentor Program innovation in anationwide webinar, “ImprovingInnovations: How to Make Data Work forYou,” United States and Canada, April 2009.

“Focus on Excellence: A Team Plan to StopFalls,” at the Institute for HealthcareImprovement Forum on QualityImprovement in Healthcare, December 2008.

“Implementation of a Team TrainingProgram for Trauma Care: The BETTER(Bringing Enhanced Team Training to theEmergency Room) Initiative,” at AmericanCollege of Emergency PhysiciansConference, October 2008.

“Is Zero VAP Truly Achievable” at the2009 American Association of Critical CareNurses ConferenceMay 2009.

“Maintaining the ACE Unit: Interdisci-plinary Teams, Protocol, and QualityImprovement Outcomes on the ACEUnit,” at the 12th Annual NursesImproving Care for Health System Elders(NICHE) Leadership Conference, February23.

“Process Improvement in CardiacRehabilitation Outcome Data Collection,”at the Quality of Care and OutcomesResearch in Cardiovascular Disease andStroke Conference, April 29.

“Survey of Post-Bariatric Surgery Patients:Characteristics Associated with Follow-UpPractices,” at the 26th Annual Meeting ofthe American Society for Metabolic &Bariatric Surgery, June 2009.

“TeamSTEPPS Implementation andSustainment in a Large IndependentAcademic Medical Center,” at the TeamSTEPPS Collaborative, June 2009.

8 SAFETY F IRST � CREAT ING A SAFE CULTURE

Creating a safe culture offers several benefits:

• Supports communication among all levels and areas of the organization.

• Encourages multidisciplinary, collaborative problem solving.

• Contributes to the consistent delivery of high quality, safe patient care.

• Allows staff to learn from mistakes rather than placing individual blame.

• Helps care providers understand how to work together effectively incomplex processes.

• Supports better interactions with patients and their families and places themat the center of their health care.

• Provides mentorship and a sense of community.

SAFETY FIRST

Creating a Safe CultureCreating outstanding patient safety and quality of care depends ondeveloping and maintaining a vibrant culture that engages caregiversin proactively finding solutions to problems, sees mistakes as opportunitiesto learn, and focuses on effective communication.

SAFETY F IRST � CREAT ING A SAFE CULTURE 9

Agency for Healthcare Researchand Quality (AHRQ) HospitalSurveyOne of the first steps in changing cultureinvolves assessing that culture. ChristianaCare is one of 190 teaching hospitals to par-ticipate in the 2009 AHRQ hospital surveyon patient safety culture. The survey, whichwas also administered in 2006, measures

patient safety culture in detail at theunit/department and at an overall hospitallevel. From 2006 to 2009, Christiana Carehas shown significant improvement in itsculture of safety. The percentage of respon-dents giving Christiana Care an overallsafety grade of either an “A” or a “B”increased significantly, from 69 percent to75 percent.

The 2009 results demonstrate the followingareas of strength:• Teamwork within units.

• Supervisor/Manager expectations andactions to promote safety.

• Organizational learning and continuousimprovement.

• Management support for patient safety.

Areas that will continue to be a focus forimprovement:• Communication between units with

coordination and exchange of key clinicalinformation.

• Non-punitive response to error and staffconcern that mistakes are held againstthem and are placed in their personnel file.

• Staff feeling free to speak up andquestion those with more authority.


Handoff CommunicationBreakdowns in communication are a majorcause of error and a threat to patient safety.To ensure that complete information istransferred along with the patient, an inter-disciplinary team at Christiana Care hasimplemented tools for three types ofhandoffs: handoffs to other departments,handoffs to other nurses and handoffs tophysicians.

• Handoffs to patient escorts and otherdepartments – Round Trip Ticket

Acute care patients often leave their unitfor tests, procedures or therapies but areusually always accompanied by a nursewho knows the patient’s information. Toensure that the information goes with thepatient, the team developed a two-partticket. The unit nurse fills out the toppart, answering questions such as “Canthe patient ambulate and transfer inde-pendently?” or “Does the patient speakEnglish?” Someone in the receivingdepartment fills out the bottom part, indi-cating any important events or changes inthe patient’s condition while the patientwas away from the unit. Names of staffmembers involved in the patient’s careand their contact numbers are alsoincluded.

• Handoffs to nurses: the DATAS tool

The team created this tool in responseto a random survey of nurses askingwhat information they most need toknow during a shift-to-shift or unit-to-unit handoff:

- Demographic and diet information

- Assessments and allergies

- Tests and test results

- Alerts such as do-not-resuscitate orders

- Status of the patient within the planof care.

• Handoffs to physicians: SBAR

After reviewing tools other hospitals useto improve handoffs to physicians, theteam chose SBAR, an acronym detailinginformation necessary for a safe handoff:

- Situation.

- Background information.

- Assessment of the currentsituation.

- Requests related to the problems beingreported.


Team TrainingAlthough safe and effective patient caredemands that diverse health care profession-als work together, most have no training incommunicating across disciplines or in beingproductive team members. To improve team-work and ensure safer practices, a ChristianaCare multidisciplinary team used TeamSTEPPSTM, an evidence-based teamwork sys-tem designed to improve patient outcomesby building communication and other team-work skills to develop a team trainingcurriculum with four core competency areas:• Leadership

• Situation Monitoring

• Mutual Support

• Communication.

Most Emergency Department and TraumaOperating Room staff have participated inthe training. All members of the peri-operative staff are expected to completethe training by the end of 2009; numerousdepartments have incorporated elementsof Team STEPPSTM Training into their dailypractices. Integrating team concepts intoits obstetrical emergency response train-ing, for example, Women and Children’shas developed a coordinated, rapidresponse to shoulder dystocia.

From the surgeon's perspective, Team Training has been a tremendous opportunityfor success. Not only have we improved our overall patient safety, but the traininghas positively affected relationships between the departments of anesthesia, surgery,emergency medicine and nursing. For the attending surgeons and surgical house-staff, Team Training has been a transformative journey, using the concepts ofcommunication, leadership and professionalism to build a foundation for betterpractice patterns and performance improvement in trauma care.

I strongly believe that this initiative will propel CCHS into the future, developingeffective team building, potentially eliminating medical errors and applying a truemultidisciplinary approach to patient care. Team Training has the potential to reduceemergency department, OR, ICU and ward disposition times and ultimately lengthof stay. This program has now been written into our resident and midlevelpractitioners' curriculum and will be an integral part of our simulation training.

Steven A. Johnson, M.D., FACS,attending surgeon and faculty, Surgery Residency Program

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StorytellingRather than presenting only graphs andcharts, which show error rates and goodcatches as numbers, No Harm Intendedpresents stories that make errors or goodcatches real by putting a human face onthem. Sharing stories about actual errorsor good catches in a blameless environ-ment enables staff not only to addresssystems-based failures but also to realize

the important role of each staff member inactively preventing errors.

After selected presenters relate their stories,participants identify points in the processand other factors that may have led to theerror – always without placing blame –and discuss changes that will help preventthe error from happening again.

No Harm Intended: LessonsLearned in Patient SafetyThe No Harm Intended sessions are basedon the premise that all harm is preventable.These sessions are designed to increasevisibility of errors, show the human

impact of errors and involve staff activelyin developing solutions to enhance patientsafety. In embracing transparency, thesesessions allow for openly discussing andanalyzing our errors so we can learn fromthem.

SafetyMentor ProgramServing as interdepartmental ambassadorsfor safety and infection control, safetymentors from each unit help staff through-out the system understand and implementsafety initiatives. Selected by unit managers,the mentors are key factors in developing aculture of safety. They encourage communi-cation throughout the unit, helping to createa blame-free environment where people cangive each other feedback and discuss andlearn from safety issues. Through monthlymonitoring of patient safety behaviors that

focus on National Patient safety goals, safetymentors also promote safe practices withintheir units. Real time observations promotepeer-to-peer feedback and positivereinforcement of safety behaviors.

The Safety Mentor Program served as thefocus group to redesign the web-basedSafety First Learning Reports, an eventreporting system. The redesign has resultedin a 17 percent increase in event reportingand an 8 percent decrease in serious eventswith harm.


Major Outcome Rate Chart

The safety mentor program has been so successful that ChristianaCare was invited to describe its development and implementation at“Improving Innovations: How to Make Data Work for You,” aninternational AHRQ webinar in April 2009.

Rapid Response TeamThe Rapid Response Team Program hasfocused its efforts on actively engagingpatient and families. Patients and familiesare now encouraged to call the Rapid

Response Team to discuss any concernthey may have about a change in apatient’s condition. Each room now has aposter reminding patients and families thatthey can call for help.


Your comfort and safety are paramount to us.If you (or your loved one) are experiencing aserious change in condition, and feel that this

change is not being recognized by your caregivers,use the phone in your room and dial 6385.

www.christianacare.orgChristiana Care is a private, not-for-profit regional health care system and relies in parton the generosity of individuals, foundations and corporations to fulfill its mission.

09NURS7

At Christiana Care, we encourageour patients and families to takean active role in patient care.


Achieving Competence Today (ACT)The 12 week graduate course, “Issues in Health Care, Quality, Cost, Systems and Safety,” isdesigned to improve patient safety and quality of care. Through a collaborative processguided by a trained facilitator, interdisciplinary teams of physicians, residents, nurses,pharmacists, other health professionals and executives:

• Identify practice-based problems

• Develop consensus to select a team project

• Work together to design and test a solution.

As they practice and improve their interdisciplinary team skills, participants learn toinvestigate and evaluate existing patient care practices and to use research-based evidenceto improve them. This year, more than 120 people have taken the class.

Since the course began in 2004, teams have developed 20 quality and safety improvementprojects, many of which have been integrated into Christiana’s daily operations. One of theprojects – “My Tissue, My Result, My Expectation,” which sets out a new OR protocol toreduce error and delay in lab processing and test results – is being integrated into theWorld Health Organization’s Surgical Safety Checklist, which will be in all ORs bySeptember 2009.

The program’s momentum is increasing along with the number of graduates whobring their knowledge and the benefits of their ACT experience to our health system.Moving forward, we anticipate that focused educational opportunities like ACT,which involve interdisciplinary professional learning and performance, will becomeeven more familiar in our community teaching hospital setting.

Brian Little, M.D., Ph.D.Vice President, Academic Affairs and Research

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28 AWARDS , ACH I EVEMENTS AND RECOGNIT ION16 ACHIEV ING HIGH REL IAB I L I TY

ACHIEVING HIGH RELIABIL ITY

In its ongoing effort to achieve the highest quality, safest and mostreliable patient care, Christiana Care has adopted the concept of bestpractices, which seeks to minimize and eliminate errors in systems.Designing and implementing processes and systems based on bestpractices is a first step in achieving high reliability. Identified throughclinical trials and studies, best practices are evidence-based, effectiveprocedures that evolve through continual testing and measurement toensure the best possible outcomes for both the health care system andits patients.

Best practices rest on the conviction that quality and safety are theproducts of well designed processes and systems that, in effect,standardize excellence.

ACHIEV ING HIGH REL IAB I L I TY 17

Our mission is to serve members of our community in their time of need, so whenone of our neighbors is sick, the right bed must be available at the right time, everytime. The Bed Access project ensures that we start each morning anticipating theneeds of our community and making sure that we can accommodate our neighborswhen they need us.

Diane C. Bohner, M.D., FACPMedical Director, Utilization Management

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”Bed Access ProjectDesigned to improve access to inpatient services, the Bed Access project is improving theinpatient journey by matching daily patient demand with available inpatient capacity.After identifying significant mismatches in bed capacity to meet daily demand and gapsin care coordination and communication, the team implemented new processes that haveled to significant reductions in overall average length of stay (LOS) and EmergencyDepartment boarding hours.

Bed-Access Project Discharge Rates. CCHS - Discharge before 2 p.m.

Bed-Access Project Avarage Length of Stay. CCHS Acute LOS. Source - Monthly Finacial Statements

18 ACHIEV ING HIGH REL IAB I L I TY

Emergency DepartmentTo ensure that the rapidly growing numberof patients in our Emergency Department(ED) does not compromise patient safetyand quality of care, Christiana Care isredesigning the entire ED triage andtreatment process.

Super TrackIn January 2008, a team of ED leaders andfront-line staff began the arduous task ofidentifying steps in the process thatadversely affected both patients and staff.Their goal was to improve quality andsafety by:

• Reducing average length of stay.

• Reducing the percentage of patients wholeave without treatment (LWOT).

• Increasing patient satisfaction.

As a start, the team re-engineered thetriage and flow of low-acuity, level-fourand level-five, patients. Once it identifiedbottlenecks and system waste, such asrework, the team implemented changes inthe system, tested them, modified themand retested, continuing to modify andretest until the change met patient needsand the staff could sustain the changes.

In tracking the results of the changes,Christiana Care’s existing EDTrackerTM

system was critical. With EDTrackerTM, eachpatient, each staff member and each pieceof mobile equipment is tagged withinfrared badges monitored by sensorsthroughout the ED. The sensors relay thereal-time location of every person and pieceof equipment in the ED to on-screen mapsof the area, eliminating wasted search-and-find time.

In addition to changes such as modifyingorder entry and establishing differentmethods of communicating among staffand departments, the redesign stationed ateam of a physician’s assistant, a nurse anda patient-care technician in each of twosmall treatment rooms close to the patient-arrival area. Having the team participatetogether in the assessment process witheach patient eliminates the patient’s havingto repeat information and speeds the triageand treatment process.

To continue to improve patient satisfaction,continuity and the safety and reliability ofcare and to decrease fragmentation and thenumber of adverse events, the teamcontinues to refine the process and expandthe redesign to the Wilmington Hospitaland to higher-acuity patients. As thefollowing numbers show, the redesign isan impressive success.

Completed Project Christiana ST


Synchronous Provider Evaluationin the Emergency Department(SPEED)SPEED, which continues the redesign ofthe Emergency Department triage andtreatment process, will improve care ofESI-3 patients in Christiana Hospital’s ED.Because ESI-3 patients – 50 percent of allpatients seen at Christiana Hospital – mayhave moderate to severe, but not life-threatening illnesses, many of them waitan average of 90 minutes before seeing aphysician and have an average length ofstay of nearly 5 ½ hours.

Building on experience in process redesignand waste reduction from the Super Trackproject, a team of direct healthcare workersand physicians is developing a new processthat will standardize many procedures,improve room use, decrease ancillarydepartment delays and improve patientcommunication and flow through the ED.Most important, the process’s greatpotential to improve overall care andaccess to emergency services is evident inthe dramatic decrease in left-without-treatment rates since the inception of theprogram.

Active Project Wilmington ST Target Go-Live July 2009

Active Project CH SPEED Target Go Live Dec. 2009


Infection ControlChristiana Care’s goal is to reduce and controlboth hospital- and community-acquiredinfections. The risk of acquiring these infec-tions is present in all health care settings.Whether endemic (common cause) orepidemic (special cause), they may affecteveryone, including patients who comeinto contact with infected individuals.

Efforts to reduce the risk of infection havefocused on improving surveillance andprevention in three areas:• Clostridium difficile infection, with the goal

of reducing the number of spores in c.difficile-patient rooms and ultimatelyreducing the risk of transmission.

• Methicillin-resistant Staphylococcus aureus(MRSA), in both inpatient and outpatientrooms, with the goal of identifyingpositive patients and isolating thempromptly. Christiana Care is alsoparticipating in a MRSA patient-safetyinitiative with Quality Insights ofDelaware, through the Centers forDisease Control and Prevention’sNational Healthcare Safety Network(NHSN).

• Device-associated infections in non-intensive-care units, with the goal ofmonitoring these infections more accuratelyand devising targeted interventionsaccordingly.

Ventilator Associated Pneumonia(VAP)To improve VAP rates, in October 2008 ateam of Christiana Care physicians andnurses began reviewing current researchand guidelines and instituting pilot proj-ects. The team has updated and is currentlyevaluating Clinical Practice Guidelines,with the intent of offering training andgoing live by Fall 2009.

Because the literature has identified oralcare, including toothbrushing and use ofchlorhexidine, as an effective measure todecrease plaque and risk of VAP, the teaminstituted a pilot project in the Cardio-

vascular ICU to improve toothbrushing andbegin use of chlorhexidine. Each patientreceives the following:

• Preoperative chlorhexidine mouth rinse.

• New toothbrush with a built-in suctiondevice.

• Perioperative chlorhexidine mouth rinsetwice a day.

The pilot is currently being evaluated.

A subgroup of the team is examining thepossibility of standardizing VAP diagnosis.VAP data are evaluated by NHSN Centerfor Disease Control criteria. The VAP ratefor all Christiana Care intensive care unitsare below the NHSN mean for like units.

Overall VAPRate (MICU, WICU, SCCC, CVICU, CICU)


Anticoagulation MonitoringBecause of complex dosing, necessary fol-low up and inconsistent patientcompliance, anticoagulation therapy posespotential risks to our patients. The anticoag-ulation monitoring program is an effort todevelop and implement protocols for pre-

scribing, dispensing, administering, moni-toring and educating patients. Our goal isto ensure that everyone has an InternationalNormalized Ratio (INR) warfarin levelbefore administering warfarin. Before theprogram, 86 percent of patients had an INR;now, 93.2 percent do.

Gluten Allergy MonitoringChristiana Care has begun monitoringgluten allergies to prevent administeringmedications that contain gluten to gluten-allergic patients. Gluten is commonly used

as filler in many oral medications. Beforethe program was instituted, up to 90percent of patients with gluten allergiesreceived a medication containing gluten.That percentage has now dropped to zero.

Virtual Education SimulationTraining (VEST) CenterThe state-of-the-art VEST Center providessafe, educationally valid, multidisciplinarytraining in a variety of simulations, fromlaparoscopic surgery to intubation to acutemedical emergencies to code blue practiceto episiotomies, all with no possibility ofpatient harm.

Often introducing healthcare professionalsto new equipment and new techniques, the

center’s simulated, real-life patient-caresituations improve learners’ skill levels andconfidence. The simulations vastly improvepatient safety and quality of care.

In the past fiscal year, the center has offeredmore than 400 simulations, involving 691hours of simulation, to more than 3,000trainees – attending physicians, residents,fellows, nurses, respiratory therapists, alliedhealth practitioners and medical, nursingand allied health students.

In response to the public’s demand for safe healthcare and a highly skilled medicalstaff, Christiana Care Health System has developed a virtual hospital, the VirtualEducation Simulation Training center. The VEST center trains healthcareproviders in direct patient care, birthing, trauma and surgery and endovascularprocedures, in a safe, controlled and educationally valid environment. Providinguniform training for and the opportunity of evaluating all CCHS employees,physicians and staff can only further improve our delivery of safe, quality care.

Glen Tinkoff, M.D., FACS, FCCMAssociate Vice Chair, Department of Surgery

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Outpatient LaparoscopicCholecystectomyThe Outpatient LaparoscopicCholecystectomy Project, begun at the endof 2008, is intended to transform thepatient-care pathway. A cross-departmentalfocus group of perioperative nurses,administrators, educators and physiciansis producing protocols and data gatheringsystems that are already enhancing severalareas of the Focus on Excellence model.

Surgical Safety Checklist: Working with thePerioperative Services Team Training WorkGroup, the focus group developed andimplemented a Surgical Safety TeamCommunication Tool that the World HealthOrganization (WHO) has adopted.

Post-Operative Protocol: The anesthesiaprotocol effectively provides a comfortablepost-operative experience. Most patients

have left the surgicenter within 2-3 hours.Of the 23 patients participating in the pro-gram to date, only two patients have beenadmitted, one for reasons unrelated to theperioperative process.

History and Assessment Document: Toreduce redundancy and paper consumption,the team is now creating an effective historyand assessment electronic document.

Costs: Patients receiving outpatient laparo-scopic cholecystectomy spend less time intreatment, reducing cost of service forChristiana Care.

Ultimately, we hope to apply this processto a broad spectrum of case types that flowthrough the outpatient system. The surgicalparticipants, for example, hope to developa similar process for general surgical proce-dures currently provided in the main OR.

Primary Stroke CenterAccreditation PreparationIn pursuing accreditation as the firstPrimary Stroke Center in Delaware, theChristiana Care stroke team is in the finalstages of preparing for an upcoming site

visit by the Joint Commission. During fiscalyear 2009, the team focused on deep-veinthrombosis prophylaxis, anti-coagulationefforts and cholesterol reducing drugs,demonstrating significant improvement ineach.

Unit-Based Medical Director(UMBD) ProgramChristiana Care’s Unit-Based MedicalDirector program not only improves qualityand safety – it also improves communicationbetween physicians and nurses. Physicianmedical directors in each front-line nursingunit help everyone in the unit – nurses,

other physicians, residents – understandand implement new quality and safetyinitiatives. Collaborating with othersin the unit, the directors help develop newquality and safety projects. Their weeklyunit education sessions foster collaborationand collegiality.

Our unit based medical directors continue to provide leadership along with thenurse managers in system-wide performance improvement and patient safetyinitiatives. This collaborative effort between physicians and nurses has beeninstrumental in the success and ongoing implementation of projects such asElectronic Medication Administration Record, Medication Reconciliation, FallsPrevention and reduction of length of stay. Our UBMDs provide invaluable insightinto how to engage our physician colleagues in important quality and safety efforts.

Janice E. Nevin, M.D., MPHSenior Vice President and Executive Director, Christiana Care - Wilmington & Associate CMO

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Hospital Consumer Assessmentof Healthcare Providers andSystems (HCAHPS) PatientSatisfaction SurveyMeasuring patient satisfaction is critical tocreating a patient and family-centeredapproach to acute care. Although theCenters for Medicare & Medicaid Services(CMS) has mandated that all hospitalsreport only a sample of patient responses tothe HCAHPS survey, in fiscal year 2009Christiana Care expanded use of the surveyto most inpatient units.

The main purpose of the survey, whichassesses major areas of hospital performancethrough standardized questions and format,is to allow the public to compare hospitals.Christiana Care also uses the survey resultsto measure progress toward internal goals.

Christiana Care has set a benchmark that atleast 80 percent of patients will check thetop box, indicating they would “Always”recommend us to family and friends. To date,75 percent of patients check the top box –compared to the national mean of 68 percent.

Survey Categories FY 2009 YTD National Mean

Recommend this hospital 76% 68%

Communication - Nurses 76% 74%

Communication - Doctors 78% 80%

Response of Hospital Staff 68% 62%

Hospital Environment 55% 62%

Pain Management 71% 68%

Communcation - Medications 57% 59%

Discharge Process 80% 80%

Year to Date March 31, 2009

Patient and Family-Centered CareTo deepen its commitment to creating a patient-centered culture, Christiana Care isadopting the core concepts of patient and family-centered care defined by the Institutefor Family-Centered Care:

• Dignity and Respect Listening to and honoring patient and family perspectives andchoices; incorporating their knowledge, values, beliefs and culturalbackgrounds into planning and delivering care.

• Information Sharing Giving patients and their families timely, complete, unbiased andaccurate information so they may participate effectively in careand decision making.

• Participation Encouraging and supporting patients and families to participatein care and decision making.

• Collaboration Collaborating with patients and families in developing,implementing and evaluating policies and programs; designinghealthcare facilities; professional education; and care delivery.

With pilot studies at both Wilmington Hospital and Christiana Hospital, Christiana Care isbeginning to integrate these concepts into patient care.


The Visiting Nurse Association (VNA)promotes and maintains the health andsafety of all members of our community,from the newest to the oldest, where theyfeel most comfortable—at home.

Managing MedicationsHome-care nurses promote medicationsafety among at-home patients. The nurses:

• Review all drugs – prescribed medications,over-the-counter medications, herbalremedies and nutritional supplements.

• Reconcile newly prescribed medicationswith ones taken previously for chronicconditions.

• Identify allergies and potential medication-medication or medication-food inter-actions and communicate them tophysicians.

• Send the medication list to physicians forverification.

• Teach patients and caregivers medicationactions, dosing, side effects andreportable signs.

• Work with patients to organize a systemto improve adherence.

If necessary, VNA nurses even help identifyresources to obtain medications.

Managing Diseases and ChronicConditionsBased on best practices and nationalstandards, the VNA’s heart failure, chronicobstructive pulmonary disease (COPD) andoncology programs help improve patienthealth and safety.

In the COPD and heart failure programs,TeleHealth, an electronic monitoring systemwith more than 100 monitors statewide,promotes self-monitoring and healthybehaviors. It enables VNA nurses to identifyimmediately any decline in a patient’scondition or any developing problem andto alert physicians so they can act morequickly and effectively to resolve theproblem.

During the past year, TeleHealth patientsrequired acute care hospitalization less thanthe Strategic Healthcare Program (SHP)reference.

Adding rehabilitation services to thedisease management programs has helpedimprove patient endurance and function.Improved ambulation for disease-manage-ment patients now exceeds the SHPreference.

Enhancing the Health of OurCommunitiesAs part of the VNA’s effort toimprove the health and safety ofeveryone in the community, thenew Caregiver EducationSeries helps caregivers learnnot only how to care forpatients but also how tocare for themselves. Sinceits inception in 2008, morethan 100 people haveparticipated in the classes,which are offered free ofcharge throughoutDelaware.

Visiting Nurse Association


Health Initiatives across Christiana Care

To provide consistent oversight and patientcare, the Trauma Program restructured itsservices throughout the continuum of care.The program expanded Advanced PracticeNurse (APN) and trauma social workevening and weekend coverage and engagedthe Clinical Decision Unit in managingblunt cardiac injury and concussion cases.

Facilitated by bedside nurses using theTrauma Rounds ABC checklist, a traumaAPN leads daily bedside interdisciplinaryrounds. Combined, these efforts have led todecreased length of stay , better coordinationof care and services, and increased employeesatisfaction.

Lenght of Stay: July 2008 - January 2009

Occupational Health ServicesOccupational Health Services (OHS) isworking with all clinicians involved in theExecutive Health program – cardiologists,psychologists, dietitians, exercise

physiologists – to improve communicationamong them and to improve turnaroundtime on the comprehensive report executivesreceive after their evaluation.

Physical Therapy PLUSWithout compromising quality of care,Physical Therapy PLUS has reduced itsappointment times to increase accessibility

and productivity. The change allows eachclinician to see three more patients a day,but still allows clinicians to spend individualtime with each patient.

Imaging ServicesImaging Services implemented a qualityassessment of MRI, CT, Ultrasound andX-Ray procedures, such as correct andcomplete imaging, correct markers andcomplete documentation. After the

assessment, Imaging Services held sectionmeetings to discuss areas for improvementand to provide training. As part of its on-going performance improvement, ImagingServices has scheduled monthly evaluationsand assessments of technical quality.

Cardiac RehabilitationWhen patients are admitted to cardiacrehabilitation, they are assessed for health,clinical and behavioral outcomes usingevidence based measures established bythe American Heart Association. When

patients are discharged, they are reassessedto determine their progress toward reachingtheir goals. Each patient’s primary carephysician and the attending cardiologistreceive the progress report.

Trauma Services

26 LEVERAG ING TECHNOLOGY

LEVERAGING TECHNOLOGY

Cutting-edge technology at Christiana Care undergirds every quality and patientsafety initiative:• Tracking people, supplies and equipment.

• Connecting large healthcare systems to remote rural practices.

• Standardizing forms and medication processes.

• Ensuring correct and readily available patient information.

• Analyzing systems to pinpoint opportunities for improvement.

• Speeding diagnoses and effective treatment plans; offering split-secondcommunication.

• Enhancing training.

• Facilitating testing and measurement – so vital to developing and maintainingbest practices.

LEVERAG ING TECHNOLOGY 27

In 2007, with the launch of the DelawareHealth Information Network, Delawarebecame the first state in the U.S. to connecthealth care providers statewide. ChristianaCare is a vital part of this network thatconnects:• Four hospital systems with six hospitals –

BayHealth Medical Center, Beebe MedicalCenter, Christiana Care Health Systemand St. Francis Hospital.

• 900 providers.

• Four Federally Qualified Health Centers– Delmarva Rural Ministries, La RedHealth Center, Henrietta Johnson MedicalCenter and Westside Family Health.

• Two National Reference Laboratories anda local pathology provider.

• Six electronic medical records (EMR)vendors that serve more than 130physicians in 24 practices.

In addition to almost 650,000 patient charts,DHIN provides users instant access to awide variety of records and reports:

• Patient demographic data.

• Payor information.

• Admission, discharge and transfer data.

• Laboratory and pathology results.

• Complete prescription and non-pre-scription patient medication histories.

• Radiology and transcribed reports.

• Biosurveillance data.

Administered by a board of directors andguided by a Consumer Advisory Committee,DHIN greatly improves patient safety andquality of care throughout the state – fromChristiana Care, the largest medical centerin the state, to small rural practices.

• Receiving reports immediately enablesphysicians to begin appropriatetreatments immediately.

• Instant access to patient bloodworkresults, antibiotic-related decision supportand out-of-range alerts enables providersto prescribe, dispense and administermedications more effectively.

• Electronic transmission reduces thenumber of lost test results and subsequentduplicate tests.

• The standardized data format reducesthe possibility of misinterpreting reportsand allows physicians to easily recognizeabnormal results.

• Clear and concise printed reports eliminatethe possibility of error resulting frompoor-quality fax copies.

• Because practitioners can act upon criticalresults of diagnostic tests within hoursrather than days, the system enablesofficials to respond more rapidly andeffectively to public health threats.

Delaware Health Information Network (DHIN)


Our nurses and physicians demonstrate their commitment to patient safety everytime they use the drug library software when programming patients’ infusions.From the very beginning, staff has used the drug libraries in programming morethan 97 percent of all infusions.

Terri Corbo, Pharm.D., BCPS, FASHPMedication Safety Officer

To increase patient safety and to makemedication administration virtually errorfree, Christiana Care implemented HospiraSymbiq infusion pumps, beginning inJanuary 2009 at Wilmington Hospital andin April 2009 at Christiana Hospital. Thepumps are commonly referred to as “smartpumps” because pump software providesalerts during programming to prevent dos-ing error – “soft” alerts that can be

overridden if appropriate and “hard”alerts that cannot be overridden.For individual patient or service lines ineach nursing unit, nursing, pharmacy, andmedical-dental staff developed customizeddrug libraries with sub modules that displaygeneric medications, “tall man” letteringfor look-alike and sound-alike medicationsand standardized intravenous infusionconcentrations.

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Infusion Pumps


With bar-coded wrist bands, the electronicmedication administration record (EMAR)and computerized physician order entry(CPOE), Christiana Care is transforming itscare delivery process – increasing efficiencyand significantly reducing the number ofmedication errors.

The wristband-EMAR-CPOE loop ensuresthe five rights of medication safety:

• Right patient.

• Right medication.

• Right time.

• Right dose.

• Right route.

Electronic Administration RecordEMAR = Bar-Coded Medication Administration(BCMA) at Point of Care (POC)Using a wireless handheld device with ascanner, screen and keyboard, a nurse scansthe patient’s wristband to identify thepatient in the system. When a list ofmedications ordered for the patientappears, the nurse scans the barcode onthe medication on the cart. To ensureaccuracy, EMAR software then matchesthe medication, the dosage and the routeagainst the medications list.

If the medication, dosage or route does notmatch or if the patient is allergic to themedication, the handheld device issues asafety alert. Beyond ensuring accuracy inadministering medications, EMAR alsofacilitates double verification of high-riskmedications and improves medication-related documentation, such as vital signsand pain reassessments.

Using EMAR ensures safe medication. Thescanning compliance rate is greater than90 percent.

Bar-Coded Wrist BandsCorrectly identifying patients is thefoundation of patient safety. Bar-codedwrist bands, which contain a number ofpatient identifiers such as name and date ofbirth, virtually eliminate patientidentification errors.

When admitted to the hospital, a patientreceives a bar-coded wristband that nursesscan to confirm the patient’s identity andmatch it to orders and prescriptions beforedispensing blood, administering lab tests,collecting specimens or administeringmedications.

Electronic Medication Technology


Computerized Physician OrderEntryCPOE is a transformational clinicalinitiative that will improve patient safetyand enhance efficiency. Because orders willbe transmitted as soon as physicians enterthem, orders will reach departments withno delays.

With bar-coded wristbands and EMAR,CPOE provides a closed loop medicationprocess. To ensure optimal patient safety,all steps in the medication cycle arecomputerized and have been reviewedfor accuracy.

A significant component of work on thesystem during FY2009 was to transition thecurrent order entry system to a “physicianfriendly” one that supports single-click

entry, defaults and other ease-of-usechanges so that physicians will embracethe new process.

Additionally, more than 300 order sets(collections of orders based on diagnosisor admission condition) or Medicine,Surgery, Psychiatry and the EmergencyDepartment have been developed to date.Order sets enable physicians to enter ordersquickly and see the best evidence-basedorder choice. To ensure that they areaccurate and comply with regulatoryagency standards, all order sets gothrough a rigorous approval process.

Physician training will begin in Fall 2009to prepare for the rollout at the end ofJanuary 2010.

Building an order-entry system that streamlines the ordering process for thephysician and, at the same time, ensures optimal safety for the patient has beenchallenging. Because hundreds of physicians, nurses and pharmacists participatedin designing the system, it supports the clinical workflow and is easy to use. It’sclear to the clinicians and to those who work on this project that we are wellpositioned for success.

Terri Steinberg, M.D., MBAChief Medical Information Officer

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Errors Intercepted


GetWell NetworkThe GetWell Network, a bedside communi-cation tool directly involving patients intheir own care, puts Christiana Care at theforefront of using innovative technology toimprove patient satisfaction and safety,quality outcomes and compliance andnursing efficiency. In October 2008,Christiana Care became the first health caresystem in the country to link the network tohospital clinical documentation software,the Cerner PowerChart.

In addition to enabling nurses to prescribespecific education videos to patients, thenetwork offers many pathways to engagepatients.

Speak Up About Your Safety – Patientsreceive a daily alert asking if they havesafety concerns. If they do, patients candocument their concerns and the docu-mentation notifies the nurse manager andthe Patient Safety department directly.

Smoking Cessation – Patients identified onadmission as smokers receive a pathwayprompt inviting them to watch the smokingcessation video. If they decline, an alertappears listing resources to help them quitsmoking.

Question of the Day – This feature enablespatients to provide daily feedback abouttheir stay. If things are not going well, staffcan immediately address patient concernsand improve patient perceptions whilepatients are here.

The GetWell Network also provides a bed-side computing station where patients andtheir families can access the Internet,research medications and request non-clinical services – freeing nurses to focus onclinical duties.

In addition to ongoing interaction betweenpatients and staff, the network alsoenhances communication through translatingnotes into other languages and providing atool for patients who are unable to speak.

Since 2006, the GetWell Network’s originalfour units in Christiana Hospital’s E Tower,consistently receive patient satisfactionscores greater than the ninetieth percentile.As Christiana Care continues to implementthe network, patient satisfaction scorescontinue to rise.

The system acts as a guide for the patients through their hospital stay,providing access to the people and resources they need to have an optimalcare experience– more actively engaging them in their own care.

Diane Talarek, RN, MA, CANChief Nursing Officer and Senior Vice President, Patient Care Services

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32 THE FUTURE OF QUAL ITY AND PAT I ENT SAFETY

FOCUS ON EXCELLENCE

Patient safety is one of the most critical healthcare challenges that we face. As welook forward to the next fiscal year, we are aiming our patient safety efforts atreducing events that harm our patients. Setting the bar high, we assume that allharm is potentially preventable. Although separating preventable from inevitableharm is difficult, with the evolution of scientific knowledge and technology, the in-evitable may soon become preventable. To ensure that we continue to movetoward preventing all harm, we will persist in our efforts to identify clinical aswell as documentation and coding opportunities for improvement. These effortswill set our agenda for the next several years, with perfect care delivery ourultimate goal.

The Future of Quality and Patient Safety at Christiana Care

Creating a Safe Culture. “Just Culture” principles support a culture that includesand values well established accountability practices for both the system and theindividual. To keep our patients safe from risk, Christiana Care uses Just Cultureprinciples as we continue transforming our culture to create reliable care deliveryand staff accountability.

A highly effective tool in transforming our culture, Team Training emphasizesopen communication, idea sharing and problem solving, all essential for safeand reliable delivery of care. Expanding this program is a key strategy for thenext year.

Achieving High Reliability. Unwilling to accept even rare failures of criticalprocesses, high reliability organizations (HROs) are committed to incorporatingbest practices into quality and safety issues. Five key concepts are at the coreof HROs:

• Sensitivity to operations. Constantly aware of systems and processes that affectpatient care, HROs work persistently to identify risks and to prevent them.

• Reluctance to simplify.Although simple processes can be highly reliable,understanding the true reasons patients are placed at risk requires avoidingoverly simplified explanations of failure (unqualified staff, inadequate training,communication failure, etc.).

James Newman, M.D., FACP Sharon Anderson, RN, MS, FACHEChief Medical Officer Sr. Vice PresidentPatient Safety Officer PI and Care Management

Quality and Patient Safety

• Preoccupation with failure. Rather than being taken as proof that the systemhas effective safeguards, near-misses should stimulate improving processes toreduce potential harm.

•Deference to expertise. To create a safe culture and to promote highly reliableprocesses, leaders must listen and respond to the insights of staff who knowfrom practical experience how processes really work and the risks patientsreally face.

• Resilience. Leaders and staff must be trained and prepared to respondeffectively when system failures do occur.

Continuing to integrate the work of our physicians, nurses, ancillary staff andleadership, we will focus next year on continuing to create highly reliable caredelivery.

Leveraging Technology. By January 2010, we will implement ComputerizedPhysician Order Entry, a transformational project that will improve patient safetyand quality of care. Because the orders as well as the identity of the orderingphysicians will be clear, this project will greatly decrease the possibility ofmedication error. And because orders will be transmitted as soon as physiciansenter them, orders will reach departments and patients more quickly. Thistransformational project also creates an opportunity to use decision support toolsin diagnosing and treating disease.

Buoyed by the commitment, focus and skill of Christiana Care’s physicians,nurses, and clinical staff we look forward to another challenging year ofcontinued growth and improvement.

PO Box 1668Wilmington, Delaware 19899-1668www.christianacare.org

Christiana Care is a private not-for-profit regional healthcare system and relies in parton the generosity of individuals, foundations and corporations to fulfill its mission. 09PERF12

Documents

Quality and Patient Safety Annual Report 2009