Center of Excellence Certification Yields Ongoing Rewards

The staff and caregivers at Bay
Medical Center’s Heart Institute
knew they were providing topof-
the-line heart care; they witnessed
superb patient outcomes every day. But
in today’s competitive healthcare market,
it’s not enough for a hospital to
believe it’s one of the best. The organization
needs tangible evidence demonstrating
its excellence to the community.

For Bay Medical’s Heart Institute
team, the desired recognition was a
Center of Excellence certification from
the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) for
acute myocardial infarction (AMI) or
heart attack.

To earn this distinction, the AMI program had an extensive
on-site evaluation by JCAHO reviewers that looked at the program’s
processes and its internal ability to evaluate and improve
care. The hospital had to exceed national benchmarks in all
areas of heart attack care, including medication administration,
testing procedures, mortality and the time it takes for a patient
to receive treatment.

By using data to affect outcomes, Bay Medical Center’s Heart
Institute was the first in Florida to receive the JCAHO distinction –
called the Gold Seal of Approval – and among the first in the
nation to receive national accreditation in heart attack treatment.

CHALLENGE #1: LEARNING HOW TO USE THE DATA
Result: Benchmarking yields concrete goals
To reach their goal, Bay’s heart team needed corporate buy-in and
better knowledge of how to use data. A culture that is committed
to performance improvement is often cited as one of the key elements
of top-performing hospitals.

According to Larry Dawson, inpatient controller at the hospital,
such a culture has been building at Bay Medical for years. “The
cultural change began at the management level.With it came a
commitment to sincerely listen to the physicians,” he says.

After achieving high-level commitment
to the certification goal, Bay
formed an interdisciplinary team made
up of physicians, directors (nursing and
non-nursing), nurses, catheterization
lab technicians, respiratory therapists,
case managers, cardiac rehabilitation
therapists, radiology technicians, pharmacists
and financial/clinical analysts
to tackle the process.

The process of reviewing and utilizing
data to affect outcomes was innovative
for Bay Medical Center; it was the
first time they had used data in an
interdisciplinary approach. “From my
experience with Solucient® products,
I knew there was more we could do with
the data. Bay’s culture and Solucient’s ability to provide data-driven
insights has been the perfect fit,” says Dawson.

The interdisciplinary group reviewed reports from JCAHO Core
Measures, detailed benchmarking reports from HBSI EXPLORE®,
Solucient’s Core Measures Solution, ConditionView™ and ACTION
O-I®. The group also compared in-house data against national
benchmarks from the American College of Cardiology/American
Hospital Association, the Centers for Medicare and Medicaid
Services and Solucient’s 100 Top Hospitals®: National and
Cardiovascular Benchmarks for Success studies.

Based on that analysis, the group addressed the program’s
weakest areas, and reinforced its strengths. For example, Bay’s
mortality rates for percutaneous coronary intervention (PCI)
needed improvement, but its overall heart attack and congestive
heart failure mortality rates were better than the benchmarks.
From this, the group decided that improving door-to-catheterization
lab times would address the PCI mortality issues while supporting
the others.

“We knew we had an excellent program. By using these tools
and benchmarking against other hospitals, we were able to validate
our intuition regarding what we did well and identify other
areas where the team could improve,” explains Mary Lindsay, the
hospital’s director of emergency and cardiovascular services.

CHALLENGE #2: IMPROVING THE CARE PROCESS
Result: Improved treatment times; dramatically increased patient volumes
One of the areas that needed improvement was the time it took to
get patients from the emergency department to the cardiovascular
unit, which averaged 60 minutes. To address this, the hospital
used benchmarking data to create guidelines on the timing of different
care aspects and determine what steps should be taken for
each. For example, time goals were set for getting patients from
the hospital door to the catheterization lab. The unit is now
accomplishing this in 30 minutes.

Through such benchmarking and goal realignment, Bay’s
Heart Institute has also:

• Decreased heart attack deaths by 24 percent between 2004
  and 2005;
• Whittled the average time from admission to EKG to just four
  minutes (the industry standard is 10 minutes); and
• Dropped the time between arrival and angioplasty procedure
  by 25 percent.

Lindsay says that seeing the data really inspired staff to make
improvements and has boosted morale. “They are now in competition
with themselves to better their times,” says Lindsay. “Staff
even created T-shirts that read ‘PCI 0-60’ to represent our goal of
reducing the door-to-catheterization lab time to less than 60 minutes
– all the time.”

To share its accomplishments with the community, Bay has
used a campaign that includes billboards, television and magazine
ads, and patient information on its website. It has followed up with
community education that centers around heart attack symptoms
and what to do in case a heart attack strikes. Bay’s performance
improvement and marketing efforts have also increased cardiology
patient volumes, which have grown by 20 percent a year for
the past three years.

The Work Continues

When asked what the most important tool in the certification
process was, Lindsay doesn’t hesitate. “It’s the data. You have to
separate out the steps – find out if you have a process, understand
the process and see how you can improve. But most of all you have
to have the data,” she says.

To maintain its certification, Bay will have JCAHO evaluations
every two years. “This work was not for a one-time gain,” says
Dawson. “The beauty and challenge of the Center of Excellence
program is that it’s real time. The bar is constantly changing;
you have to change with it.”

In addition to maintaining certification, Bay Medical’s
heart attack team has other goals. They’d like to become a
congestive heart failure Center of Excellence, establish pointof-
care testing, shave the time it takes to get lab results to
the department, and, finally, find a way for heart attack
patients to bypass the emergency department and go
directly from the EMS to the catheterization lab. They know
from experience that credible data will serve as the foundation
of their efforts.

About Solucient and Thomson Healthcare

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