Achieving a new bottom line: Saved lives

Tired of lagging behind in hypertension control, a team shows what performance improvement is all about

THURSDAY, DECEMBER 11, 2008

The Problem
Internal Medicine at Skyline Medical Center in Colorado had the worst hypertension control rate in the region: 60%-6 points lower than the regional performance goal. 

The Solution
Putting their partnership training to work, the third-floor internal medicine unit-based team used the Plan-Do-Study-Act cycle of the Rapid Improvement Model to develop a hypertension clinic.

The clinic allows many patients to be seen and treated more quickly, without having to schedule a full appointment with a doctor.

Here's how it works: Staff contact patients who have had high blood pressure readings to come in for another reading. Before patients arrive, a clinical pharmacy specialist reviews their chart and recommends medication and lab work, in case their blood pressure is still high the day of the appointment.

Performance improvement: 'It's just part of our day.'

If it is, a registered nurse implements the pharmacist's plan. A follow-up appointment is booked immediately for a return visit in four to six weeks.

"It doesn't feel like extra work," said Dominique Spain, MA, SEIU Local 105. "It's just part of our day."

The Results
The team's goal was to reach a 66% hypertension control rate by 2009, which they accomplished in 10 months, two months ahead of schedule. As a result, 350 hypertensive patients are now leading healthier lives.

If they maintain their current pace, the team expects that in five years it will save 11 lives and more than $500,000 by cutting back on ER visits, hospitalizations and skilled nursing facility days. But Sean Riley, MD, the team's physician co-lead, expects to do even better than that. He projects that over the next year, the control rate be closer to 75%.

The key to success, said Dr. Riley, was that the idea was jointly crafted, with a shared understanding of the business, in a unit-based team.

"If I had just given this list of patient names to the staff, it would not have worked," Dr. Riley said. "This is a sharing of ideas, and it opens the lines of communications &.There's a sense of involvement that wasn't there before."