Hospital Engagement Networks Lauded for Lessening Hospital Harm, Costs

Hospitals participating in HENs have "decreased central line infections by more than 45%" in the last two years, says CMS. The largest coalition, operated by the American Hospital Association, says it has saved $201 million.

The largest of 26 coalitions participating in Hospital Engagement Networks, a $218 million federally funded program, has prevented 69,000 patients from hospital-caused complications at 1,600 hospitals and saved the nation more than $201 million in its first two years compared to rates from the recent past.

That was the report from the HEN operated by the American Hospital Association. AHA president and CEO Rich Umbdenstock said operational and cultural changes have reduced "infections, pressure ulcers, and other key areas across the board… This is great news for patients and hospitals."

Patrick Conway, MD, chief medical officer for the Centers for Medicare & Medicaid Services, said that overall, hospitals in the 26 HENs in the last two years have "decreased central line infections by more than 45%, decreased surgical site infections by more than 22%, and… early elective deliveries… by approximately 50%; these Hospital Engagement Networks are a major driver of that work."

Conway added that the statistics show that "these are hundreds of thousands of patients who don't experience harm, our families, friends, mothers, fathers, sisters, and brothers" representing "millions of dollars of potential savings. So this major investment is paying dividends."

Umbdenstock and Conway made their remarks during an AHA Town Hall webcast Wednesday in which leaders from the Rockford Health System in Rockford, IL and Eastern Oklahoma Medical Center in Poteau, OK, two organizations participating in the AHA's HEN, presented specifics on how the project had improved care at their hospitals.

And while he said he was pleased that 80% of the nation's hospitals now participate in these HENs, which were set up under the Partnership for Patients made possible by the Patient Protection and Affordable Care Act, Conway said five key areas still need attention:

• 1,300 hospitals still don't participate in the HEN program.
• Not all HEN hospitals report data for all 10 types of preventable harm targeted by the HEN program.
• Hospital quality leaders need to involve members of their C-suites to expand the types of harm they're targeting. "Working on one or two areas is great. But working on all 10 areas, maybe even new areas of harm not identified yet by Partnership for Patients, is the goal," he said.
• Hospitals have recognized the harm that a catheter-associated urinary tract infection causes. "The next phase is how do we work to reduce that harm…and spread best practices…" and eliminate disparities in practices across the board.
• Hospitals need to find ways to engage patients and families in this effort. Those patients and families "identified issues that we as providers often hadn't seen" and are often "the most valuable members of our team," Conway said.

In order of their dollar savings, these types of adverse events are where the AHA's HEN boasts its biggest savings:

• $166.3 million because 50,442 patients were prevented from requiring a readmission within 30 days.
• $15 million because 1,337 patients were prevented from acquiring a surgical site infection.
• $8.45 million because 611 patients did not develop a central line-associated bloodstream infection (CLABIS)
• $6.43 million because 368 patients did not have a ventilator-associated pneumonia.
• $3.13 million because 13,340 babies were not electively delivered without medical necessity before 39 weeks, resulting in 640 babies who did not require expensive hospitalization in a neonatal intensive care unit.
• $1.22 million because 2,806 patients did not develop a CAUTI.
• $933,400 because 96 patients did not develop a stage III or IV pressure ulcer
• $210,000 because 72 patients did not develop a post-operative pulmonary embolism or deep vein thrombosis (venous thromboembolisms or VTE).

The federal money provides support to build learning collaboratives, conduct training programs, technical assistance enabling hospitals to track and monitor improvement, and identify high-performing hospitals to serve as models for other hospitals trying to improve care.

Conway, a practicing pediatric hospitalist, stressed that hospital networks to prevent harm solve problems for everyone. "A few months ago during post-op monitoring, we had a near miss event in the hospital that actually is now going to allow us to update a clinical standard to point to a best practice in post-op monitoring of patients."

He also says that during his time as a medical resident, a neonate died from a central line infection acquired in the neonatal intensive care unit. "The thinking at that time [was], and the attending said this to the family: 'You know, these things aren't preventable.' We now know they are preventable, and we're preventing them at a national level."

Melinda Davis, chief nursing officer for 84-bed Eastern Oklahoma Medical Center, a rural hospital, said that her hospital chose certain types of harm for focus, and managed to reduce VTEs, ventilator-associated pneumonias, CAUTIs, CLABSIs, and surgical site infections to zero.

It also achieved a 40% reduction in adverse drug events, pressure ulcers, early elective deliveries and falls.

Gary Kaatz, president and CEO of Rockford Health System, which includes 396-bed Rockford Memorial Hospital, said his organization has reduced by more than 40% eight types of adverse events, in part by gaining buy-in from the board.

That is accomplished, Kaatz said, by being transparent about patient harm with the hospital board, and taking stories of patient harm to them to "put a face on a situation that didn't come out the way we thought it would. It's very humbling. It's very educational and believe me, it gets everybody involved to make sure that we learn from that and don't repeat it."

Kaatz also urged hospital C-suite leaders around the country to not dismiss the opportunities to learn if they become a patient themselves.

"I was a patient. I had surgery on my quadriceps tendon a couple of years ago….I don't wish that on anybody, but once you have been a patient yourself, as a CEO you do look at things a bit differently. To the extent you can simulate that in your own environments, I would highly recommend it."

Added Umbdenstock, "I always hear from colleagues at the hospital level what they've learned and what they've actually experienced during the course of care."