Because Every Patient Counts

At first, staff at Carson City Hospital in Michigan were incredulous when quality department staff told them their scores on compliance with ideal care measures were lower than the standard the 77-bed acute care hospital had set.

“Our nurses didn’t really understand what core measures were really, really all about, or what it takes to actually get in compliance with those measures,” said Joan Sweet, vice president and chief quality/risk officer at Carson City Hospital.

The hospital was searching for a way to re-educate and re-energize staff members about the importance of documenting core measures. These efforts culminated in a campaign called “Because Every Patient Counts,” which focuses on achieving a perfect measure of ideal care score for every patient.

If that goal seems ambitious, it’s because the patient pool is relatively small. In a small population, one missed patient results in a significant drop in compliance rates. To achieve real improvement, no patient can be left behind.

Implementation included creating one-page education sheets for each measure based on information in the CMS specifications manual. A different measure was highlighted each week. The information was then posted on communications boards on every nursing unit and in the weekly newsletter. Additionally, managers and supervisors were expected to review the material with staff.

Carson City Hospital soon saw its re-education campaign bear fruit. The compliance rate for measures of ideal care rose from 83 percent in the third quarter of 2010 to 94 percent in the same quarter of 2011.

Said Ms. Sweet, “My advice would be, you can’t assume that your message is heard. There’s a lot of noise going on on each nursing floor—they’ve got a lot of things going on they have to complete every day. You have to keep educating, educating, educating.”