Patient Safety Indicator Composite

The Centers for Medicare & Medicaid Services have identified a list of patient conditions considered preventable through proper hospital care. These include hospital-acquired pressure ulcers, post-operative pulmonary embolism or deep-vein thrombosis and post-operative sepsis. If we have low rates of these conditions at our hospitals, then we're doing our job right, and you can feel assured that you're getting quality care. These measures are also publicly reported on the Colorado Hospital Association (CHA) http://www.hospitalquality.org/, so they are one way to compare the performance of hospitals in Colorado.

Pressure Ulcers

Pressure ulcers, often referred to as bed sores, occur when skin breaks down after the body remains in one position for too long. Constant pressure, often over bony parts of the body, reduces blood flow, leading to these open wounds.

Pressure ulcers can result when patients at risk are not tended to thoroughly and consistently. Pressure ulcers can lengthen a patient's hospital stay, and the open sores can put patients at risk for other infections.

Exempla health care providers screen patients for pressure ulcers upon admission to our hospitals, then work to make sure patients don't develop them while in our care. Quality care for patients at risk for pressure ulcers includes:

• Regularly checking a patient's skin
• Turning patients in their beds
• Moving patients properly
• Using bed surfaces that allow for pressure redistribution
• Maintaining clean skin
• Managing incontinence
• Promoting good nutrition.

How are we doing?

Pressure ulcer rates are defined as the number of cases per 1000 patients with hospital stays longer than 4 days. Exempla's goal by 2012 is to have fewer than .84 cases per 1000 patients at risk, or 1% of those patients, so a lower score indicates better performance. We also report the number of actual cases of pressure ulcers.

 Falls with Injury 

Falls with injury is a possibly preventable hospital event that is non-reimbursable per new CMS guidelines.   

How are we doing?

Deep venous thrombosis (DVT) is essentially a blood clot that occurs in veins, usually in the arms and legs. Pulmonary embolisms (PE) are clots that have broken off from the primary clot site (such as the calf muscle) and have lodged in the lung, preventing adequate ventilation and causing shortness of breath and pain.

What do deep venous thromboses or pulmonary embolisms indicate about care?

Deep venous thrombosis (DVT) or pulmonary embolism (PE) can result when patients at risk do not receive recognized preventive care pre- and post-operatively. DVT or PE can lengthen a patient's hospital stay and can lead to additional problems such as pneumonia or internal bleeding.

Quality care for Exempla's patients at risk for deep venous thrombosis or pulmonary embolism includes the use of preventive measures before, during and after surgery. These measures include one or more of the following:

• Using anti-embolism stockings
• Prescribing blood-thinning medications (heparin, coumadin, among others)
• Using an intermittent pneumatic compression device (IPC) that alternately inflates and deflates knee-high boots, which results in decreased pooling of blood in the legs

• Using venous foot pumps, designed to imitate the physiological pumping of blood that occurs when walking, which decreases the risk of blood clots

The Patient Safety Indicator (PSI) rate for these measures is calculated from the number of cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 1000 surgical discharges with an operating room procedure. By 2012, our goal is to have no more than 0 per 1000 patients at risk. We also report the number of actual cases of pressure ulcers.