Process improvements generate big returns
Katherine Rhodes, RN, BSN, COHN-S, CIC
Texas Health Southwest
Ft. Worth, TX
Katherine Rhodes’ unrelenting commitment to infection prevention process improvements has positively influenced the health of innumerable patients at her 14-hospital system.
In recent years, her leadership has been particularly impactful among those most vulnerable to infection – newborns and the elderly. In late 2008 and early 2009, Texas Health Southwest recorded a number of newborn prophylaxis “near misses,” in which hospital staff discharged newborns prior to receiving key maternal test results. Protocol requires that newborns whose mothers are identified as HIV, hepatitis B, or syphilis positive receive evaluation and prophylaxis prior to discharge. “There was no harm done, but it was a huge risk,” Rhodes explained.
With help from a multidisciplinary team, Rhodes developed education programs, automated lab alerts, formalized checklists, and inter-departmental communication processes. Near misses dropped to zero, earning Texas Health Southwest the 2011 National Premier American Express Insurance Exchange (AEIX) Risk Management Award.
“The success of any infection prevention program hinges on including the end users,” says Rhodes. “Engage them throughout the process.”
Rhodes applied this philosophy again when looking for solutions to increasing Clostridium difficile (C. diff) incidence and costs. “We have 11 nursing homes within a 1.5 mile radius of our hospital,” said Rhodes. “We were seeing a high incidence of C. diff and increased testing costs.”
Rhodes engaged another interdisciplinary team to help streamline management of C. diff patients, minimize transmission, and reduce inappropriate testing. The team reviewed and implemented evidence-based C. diff management recommendations, and updated electronic orders to reflect the evidence-based testing protocol.
During a six-month evaluation period, inappropriate C. diff tests decreased from 173 to two, resulting in an estimated annual savings of $28,700. C diff cases dropped from 0.52 per 1,000 patient days in 2007 to 0.18 per 1,000 patient days the following year.
Rhodes always recognizes these and other achievements with front-line staff. “Take time to celebrate your successes,” she said. “This makes results sustainable.”