December 14, 2017

When prevention is the cure

Kaiser Permanente’s annual quality and patient safety awards recognize programs that improve care.

“Preventing something never gets the attention that treating something does,” said David Witt, MD, co-chair of Kaiser Permanente Northern California’s Regional Infection Control Committee. “That’s one of the strengths of Kaiser Permanente. We actually do preventive medicine.”

On Nov. 28, preventive medicine got its due when leaders from across Kaiser Permanente gathered to celebrate the 2017 recipients of the James A. Vohs Quality Award and the David M. Lawrence, MD Patient Safety Award. Created to honor the contributions of two Kaiser Permanente leaders, the awards recognize projects that advance the quality of care and improve patient safety. They’re presented annually to encourage the sharing and spread of best practices throughout the organization.

2017 Award Winners at a Glance

Lawrence Patient Safety Award

Preventing Hospital-Acquired Pneumonia

Hospital-acquired pneumonia is one of the most common and lethal forms of hospital-acquired infection. A 2008 analysis by Kaiser Permanente Northern California found the average length of stay was 13 days longer for patients with HAP and that these patients were six times more likely to die in the hospital.

In response, Kaiser Permanente Northern California implemented a bundle of interventions, “some evidence based and some common sense based,” said Dr. Witt. Key elements include reducing the use of sedating medications, improving oral hygiene and encouraging twice-a-day ambulation.

By the end of 2016, HAP rates had decreased by 66 percent, preventing an estimated 308 deaths and nearly 23,000 unnecessary hospital days.

“What we’re doing is making a difference, not just at one hospital, but all over Northern California,” said Clinical Adult Service Director Cathy Parker, RN.

Lawrence Patient Safety Award

Reducing C. Difficile Infections

Man in hospital bed speaking to doctor dressed in medical scrubs

As many as 14,000 patients die in the U.S. each year from C. difficile infection, with exposure typically happening in health care settings. “It’s a devastating disease that no patient should face,” said Allyson Mason-Herr, RN, chief nurse executive at Kaiser Permanente’s Roseville Medical Center.

The hospital set out to reduce CDI by focusing on the patient’s care journey. “We looked at where they go, what they do, and how they might come into contact with C. diff,” said emergency physician Tom Russell, MD.

The project team identified the radiology and emergency departments as two potential hot spots for patients at risk of CDI. Armed with that knowledge, they developed a series of interventions to prevent transmission of the bacterium, including enhanced monitoring and cleaning of radiology equipment, a detailed ED protocol for identifying and isolating patients with CDI, and visible reminders for staff to wash hands and put on protective equipment when caring for patients with CDI.

This strategy yielded a 45 percent reduction in CDI at KP Roseville, and the practice was rapidly implemented at all KP Northern California hospitals.

Vohs Quality Award

Primary Care Plus

Asian male patient being examined by African American doctor

Historically, a small percentage of patients uses a disproportionate share of health care services. These patients typically have complex medical conditions and unmet social needs. Kaiser Permanente Colorado developed Primary Care Plus to better serve these vulnerable patients.

Eligible members work with an interdisciplinary team — including a physician, nurse, pharmacist and social workers — to identify their medical and non-medical needs. “We help them find affordable housing, make utility payments, get hearing aids and dentures — it runs the gamut,” said Merrill Zierten, RN.

Ongoing monitoring is key to the program’s success. “We make sure we are reaching out to patients with regularly scheduled visits so we can get out in front of any needs they have,” said Wendolyn Gozansky, MD, MPH, vice president and chief quality officer for KP Colorado.

The project has increased member and caregiver satisfaction, improved quality outcomes, and reduced pharmacy costs and utilization of inpatient care. “I’m incredibly proud of the work my teams have done and proud that the organization I work for lets us deliver transformational, exceptional, patient-centered care,” said Gozansky.