Sepsis is the major cause of mortality both at Virginia Mason and nationally. In improvement events at Virginia Mason focused on acute and unstable patients, early identification and treatment of patients with sepsis was identified as a potentially rich area for additional improvement work. Virginia Mason then began a series of events focused specifically on the issue of sepsis, ultimately leading to a protocol termed the “Power Hour.” The Power Hour has cut recognition time in the hospital from eight hours to 30 minutes, and decreased the time to antibiotic administration from 140 minutes to 66 minutes on inpatient units. After successful implementation in the hospital, the Power Hour was expanded to the Outpatient Infusion Center (OIC) where it decreased time to treatment from about nine hours to less than 60 minutes.
In years past, the process for admitting or transferring patients to Virginia Mason from clinics, hospitals and regional providers involved multiple calls, potentially from multiple different locations within the organization. Virginia Mason began a series of improvement events, starting with a 3P and including multiple RPIWs and kaizen events, aimed at creating a single point of entry for patients, regardless of their origin point. All of those incremental improvement events culminated in the creation of our hospital admissions center, resulting in decreased wait times and fewer handoffs for patients.
A patient with a new hip or knee has restrictions and limitations which make getting into a car a significant challenge. The Physical Medicine and Rehabilitation Department at Virginia Mason owned a mocked up car for patients to practice on, but it was outdated and had functional limitations. It couldn’t be adjusted for the variety of heights of today’s vehicles, and it was very heavy and could not be moved to accommodate patient needs. An initial kaizen event was held with the goal of creating something new to meet this need. Using the concepts of Moonshine, the team created a prototype which has been tested and refined through multiple Moonshine work sessions. Virginia Mason partnered with MJM International Corporation to manufacture the new therapy car. It is now available for other hospitals and rehabilitation facilities to purchase through Patterson Medical.
The transition of a patient from hospital to home can be very complicated for both patients, family members, and care providers. If discharge instructions are not clear, follow-up appointments are not made prior to discharge, and post-discharge follow-up calls by a registered nurse do not consistently occur, patients may experience an unplanned admission to the hospital or emergency room. Virginia Mason kicked off work on optimizing care transitions for patients discharging from the hospital with a 3P (Production, Preparation, Process) event and, over several years, built incrementally on that 3P with a series of RPIWs and kaizen events. After one of the RPIWs, the decision was made to centralize follow up discharge calls for the benefit of our patients and care providers, and the Transitions Support Center was opened in 2017.
Opioid misuse has reached epidemic proportions in the United States. Morbidity and mortality have increased proportionately to the unprecedented use of opioids during a time when aggressive use was encouraged and thought to be safe and effective. There has been marked progress in addressing this epidemic. At Virginia Mason this has been accomplished with the use of our Virginia Mason Production System in developing processes, tools, and common language while fostering team and leader awareness and engagement. The Virginia Mason Production System has had a pivotal role in the work. The use of tools outside events, in preparing for, and within events have increased understanding and accelerated progress. Through a series of seven rapid process improvement workshops, two kaizen events and a visioning session from 2016 to 2020 we have made impressive progress in all clinical departments across the continuum of care by identifying and treating Opiate Use Disorder, reducing acute prescribing, and supporting people on chronic opioid therapy to taper or stop opioids. Since October 2017, when the organizational guiding team began to establish focus on acute prescribing practices, there has been a 16% improvement in the percent of opioid naïve patients whom receive an initial acute prescribing of > 42 tablet and a 30% improvement since the designation of an organizational priority in January 2017.
Virginia Mason used VMPS to develop a Patient Safety Alert (PSA) system that requires all staff who encounter a situation likely to harm a patient to immediately report it and cease any activity that could cause further harm. If the safety of a patient is indeed at risk, an investigation is immediately launched to correct the problem. From the program's inception in 2002 through September 2020, more than 120,000 PSAs have been filed. Patient safety at Virginia Mason has increased and professional liability claims have dropped.
The unusual and challenging times of COVID-19 caused Virginia Mason to think differently about how we do our work while keeping the health and safety of our patients, team members and community top-of-mind. We have used our proven Virginia Mason Production System (VMPS) improvement and innovation tools while leading through this crisis. Daily management routines and standard work were rapidly adjusted with the onset of the pandemic, which opened communication of essential information to vital areas and removed artificial barriers to implement key work. The use of VMPS tools allowed us to understand patient flows to design a new care unit, open screening stations at all medical center entrances, provide virtual care for our patients, and allocate precious PPE and provider resources. We continue to evolve and refine our COVID-19 responses throughout the pandemic, learning and shifting with the ever-changing landscape.
Emergency departments (ED) are a major portal of entry for our patients into the hospitals. Hospital capacity continues to be challenging and can result in ED boarding. In 2011, after multiple improvement events including a 3P to design the new space, Virginia Mason moved its ED into a more efficient space. Since then, the ED has continued to work on improvements to ensure safe and high-quality care. Using VMPS, we have successfully implemented an abundance of processes for improvement. New processes that have come from kaizen events include implementing direct bedding and having providers see appropriate patients in the triage area during surge times. This is done by using standard clinical assessment tools to quickly identify and sort patients' care needs. Those requiring minimal services receive treatment and are discharged without going to patient-care beds, creating capacity for patients who require more extensive services. Better never stops in the ED at Virginia Mason Medical Center. We continue to improve and implement processes to meet the needs of our community we serve.