Timely, acuity-stratified care delivered by the coordinated efforts of a team of healthcare professionals has the potential to nationally save nearly 100,000 hospitalized patient lives a year, as well as significant healthcare dollars, according to a large prospective study by Geisinger's Director of Surgical Innovation, Thanjavur S. Ravikumar, M.D., FACS.
In contrast to many ongoing efforts nationally that compare quality of care between hospitals, this novel program of hospital system redesign focuses on real-time outcome improvements accomplished through a multidisciplinary team approach to dynamic risk stratification of every patient, coupled with real-time risk mitigation. By demonstrating that this program reduces hospital deaths at the same time minimizing cost, the results contribute to a growing body of knowledge that says that higher healthcare spending does not correlate with higher quality of care.
The Geisinger study, published in the September issue of the Annals of Surgery, followed more than 100,000 patients prospectively over nine years in three hospital systems. Initially piloted and validated for post-surgical patients, the workflow redesign program was recently implemented across all hospitalized patients at one of Geisinger hospitals. Based on an 18 percent to 25 percent reduction in hospital mortality observed consistently after implementation of this program in prior and current studies, Dr. Ravikumar estimates that it has the potential to save up to 95,000 lives a year if adopted nationally. While there will be a small incremental cost in staffing, this is overshadowed by financial savings in length of stay reductions, optimization of resource utilization and the avoidance of complications.
The program named "Continuum of Care," and led by co-author Cordelia Sharma, M.D., a Geisinger critical care physician, involves redesigning the workflow and delivery of hospital-based care to maximize clinical effectiveness. Similar to the "patient-centered advanced medical home" model, the program emphasizes timely comprehensive and coordinated care that is personalized to the patient's needs and makes use of Geisinger's advanced electronic clinical information system.
"The components include patient cohorting, unit-based team building, multidisciplinary team rounds structured for quality, actively managing risk-prone patients by acuity-stratified rounding (Hawk rounds) and safety-net creation outside of ICUs," said Dr. Ravikumar.
The article can be found at: http://journals.lww.com/annalsofsurgery/Abstract/2010/09000/A_Validated_Value_Based_Model_to_Improve.9.aspx
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