How do we define healthcare quality?
It is personal, humane, both high-touch and high-tech, compassionate, complex and unique to each person. The Institute of Medicine (IOM) defines six dimensions of healthcare quality: safe, timely, effective, efficient, equitable and patient-centered. All dimensions are important and need to be monitored and improved on a continuing basis.
What does it mean to be safe?
Safe means freedom from accidental harm. It is the most important dimension and the first rule for all care providers: "First do no harm."
At Cottage, we have an infection control program that monitors all laboratory cultures to identify and prevent infections for patients in our hospitals. Our two dedicated infection control practitioners have a comprehensive program of education and prevention that touches every corner of our organization. We have a state-of-the-art electronic surveillance system called MedMined that identifies trends and patterns so we can reinforce best practices or implement additional methods to prevent hospital-acquired infections before they begin.
All employees are required to report any incident that may put a patient at risk for harm such as a fall, medication error, equipment issues or treatment delays. These events are handled immediately by the staff who provide the direct care and monitored for any concerning trends so that actions can be taken to prevent their recurrence.
What are we doing to increase patient safety?
Our surgical infection rates are well below national averages. We are currently investing in excess of $15 million in new information technology to improve patient safety and support the implementation of a fully electronic medical record by the end of 2007.
What does it mean to be timely?
Timeliness means prompt access to diagnosis and treatment. We measure wait times in the Emergency Department, monitor surgical delays and discharge times, and compare ourselves to other healthcare systems and hospitals around the country in order to establish targets for improvement. Cottage has applied proven methods to reduce redundancies and waste so that our patients do not wait needlessly.
How timely is the care we provide?
Our length of stay in the Santa Barbara Cottage Hospital Emergency Department averages about 2.5 hours from arrival to discharge, or 4.5 hours if you are admitted. While these times are now at or below the national average for EDs, we are working hard to reduce them even more. The same group of emergency physicians staff both Santa Barbara and Goleta Valley Cottage hospitals. Because GVCH is often less crowded, wait times may be shorter there.
What does it mean to be effective?
Effective means practicing “evidence- based-medicine.” We monitor compliance with the best practices across the country for pneumonia, heart attack, heart failure and surgical infection prevention. We publicly report these measures so that our patients can compare our performance to other healthcare systems or hospitals (see links to other Public reporting sites). The trauma, critical care, cancer, cardiac surgery, bariatric surgery, and catheterization laboratories each have a detailed outcomes database to monitor and support improvement efforts.
How effective is our care?
The Santa Barbara Cottage Hospital emergency and critical care departments have recently implemented protocols to ensure rapid diagnosis and treatment for sepsis, or severe infection. The mortality rate for sepsis shock — the most severe form of sepsis — is less than half the national average as a result of our efforts to implement evidence-based practice guidelines in the emergency and critical care departments.
Also, over the past two years, implementation of nursing protocols has led to a three-fold increase in the number of patients receiving a pneumococcal vaccination upon discharge.
In addition, CareScience, an external quality rating organization, just recognized our cardiac surgery and stroke programs as being in the top four percent of performers nationwide.
What does it mean to be patient-centered?
Patient-centered means that each patient is treated with dignity and respect and that their experience is overwhelmingly positive. We distribute over 4,500 surveys a month to our patients. Results are tracked and reviewed on a regular basis by managers and staff. Patients are visited by nurse managers during their stay to address any concerns or special requests. A full-time patient advocate is available to ensure concerns are addressed in a timely and satisfactory manner.
How do our patients rate their experience?
Patient ratings of how well the Emergency Department staff kept them informed about their medical condition and treatment placed us in the top 10 percent of hospitals nationwide. We strive not only to meet but to exceed our patients’ expectations for their health care and will continue to move forward with evidence-based practices that not only improve the quality of care provided but that keep Cottage on the cutting edge of medicine in the country.