Regional Health Recognized for Best Practices

2011 Premier Breakthroughs Conference and Exhibition

Several Regional Health employees were selected to share their research and best practices with health care professionals from throughout the United States at the 2011 Premier Breakthroughs Conference and Exhibition in Nashville.

Read about Regional Health honors below.

Safety, Quality & Cost Improvement through Collaboration

Premier Presenter
Mark Brodin,
Vice President of Decision Support
Regional Health

Avera Health and Regional Health, with support from Premier, have focused on improving quality and safety while reducing cost. We have successfully engaged clinicians from each system in sharing best practices, standardization and aggregating purchase volumes. The presentation discussed methods to overcome challenges and barriers to integrate value analysis teams from two health care systems over a large geographic area as well as key success factors.

Rapid Admissions Unit: An Innovative Approach to Patient Flow

Premier Poster Presenter
Tasha Frisinger, RN, BSN,
Director of Clinical Coordination and Staffing
Rapid City Regional Hospital

High volumes in the emergency department were creating an interrupted admission process that delayed the plan of care and compromised patient through put. As the patients waited for an inpatient bed, the same assessment was being completed numerous times during the interrupted admission process. The receiving units were overloaded with the acuity of patients and the in-depth admission process requirements. Patients frequently waited up to eight hours before the admission was complete and the plan of care started. This increased the length of stay for the patient. The goal of our admission unit improved patient outcomes, decreased through put times while improving patient, staff and physician satisfaction.

One System of Care: One Electronic Chart

Premier Presenters

Heidi Tennyson (left)
Programmer Analyst
Regional Health

Jennifer Gholson
Clinical Analyst
Regional Health

Regional Health successfully implemented Meditech's scanning and archiving application to improve information shared between all of Regional Health's hospitals and to achieve a hybrid electronic record. The success of our method came through the continual cycle of receiving feedback and making changes to the electronic medical record to make it more user-friendly. Participants learned the importance of identifying and including all the stakeholders of a scanning and archiving project. Specific points of collaboration between all hospitals were presented, such as forms considerations and electronic chart design. Participants also understood why over-communication of this project is necessary and what pitfalls can occur when communication between different types of stakeholders was lacking.

Hospital to Home: A Value-Added Approach to Reducing Readmissions

Premier Presenter
Randee Handcock
Director of Clinical Integration
Regional Health

This session focused on successful approaches for reducing readmissions and improving outcomes, while promoting accountability and coordinating care across the continuum. Participants learned detailed data analysis techniques to understand the root causes of avoidable re-hospitalizations (ARH) as well as understanding process-driven techniques to reduce the incidence of ARH. The presenters also highlighted tools and techniques to partner with community skilled nursing facilities and home care agencies, and share successful methods for managing chronic disease and developing educational resources to support the patient from hospital to home.

Who Ya Gonna Call? Clot Busters!

Premier Poster Presenter
Kathy Hill, MSN, RN
Clinical Quality Stroke Coordinator
Rapid City Regional Hospital

Rapid City Regional Hospital (RCRH), a Joint Commission Primary Stroke Center, set out on its journey to obtain stroke certification in 2008 in order to provide the expansive rural area, quality acute stroke care. RCRH received certification as a Joint Commission Primary Stroke Center in February of 2009 and recertified in March of 2011.

Changing the culture of the organization to recognize stroke as an emergency with possible acute treatments was important. Therefore, a physician champion, in addition to a full time stroke coordinator, was put into action to coordinate the changes.

Prior to 2008, RCRH did not use thrombolytic in the acute stroke patient routinely. Physician apprehension, urgency of the situation, and timeliness of patient presentation were a few of the barriers to treatment. Based on Clinical Practice Guidelines, "stroke alerts" were instituted along with order sets and polices to streamline the treatment of strokes in the emergency department. Since that time, thrombolytic treatment increased from 0% of patients treated to the current national average of 4%.

RCRH continues to strive for excellence in stroke care by continually improving processes to put patients and their families first. We continue to work with network facilities to speed transfers, educate the public and decrease door to needle times in the Emergency Department.

Behavioral Health in the Northern Hills

Premier Poster Presenter
Lacey Joens, RN
Director of Emergency Services and Trauma Coordinator
Spearfish Regional Hospital

We determined in the process of providing care to potential behavioral health patients repeated services resulted in delay of care, unnecessary cost to the patient and counties involved, and patient and staff dissatisfaction. This resulted in a team of different agencies pulling together to improve the quality of care for the patient by eliminating extra visits and expediting the services provided.

Implementing Programs that Protect Workers & Patients

Premier Presenter
James Keegan, MD
Chief Medical Officer, Regional Health
Chief Executive Officer, Regional Health Physicians

I discussed how we as a state led the country in vaccinating adults for H1N1 influenza through a coordinated partnership with South Dakota State Department of Health and the three major health systems in South Dakota. The public/private consortium allowed us to be flexible but use existing infrastructure and resources to lead the U.S.

ED Diversion: Success on the Pine Ridge Indian Reservation

Premier Presenter
Sandra Ogunremi, DHA
Director, Office of Rural and Frontier Health
Regional Health

One of the most complex challenges to meeting the health needs of people living in rural and remote locations is scarcity of specialty services. The Pine Ridge Regional Medical Clinic (PRRMC) officially opened its doors in December of 2008. The clinic was created through a grant from the South Dakota Department of Social Services for the purpose of reducing emergency room utilization by providing local, specialized health care to the people living on the Pine Ridge Reservation.

The Pine Ridge Indian Reservation faces a unique set of challenges including a tremendous lack of specialty care available to the residents. Prior to the inception of the Pine Ridge Regional Medical Clinic, patients would have to travel over 200 miles roundtrip to see their specialty care provider.

Drs. Keegan and Ogunremi presented on the Pine Ridge Regional Medical Clinic at the Premier Breakthroughs Conference. They highlighted that this clinic is run by a unique health care model where:

Family appointments are scheduled together
Family health education is held
Utilize the patient navigation system
The provider follows up with the patient after the appointment

The clinic is very results driven and in order to gauge the effectiveness of the specialty clinic, the following steps are taken:

Conduct surveys of new patients regarding: height, weight, age, health evaluation and general health rating
Track patient compliance rates
Examine all patients' past and current emergency room history
Patients fill out a new survey every six months
A yearly review of the specialty clinic is conducted by an independent consulting firm

Since the clinic began it has grown to serve more than 400 patients and the patient compliance rate is greater than 65%. This is a vast improvement over the 20% compliance rate when patients had to travel from Pine Ridge to Rapid City to see the specialty providers. A decrease in emergency room visits has occurred due to the fact that the patients now have a better understanding of how to manage their chronic health conditions.

The Emergency Room Diversion Grant ended on April 14, 2011 and the clinic is now operated through a collaborative agreement between Regional Health Physicians, the Pine Ridge Indian Health Services Hospital and the Oglala Sioux Tribe Health Administration.

Achieving Pharmacy Efficiencies in Non-Actue Care Facilities

Premier Presenter
Scott Peterson
Assistant Director of Pharmacy
Rapid City Regional Hospital

Sarah Rall of the Marshfield Clinic and I were co-speakers on the topic of "Achieving Pharmacy Efficiencies in Non-Acute Care Facilities." I focused on the implementation of an Automated Dispensing System (ADS) in the Custer Regional Senior Care facility. The stated and achieved goals of the project were: 1) reduce waste of medication; 2) reduce lag time to administration; and, 3) reduce potential for drug diversion. The provision of medications to long-term care facilities has not fundamentally changed in over 30 years and the implementation of an ADS in the Custer nursing home is a major advancement.

Influence of Antibiotic Stewardship Program
for Quality Advisor Pneumonia Outcomes

Premier Poster Presenter
Deonne Taylor, RN
Clinical Quality Coordinator - Pneumonia
Rapid City Regional Hospital

The unification of efforts through a team perspective work together in addressing appropriate antibiotic use in western South Dakota, southeastern Montana, northwestern Nebraska, southwestern North Dakota, and northeastern Wyoming. The service areas also include four of the seven Indian reservations in the state.

Rapid City Regional Hospital has developed and maintained a long standing partnership with Regional Health Network's hospital physicians and outlying facilities (those outside of the network) to improve the quality of antibiotic therapy for each individual in the above stated areas. Appropriate antibiotic therapy is based on risk factors for specific organisms, local patterns of antibiotic resistance, prevalence of offending organisms and the attendant effort on disease outcomes. An improvement plan, as appropriate for the local bacteriology, has been developed.

Evidence-based action steps have been implemented to prevent antimicrobial resistance among specific patient groups. Ongoing physician and nursing staff education, concurrent feedback and instruction is provided to physicians, specialty groups and nursing departments throughout the network and outlying facilities. This program has been successful in the prevention and reduction of antimicrobial resistance, as well as a resultant reduction in mortality and readmission rates for pneumonia patients.

Implementing a Blood Management Program

Premier Presenter
Jody Thompson
Blood Bank Supervisor
Rapid City Regional Hospital

To implement a blood management program we focused on evidence-based standards for blood management and utilization, while identifying successful tools and approaches implemented in two very different organizations. We highlighted collaborative approaches for establishing a culture of safety, identifying critical data reporting and benchmarking mechanisms to improve the effectiveness of blood product utilization. The goal was to present successful techniques for developing a safe, effective and timely blood management program geared towards increasing patient safety/outcomes and reducing the financial impact of transfusion for the hospital.