September 25, 2014

Dear Friends and Colleagues,

Clinical quality is the hallmark of an excellent healthcare institution and what we have emphasized over the past decade at NCH Healthcare System. We have also supported transparency, in encouraging the public to know where we rank in terms of quality.  Indeed, quality and transparency are two sides of the same coin for our industry and for NCH.

That’s why it was so revealing—and disturbing—when two Florida Hospital Association (FHA) committees met recently in Orlando to push both agendas forward for the 300 Florida hospital members. Our state’s numbers, quite frankly, are not good.

Florida is ranked 33rd in the nation by Florida State Health Insurance (http://www.floridastatehealthinsurance.com/florida-health-care-ratings/). The Commonwealth Fund rates Florida as 41st for health care quality overall and 35th in terms of affordability and access to medical care. (http://datacenter.commonwealthfund.org/scorecard/state/11/florida/) These measures put Florida in the third or fourth quartile with the first quartile being best. These are sad and sobering metrics for a state about to become the third most populous in the nation, joining California and Texas who are one and two, respectively.

Obviously, our state has to do better. Florida is challenged by its diversity and size. According to the FHA, 21% of Florida’s population lacks health insurance, while the national average is less at 16%. Florida has about 26 family doctors for each 100,000 people in its population, compared to a national average of 32 doctors. And Florida has the third highest rate of hospitalization in the nation. In response, some Florida healthcare systems, penalized for excessive readmissions and infections, are planning monumental building projects.

At NCH, we are proud to say, the news is much better, as we will report at an upcoming FHA-sponsored Hospital Engagement Network event.

  • NCH hasn’t had a Central Line Associated Blood Stream Infection in Progressive Care for three years, nine months; in ICU for four years, seven months; in Surgical ICU for three years, 10 months; and in Cardiovascular Recovery Unit for four years, nine months.

  • Sepsis mortality has dropped at NCH from approximately 33% to 8% by using predictive analytics created by Cerner, which enable us to identify patients about to deteriorate so we can administer appropriate antibiotics and other treatments, thus avoiding a “crash.”

  • NCH converted an evidence-based basal bolus insulin program to a Computer Provider Order Process to improve overall glycemic (blood sugar) control for our patients and reduce the occurrence of hypoglycemic adverse drug events. Measured hypoglycemia rates resulted in a 48% reduction in the year-to-year overall hypoglycemia rate. Our multi-disciplinary Glycemic Control Committee, a sub-section of the Pharmacy and Therapeutics Committee, meets monthly to further improve the clinical orders management process.
Yes, there is much positive news on the NCH clinical quality front, and we are striving towards price transparency as an institution as well.

On this Sunday’s Naples Daily Newsmakers (ABC 7 at 10 a.m.), Jeff Lytle and I will discuss the current state of local and state healthcare with an emphasis on two vital components—quality and transparency.

Respectfully,
 
Allen S. Weiss, M.D., President and CEO

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