We have been designing and hardwiring evidence-based best practices into our processes to consistently deliver reliable care across the system since 2015. This effort entails extensive research and the collective expertise of our clinical teams, patient safety and quality improvement specialists, employees and operational leaders. They review industry benchmarks, share lessons learned and set aggressive performance goals to promote ongoing improvement.
To improve clinical performance, we invest in programs that make care delivery:
Consumers count on us to deliver on our promise of safe, reliable care, so we continually raise the bar on error prevention. To reach our goal of zero preventable harm events, we:
- Use a comprehensive set of error prevention tools, such as those that verify patient identity and medication.
- Adhere to safety policies, processes and systems.
- Mandate that every member of our care team speak up for safety by reporting unsafe behaviors and near misses. We then share management practices and alert system leaders when issues arise to mitigate risks that could occur elsewhere in the system.
- Conduct safety briefings at shift changes to address emerging concerns.
- Capture safety events and near misses to identify trends, accelerate improvements and monitor performance.
- Reduced serious harm event rates – which examines how many potentially harmful events occur in relation to the number of patients we serve – by 45% since 2018.
- Designed a Deterioration Index within our electronic health record to continuously monitor gradual changes in blood pressure, temperature, oxygen, labs, and other risk factors. Studies show most severe adverse events are preceded by abnormal physiological signs that may be subtle and difficult to recognize. The tool collects patients’ clinical data and calculates a risk score every 15 minutes. If conditions worsen, caregivers are alerted to take prompt action.
- Developed a new tool that predicts a patient’s fall risk based on age, vital signs and other clinical factors. Since the pandemic began, more patients across the nation have fallen. This may be due to fewer visitors at the bedside, closed doors on COVID-19 units or loud air scrubbers that make it difficult for caregivers to detect patient movement. We can immediately deploy interventions, such as non-skid footwear or yellow gowns that signify higher risk, to reduce falls based on the score.
- Increased the reporting of errors nearly two-fold, including near miss events that are detected before reaching a patient. Near miss events provide insight into areas for process change that can prevent future harm.
Continuously delivering high-quality care is a key strategy for Texas Health to improve our communities' health and well-being. In addition to the strategies implemented to reliably deliver safe care, we:
- Design and deploy innovative care models that measurably improve consumers' quality of care and reduce healthcare-associated infections.
- Engage multidisciplinary teams to integrate best care practices into standardizing care.
- Develop and deploy robust infection control processes, tools and evidence-based practices.
- Design interventions that improve care delivery and outcomes.
- Improve how we document and coordinate care and reach out to patients after they have been discharged to make sure they adhere to care plans.
The Joint Commission assesses our entities to determine if our quality practices meet its rigorous standards. We also track patients’ mortality ratio, readmission rates, healthcare-associated infections and average length of hospital stay to monitor if trends are positive and take action if needed.
- Continued delivering quality care and improved in three of four key clinical performance indicators despite three surges of COVID-19, workforce shortages and severe weather events. Please see our 2021 Social Purpose Summary Report for data on key quality measures.
- Took steps to mitigate central line associated bloodstream infections (CLABSI), which increased nationwide due to seriously ill COVID-19 patients, longer hospital stays and the varied experience of temporary care teams. We formed a CLABSI task force, reinforced our infection-control processes and appointed vascular access teams to maintain central lines and monitor emerging infections.
- Optimized and standardized how we document consumers’ care experience to deliver faster, appropriate and well-coordinated treatment. We brought together coders, care transition teams, physicians on the medical staffs, nurses, navigators and other clinical leaders to design a new documentation workflow guide to provide physicians with a comprehensive view of the treatment journey based on a specific diagnosis. As a result, we were able to drive better diagnosis and treatment, make care transitions more seamless and improve health outcomes.
- Created a new alert and admission screening process to detect Candida Auris, a type of fungus that can enter patients’ bloodstreams and cause infections. The emerging disease is resistant to common antifungal drugs. To prevent its spread, we isolate positive patients until their results are negative.
- Reduced the likelihood of surgical site infections by creating an infection-control bundle of best practices – from cleaning to antibiotics to the frequency of taking a temperature – that caregivers can implement before, during and after surgery.
- Continued to be recognized for our commitment to quality. In 2021:
- Eleven Texas Health hospitals earned four- or five-star ratings on the Centers for Medicare & Medicaid Services' Hospital Compare website.
- Five wholly owned hospitals maintained Magnet designation for nursing excellence by the American Nurses Credentialing Center and nine are Pathway to Excellence® facilities. Texas Health Presbyterian Hospital Plano earned Magnet status honor for the fourth time. As of May 2021, only 580 hospitals worldwide and 53 in Texas had the Magnet designation.
- Seven Texas Health hospitals earned the American College of Cardiology’s National Cardiovascular Data Registry Chest Pain-MI Registry Performance Achievement Award.
- Three Texas Health hospitals were named by U.S. News & World Report among the Top Hospitals in Dallas-Fort Worth.
Variant Surges Forces Shift in Care
Delivering safe and reliable care – especially in times of unprecedented surges of COVID-19 – calls for proactive planning and collaboration. When virus cases spiked in August 2021, Texas Health Presbyterian Hospital Rockwall was forced to temporarily close its offsite emergency department so that medical staff could work at the hospital's main campus to treat patients hospitalized by the virus.
Due to space constraints and increased patient volumes, hospital leaders worked with the North Central Texas Regional Advisory Council, the Rockwall Fire Department, Rockwall CERT and EastTex Regional CERT to build a climate-controlled medical tent. This enabled us to deliver care to patients in a safe, clean environment.
We invest in ways to make care delivery and health outcomes more equitable to reduce health disparities and meet a variety of consumer needs across North Texas. To advance health equity, we are:
- Improving consumers' access to care by:
- Advocating for Medicaid expansion to extend services and resources to uninsured, underinsured and underserved communities.
- Expanding graduate medical education programs to grow the physician workforce in North Texas.
- Forging community affiliations to leverage existing resources and address specific needs.
- Building a continuum of care infrastructure outside of traditional contact points, including urgent care clinics, telehealth and mobile health services.
- Identifying and addressing social determinants of health by:
- Systematically collecting data to identify trends and close gaps. When screening patients, our clinical teams capture 10 dimensions that impact health and well-being, such as their housing status or financial concerns. We add these responses to our electronic health record and color-code them based on the level of concern so we can connect them with resources and services to help alleviate these issues.
- Designing and funding tailored interventions for underserved communities.
- Delivering culturally sensitive care by training our workforce on inclusive practices and consulting with consumers in their preferred language.
- Completed the DFW COVID-19 Prevalence Study in collaboration with UT Southwestern. Over 21,000 total participants enrolled, representing a diverse cross-section of the region’s population. The study provided insights into approaches for community engagement that are being used in current outreach initiatives.
- Participated in state and national level collaboratives to improve maternal health, an area with identified disparities in maternal mortality rates.