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Going my way

Another side effect of the project has been to build teamwork between physicians and nurses. When nursing staff and medical staff are all tracking the same measures, project coordinators said, it’s easier to convince physicians to do things a certain way.

“On the West Coast, we leave so much to the physician practices,” said Chief Nurse Executive Gwen Matthews, RN, MSN, of the Glendale (Calif.) Adventist Medical Center. “It’s good to have protocol-driven measures. We will have some standardization in medical practice.”

One of the treatment measures for hip and knee replacement patients is to discontinue antibiotics within 24 hours after surgery. When you have an orthopedist who’s been practicing for 25 years, Matthews said, that physician may have a different approach to treatment. Now, nurses can point to the quality measures to reinforce the standards.

The Glendale hospital is one of 10 Adventist Health System hospitals participating in the pay-for-performance project. About 41% to 47% of its patients are Medicare recipients. Hospitals have been used to monitoring quality internally, Matthews said.

Now, there’s a wildfire of support for outside agencies looking at patient care and quality improvement.

“They’re holding hospitals accountable and, as a consumer, I think that it’s time,” she said.

Sheila Strand, RN, is director of quality resources at the 302-bed Adventist Medical Center in Portland, Ore., where 35% to 40% of the admissions receive Medicare benefits. Although the hospital doesn’t perform bypasses, it has a large number of patients seeking treatment for the other four quality measurement conditions.

Strand also sees nurses and medical staff working more closely together these days. “This is the first time in a formal way that we’ve aligned the medical and nursing staff,” Strand said. Her hospital has regular meetings of a quality council that RNs, physicians and other clinicians attend.

At those meetings, nursing leaders forge team relationships with the physicians. When a change needs to be made, Strand said, the decision has some “oomph to it” since the entire team endorses it.

Nurses are playing a key role in extracting the information to log into the database. The hospital collects half its data on paper and half electronically. RNs also audit the data to correct errors, a reason the hospital has such clean data, Strand said.

She believes the measures being tracked eventually will become mandatory for all hospitals with Medicare admissions. Once the project results for each hospital become public, she thinks consumers will use the information to make care decisions.

Strand receives calls from people with inquiries such as how many times a physician who has scheduled them for a surgery has performed that procedure. Such calls are becoming more frequent, she said, as consumers take a more involved role in their care. Yet the biggest consumers of quality data will be employers who purchase health care benefits, she said.

“This project covers Medicare, but most people will tell you that how you treat your Medicare patients is an indicator of how you treat all your patients.”

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