RESEARCH AND EDUCATIONAL FOUNDATION OF THE OHIO HOSPITAL ASSOCIATION
155 East Broad Street 301, Columbus, OH 432153640 www.ohiohospitals.org

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Organizations Filed Purposes: The mission of The Research and Educational Foundation of The Ohio Hospital Association is to evaluate, focus and engage in change activities that lead and enable the pursuit of excellence in safety and quality and in improving the health of our communities.

Quality Programs Sepsis Mortality: For the fifth year, the OHA Statewide Sepsis Initiative was facilitated in response to the OHA Board-directed goal of a statewide reduction in sepsis mortality to 14.9%. One hundred twenty-five member hospitals have maintained their commitment to participate in the ongoing initiative which includes data submission regarding compliance to the elements of the 3-hour sepsis bundle, monthly educational/coaching call and dissemination of effective practices. A sepsis website was hosted and maintained. Monthly evidence-based, continuing education webcasts were posted to the site along with evidence-based literature and resources. OHA analyzed and provided quarterly sepsis comparator data outcomes reports to participating hospitals. Report enhancements were made to include incidence, mortality, length of stay, readmissions, admission source, and 3-hour bundle element compliance. Hospital Improvement Innovation Network (HIIN) OHA was awarded the Hospital Improvement Innovation Network award effective September 28, 2016. Recruitment was conducted and 104 hospitals submitted commitments to participate. The initiative was designed to reduce all-cause preventable inpatient harm by 20% and readmissions by 12%. Hospital commitments included: -Work with OHA to assess the organization's current improvement projects and areas of need for improvement -Implement OHA's recommendations for the organization's participation in this project whether that will be to sustain current improvements or to implement new initiatives -Form a multi-disciplinary team which include: * Senior health care facility executive champion(s) * Site project team leader * Physician champion(s)/epidemiologist(s) * Quality/process improvement specialists * And others as appropriate such as: ~ Nursing manager/director/champion(s) ~ Bedside nurses and pertinent clinical disciplines ~Data collector/submitter (if different than someone listed here) ~Infection control practitioner(s) ~Pharmacy ~Laboratory -Submit the required outcome and process measures on a monthly and quarterly basis to the OHA, allowing enough time to provide aggregate data to CMS by the assigned due date. -Develop an action plan based on a completed gap analysis -Implement harm reduction strategies to meet or exceed HIIN improvement goals -Incorporate patient centered, person and family engagement and safe care practices into all methodologies -Consider health disparity and health literacy in the development of patient education materials, communications, and care planning -Incorporate antibiotic stewardship into improvement plan -Host the regional coordinator onsite on a quarterly basis -Submit monthly data collection by the established due date -Meet regularly with team to develop strategies for improvement and reporting process -Share internal data with leadership and staff so they can continually work on improvement plan -Conduct educational programming for staff to meet the project goals as appropriate -Identify any problems with project implementation and alert the regional coordinator as soon as possible -Collaboration with other hospitals participating in the OHA HIIN -Share effective practices with regional coordinators -Provide baseline data and metrics -Provide monthly process and outcome measure data either by granting access to NHSN or enter data onto the OHA data entry site -Provide quarterly process and outcome measure data through existing administrative data set -Participation by at least one member of the organization in monthly coaching calls, webinars, conferences, etc. -Participation as a mentor facility, as requested and able, for an area of identified strength -Recognize that in addition to meeting the base 20/12 reduction goals, HIIN continued to place additional emphasis on the following: * Adverse drug events (ADE) to include opioid safety, anticoagulation safety, and glycemic management * Catheter-associated urinary tract infections (CAUTI) to all hospital settings, including avoiding placement of catheters in the ER and in the hospital * Central line-associated bloodstream infections (CLABSI) to all hospital settings * Clostridium difficile (C. diff) infection, including Antibiotic Stewardship * Injury from falls and immobility * Sepsis and septic shock * SSI to include at a minimum, colon, abdominal hysterectomy, total hip replacements and total knee replacements * Venous thromboembolism (VTE), at a minimum to all surgical settings * Ventilator-associated events (VAE) to include Ventilator-associated conditions (VAC), infection-related ventilator-association complications (IVAC) and ventilator-associated pneumonia (VAP) * Readmissions -In addition to the required base measures outlined above, each hospital participated in at least one of the selected initiative(s) below: * Multi-drug Resistant Organisms (e.g. MRSA, VRE, CRE, etc.) * Hospital culture of safety that fully integrates patient safety with worker safety * Iatrogenic delirium -Developing a metric to measure and report all-cause harm within the HIIN Network OHA commitments included: * Provide outcomes data using existing data sources * Obtain data from NHSN on behalf of our organization * Provide a web-based data entry site to enable timely data collection and submission * Provide free access to Wayfinder and associated data reports for the duration of HIIN * Provide Hand Hygiene Process Observers to collect up to 150 hand hygiene observations monthly from our organization at no additional cost to hospitals * Provide Educational programming and resources related to the HIIN topics * Provide Regional Coordinators to serve as a reference and support to our organization * Provide engagement awards based on the level of engagement and level of attainment of benchmarks at the end of the contract Continuous Service Readiness (CSR): Access to continuous survey readiness services for hospital accreditation were facilitated for member hospitals via subscription to the CSR consultant service for 95 hospitals. Provided both a Spring and a Fall conference related to accreditation standards. Regional Quality Collaboratives: Regional quality collaboratives were facilitated in the Northeast, Central and Northwest Ohio regions. Each collaborative was facilitated by two co-chairs. Collaborative services included facilitating meetings and providing quarterly data reports including PSI, readmissions, sepsis. Quality Summit: The 12th Annual Quality Summit was conducted on June 5, 2019 with over 450 attendees participating. The summit was held at the Columbus Hilton at Easton, Columbus, Ohio and featured three panel presentations including, The Impact of High Reliability Organizations, High Reliability Rounding and Equity of Care. Seventy professional poster presentations with ample networking opportunities to disseminate effective practices were coordinated. Following the summit, recordings of panel presentations and poster abstracts were posted to the OHA website. Hand Hygiene: The hand hygiene program contracted hand hygiene observers and reporting continued. Certain hospitals and hospital systems saw the need for continuous hand hygiene monitoring on a monthly basis and at higher thresholds of observations than associated with projects typically led by OHA. This program afforded data continuity for dashboard purposes and avoided the loss or lag of data between OHA projects & funding, such as the HIIN programs. Innovations in statewide hand hygiene included: - Continuation of huddles to include and address HH rates and goals - Updates of HH to performance expectations in job descriptions and unit policies and procedures - Regional re-training and education for process observers - Expansion of education content to address a culture of change managers and leaders WayFinder: As the Institute was awarded the federal HIIN contract through CMS, REF continued to work on the usage of the Battelle WayFinder platform. This predictive analytics platform was provided at no cost to HIIN-participating hospitals. REF worked with participating hospitals to provide user training and platform improvement. REF worked with Battelle to create a supplemental monthly summary report for the data inclusive of the platform. These reports were posted on a regular basis to the platform and is of no cost to participating hospitals. Physician Leadership Council: The Physician Leadership Council brought together clinical leaders from 22 hospitals and health systems around the state, collectively representing more than half of the acute care hospitals in Ohio. In 2019, the Council's work was directed toward improving physician and other clinician engagement through assessment and intervention, both at the individual and system level and EHR optimization. Four meetings of the Physician Leadership Council were facilitated during the year.

Ohio Patient Safety Institute Patient Safety Organization (OPSI PSO): Patient safety data collection and analysis was continued for 49 members voluntarily participating in OPSI Patient Safety Organization (PSO) while securing uniform federal confidentiality and privilege protections. Based on OPSI's 3 objectives, the following will outline 2019 accomplishments. OPSI shall set the Ohio patient safety agenda as the convener or facilitator by: * Identifying, sharing, disseminating best practices, and using those practices to set statewide benchmarks * Acting as the catalyst to provide safe patient-centered care along the continuum Current and Potential Activities/Programs in support of objective: * Best Practice Award (annual) - 2019 Best Practice Awards was presented June 5, 2019 to: -Cleveland Clinic Main Campus received the OPSI Acute Care Best Practice Award for "Discharge Checklist." -Nationwide Children's Hospital received the OPSI Primary Care Best Practice Award for "PCP: Continuity of Care" -Cleveland Clinic Fairview Hospital received the OPSI Patient Engagement Best Practice Award for "Reduction of Opiate Use in Post-Operative Cesarean Section Patients." * National Patient Safety Week - "Together in Safety" - March 10 - 16, 2019 - developed calendar, posters, daily messaging, free teleconferences to support patient safety week at the hospitals. Had high respond to teleconferences and posters * Medication Safety Brochures - continue receiving requests for brochures and cards * Updated the medication brochure this year to meet current standards * OHA Partnership for Patients Hospital Improvement Innovation Network (OHA HIIN): - HIIN option year contract was awarded March 25, 2019 and will continue to March 31, 2020. - Currently 85 hospitals have signed up to participate in the OHA HIIN. Results to date: ~ Met or exceeded targets - Anticoagulation, Glucose management, Opioid, CAUTI, CLABSI, CDI, SSI (Colon, Hysterectomy), Sepsis, PVAP, MRSA, Worker Safety, Iatrogenic Delirium ~ Making progress but not at target -Falls, VAE ~ Opportunity - Pressure Ulcers, VTE, Readmissions As a designated PSO, OPSI will be a conduit to identify opportunities for improvement and effective practices by: * Adopting and developing tools to enhance patient safety * Providing leadership and consulting services to integrate evidence-based safe practices in healthcare settings * Working with local, state, and national partners whenever possible Current and Potential Activities/Programs in support of objective: * Recruit members to PSO - Currently have 60 hospitals enrolled * New so far this year - Kettering Health Troy Hospital, OhioHealth Grove City * Recruitment Efforts * Deborah Zanath contacted potentially interested hospitals ~ Contacted 46 hospitals, quotes sent to 11 hospitals, multiple presentations * Patient safety alerts, etc. from PSO - ~ Currently sharing national alerts * Held quarterly OPSI PSO User Groups * Webinars * Transgender Patient Safety - Advanced Concepts * Leveraging the EMR to Improve Sepsis Outcome: A Quality Improvement Project * A Multidisciplinary Perspective on Optimizing Safe Implementation and Use of Infusion Pumps * ECRI Institute's Top 10 Patient Safety Concerns * Bridging the Gap Between Implementation Science and Integration of Best Practice: A Practical Approach OPSI shall be a leader in creating a learning culture that emphasizes patient safety through professionalism, collaboration, interpersonal skills, and teamwork by: * Spreading a culture of safety, mitigating risks, facilitating effective communication, and enhancing safe behavior Current and Potential Activities/Programs in support of objective: * 2019 Best Practice OPSI Audio Conference Series * Diagnostic Error OPSI Audio Conference Series

Community Health: Opioid Response Initiative (ORI) The Opioid Response Initiative targets hospitals most disproportionately affected by the opioid epidemic, bringing together hospital leaders from 23 sites around the state. The goals of the ORI are divided into three focus areas of advocacy, intervention and economic sustainability with clinical interventions grouped into target areas of prevention, harm reduction, and transition to treatment and recovery. In addition to the remarkable clinical initiatives launched by member hospitals and spread among ORI participants, much of the efforts were concentrated in two areas: * Data and Grant Development * As a data support area: -Continued support for the public data release for opioid overdose with data presented statewide, by market area, and by county, with appropriate HIPAA restrictions -The Opioid Data Collaborative, or ODC, was launched July 2018 to serve as a data-aggregating and benchmarking service for opioid prescribing at participating hospitals with a goal to support hospitals' internal efforts in right-sizing opioid prescribing by peer-to-peer education and large statewide comparison groups -The practice areas include emergency departments, hospital discharge, outpatient surgical centers, and physician offices -Participating hospitals receive free quarterly reports. First reports were delivered in December 2019: 1. Data Integrity Report - this includes data at the hospital level and is intended to provide a view of the data the facility has submitted 2. Use Case Report - this includes data for hospital(s) and health system (if applicable) and is intended to provide information about data compared to the project-wide benchmarks 3. Provider Report - this includes data for each individual hospitals' providers and is intended to provide information about the hospital specific data compared to the health system (if applicable) and the project-wide benchmarks for hospitals who submit this data. -At the time of this submission, there are 103 participating hospitals Under the grant development efforts, successes included: -The Cardinal Health Foundation supported a three-pronged approach to the opioid epidemic including 1) a patient, community, and clinician online resource hub to bring the most up-to-date information around treatment resources and interventions, 2) launch of the Opioid Data Collaborative to benchmark opioid prescribing around the state, and 3) exploration of resources to provide alternatives to opioids in patients with chronic pain and on chronic opioid medications. The work began in 2018, the contract was amended in mid-2019, and was completed in early 2020. Award: $353,334 for 18 months -The Coverys Healthcare Foundation approved a grant that began in January 2019 that focuses on clinician education. These efforts include regular opioid-related webinars, provision of an online learning tool called Smart Rx that provides education on guidelines and recommendations as well as Ohio-specific regulations and laws, and lastly ongoing support of the Opioid Data Collaborative. Award: $288,677.82 over 3.5 years. Infant Mortality - Presented an annual data analysis of the Ohio Infant Mortality data and rankings for the various OHA clinical and executive boards. - OHA served on executive/steering committees for the Ohio Perinatal Quality Collaborative, Cradle Cincinnati, NAPPSS National Coalition, and Ohio March of Dimes. Safe Sleep - OHA continued its "Safe Sleep is Good4Baby" initiative aimed at promoting the ABC's of safe sleep practices in Ohio. In 2017, OHA and the Ohio Department of Health partnered to create a free resource for hospitals around promoting 'safe sleep and breastfeeding'. This resource was further distributed statewide in 2019 at no cost and is available online. - Maintained the statewide interactive map for Ohio Department of Health of the locations of Cribs For Kids sites across the state. - In partnership with member hospitals, ODH, and the leadership of the NAPPSS-INN initiative, OHA helped recruit four member hospitals into the latest cohort of this national initiative to improve breastfeeding and safe sleep outcomes. These hospitals were MetroHealth Medical Center, Mount Carmel St. Ann's, Mercy Health Anderson Hospital, and The Christ Hospital. OHA is also supporting these hospitals with free onesies and breastfeeding education. Breastfeeding - The First Steps for Healthy Babies, a quarterly recognition program for hospitals implementing the 10 Steps to Successful Breastfeeding, was launched in March of 2015 in partnership with the Ohio Department of Health. In 2019, the program expanded its reach to over 95% of the maternity hospitals in the state. - The First Steps program partnered with the Ohio Lactation Consultants Association (OLCA) and Ohio Breastfeeding Alliance (OBA) to revive a 'Bag Free' recognition program for hospitals. This program launched in early 2016 and was continued in 2019. 80 hospitals were recognized for their work in 2018, with two hospitals also given honorable mention recognition. This reflects over a 50% increase in participation since the first year. - The First Steps program was invited to the Annual OLCA conference on March 2019. Ryan Everett presented at the main session about the First Steps program and the progress made in Ohio. This was followed with a recognition of all awarded hospitals for the 'Ban the Bag' program. Maternal Health On April 15, 2019 OHA sent out a survey to representatives from all the maternity hospitals in Ohio. Follow-up conversations and reminders occurred over the following months to improve the response rate. In July, the survey was closed with roughly 2/3 of the hospitals having completed the survey. We also collected feedback through meetings such as the OHA Board, CAC, and IHI Board. Additionally, OHA staff communicated with hospital teams and partner organizations during this time to gather additional feedback. Based on the feedback gathered during the statewide environmental scan, OHA staff presented three potential strategies to the Clinical Advisory Committee. All three strategies were approved by the CAC and sent to the OHA Board for approval. At the OHA Board retreat in August, the strategies were adopted. Strategy #1 is to begin this work by focusing on and supporting hospitals with the hypertension and obstetric hemorrhage bundles/indicators. Strategy #2 is for Ohio to join the national AIM initiative. Strategy #3 is for OHA to develop a steering committee to guide our work in this space. In November, OHA reached out to members hospitals/health systems and partner organizations to invite them to join the maternal health steering committee. Representatives from rural hospitals, large systems, AWHONN, ACOG, OPQC, and others have already accepted the invitations to join. OHA hosted a 'kick-off' web-based call with this group on December 18, 2019 to develop the structure and focus for 2020 and beyond.

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