Clinical Quality | Hunterdon Healthcare System

Quality at Hunterdon Medical Center


 
 

Clinical Quality

Hunterdon Medical Center leads hospitals in New Jersey and the U.S. for many leading performance indicators of quality healthcare. These quality measures are gathered by three leading organizations:

  1. The Centers for Medicare and Medicaid Services (CMS) -- CMS is a federal agency within the U.S. Department of Health and Human Services that oversees Medicare and works with state governments to administer Medicaid.
  1. The Joint Commission for the Accreditation of Healthcare Organizations (TJC) -- The Joint Commission for the Accreditation of Healthcare Organizations is an independent, not-for-profit organization that accredits and certifies over 17,000 healthcare organizations and programs in the United States.
  1. The New Jersey Department of Health and Senior Services -- This state agency oversees public health services, senior services and health systems as well as healthcare management and administration in New Jersey.

Quality Indicators – Hunterdon Medical Center measures quality based on its response to the following situations:

Hunterdon Medical Center Heart Attack Care

Hunterdon Medical Center provides fast treatment for heart attacks. HMC’s door-to-balloon time (which varies quarter to quarter) averages less than 60 minutes, which is faster than national guidelines.

Heart Attack Measures
A heart attack (also called an acute myocardial infarction or AMI) occurs when arteries leading to the heart become blocked and cause the supply of blood to be slowed or stopped. When this happens, heart muscle doesn’t get the oxygen and nutrients it needs. As a result, any heart tissue that is affected may die.

Due to the urgent nature of a suspected heart attack or AMI, it is vital to recognize symptoms provide heart care quickly, particularly for patients who may have previously experienced cardiac arrest. The longer the heart muscle is deprived of oxygen by coronary artery disease or a sudden heart attack, the more damage to the heart muscle occurs.

The most crucial element that affects the survival of patients having a heart attack is how quickly the arteries of the heart can be reopened. All elements of heart attack care are important, yet receiving medication or a procedure to unblock blood vessels sooner translates into higher survival rates.

The chart below shares how heart attack/AMI care is measured and evaluated. A high score is good.

Heart Attack

HMC 2010

HMC 2011

HMC 1st Q 2012

National Average

NJ Average

ASA (Aspirin) on Arrival

99%

98%

100%

99%

99%

ASA (Aspirin) on Discharge

100%

100%

100%

99%

99%

ACEI or ARB for LVSD

96%

100%

100%

98%

97%

Adult Smoking Cessation

100%

100%

Discontinued Measure

100%

100%

Beta Blocker at Discharge

99%

97%

100%

99%

99%

Primary PCI 90 min of Arrival

96%

94%

95%

94%

93%

Lipid Lowering Medication, (Statin) prescribed at discharge

N/A

N/A

100%

98%

98%

 

Definition of Chart Terms

ASA (Aspirin) on Arrival
Providing people with aspirin is an important part of treating heart attacks. It can help break up blood clots, prevent new ones from forming, and may reduce the severity of a heart attack.

ASA (Aspirin) on Discharge
Regular aspirin use may reduce the risk of another heart attack.

ACEI or ARB for LVSD
LVSD is Left Ventricular Systolic Dysfunction, which means the heart may not be pumping efficiently. Two drugs, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), can help treat heart failure or prevent decreased heart function.

Adult Smoking Cessation
Smoking is a major risk factor for heart disease. People who receive smoking cessation advice from healthcare providers are more likely to quit.

Beta Blocker at Discharge
Beta blockers are a type of medicine that have been shown to lower blood pressure, treat chest pain (angina) and heart failure, prevent future heart attacks and decrease the chance of death following a heart attack.

Primary PCI 90 min of Arrival
Primary Percutaneous Coronary Intervention, or PCI, is often the most effective method for opening blocked blood vessels that cause heart attacks. Interventional cardiologists may perform PCI or provide medicine to open blockages, and in some cases, may do both.

Hunterdon Medical Center Heart Failure Care

Hunterdon Medical Center provides expert care to help diagnose and manage heart failure. Our goal is to improve heart function for all heart failure patients.

Our success in treating people for heart failure (also called congestive heart failure) is measured by the percentage of patients that receive appropriate treatment. The goal of Hunterdon Medical Center is to provide all appropriate measures for treating heart failure 100% of the time.

Heart failure means the heart can't pump enough blood to meet the body's needs. “Congestive” refers to a buildup of fluid. This condition can cause shortness of breath, swelling of limbs and other symptoms. Underlying problems such as coronary artery disease and high blood pressure can contribute to this problem.

The goal of Hunterdon Medical Center when treating heart failure is to provide specific tests and medication to improve heart function. Additionally, Hunterdon Medical Center provides lifestyle counseling to help our patients embrace ways to improve their health after being discharged from the hospital.

Congestive Heart Failure Measures
The chart below shows how heart failure is measured and evaluated. A high score is good.

Heart Failure

HMC 2010

HMC 2011

HMC 1st Q 2012

National Average

NJ Average

Discharge Instructions Complete

85%

89%

85%

93%

96%

Evaluation of LVS Function

99%

99%

100%

99%

100%

ACEI or ARB for LVSD

97%

81%

84%

96%

98%

Adult Smoking Cessation

100%

100%

Discontinued Measure

99%

100%

 

Definition of Chart Terms

Discharge Instructions Complete
Discharge instructions ensure that patients and their families understand recommendations for diet, physical activity, weight monitoring, prescription drug use and follow-up care as well as the signs and symptoms of worsening heart failure.

Evaluation of LVS Function
Evaluation of Left Ventricular Systolic (LVS) Function is a measure of how well the heart is pumping. Hunterdon Medical Center’s expert cardiac staff determines LVS Function by reading the results of an echocardiogram, which records heart activity.

ACEI or ARB for LVSD
LVSD is Left Ventricular Systolic Dysfunction, which means the heart may not be pumping efficiently. Two drugs, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), can help treat heart failure or prevent decreased heart function.

Adult Smoking Cessation
Smoking is a major risk factor for heart disease. People who receive smoking cessation advice from care providers are more likely to quit.

Hunterdon Medical Center Pneumonia Prevention and Care

When a patient arrives at Hunterdon Medical Center with signs and symptoms of pneumonia, our expert staff provides quality care to diagnose and treat.

Pneumonia is a lung disease caused by a viral or bacterial infection. It can spread to the blood, lungs, middle ear or nervous system. Pneumonia can fill the lungs with mucus, causing lower blood oxygen levels. It mainly causes illness in children younger than age 2 and adults over age 65, and can lead to death in these populations. About 2 million people in the U.S. develop pneumonia each year.

Providing appropriate antibiotics in a timely manner and giving oxygen as needed are treatments that improve the outcomes of pneumonia patients. Preventive measures such as flu and pneumococcal vaccines, as well as smoking cessation counseling, also help reduce the incidence of pneumonia.

Pneumonia Measures
The chart below shows how pneumonia care is measured and evaluated. A high score is good.

Pneumonia

HMC 2010

HMC 2011

HMC 1st Q 2012

National Average

NJ Average

Pneumococcal Vaccination

95%

96%

Moved to a separate measure

95%

98%

Initial Blood Cx (culture) before First Abx (Antibiotic)

97%

99%

100%

97%

98%

Adult Smoking (Cessation Advice)*

95%

100%

Discontinued Measure

 

98%

100%

Initial Antibiotic Within 6 hrs of Arrival

97%

95%

Discontinued Measure

96%

98%

Antibiotic Selection

96%

96%

97%

95%

97%

Influenza Vaccination

89%

96%

Moved to a separate measure

93%

96%

*Added the term (Cessation Advice) to be consistent with other care measure charts

 

Definition of Chart Terms

Pneumococcal Vaccination
Screening for pneumonia and providing pneumococcal vaccine to eligible patients may reduce the incidence of infection. The vaccine is safe and may last up to 10 years. It protects against 23 types of bacteria that cause pneumococcal pneumonia and other pneumococcal diseases. It may be best to get the shot between ages 50 and 65.

Initial (Blood Testing) Before First (Antibiotic)
When a patient arrives at Hunterdon Medical Center with pneumonia symptoms or any kind of respiratory distress, our expert staff may administer a blood test for bacteria associated with pneumonia infection. This test, while the patient is being evaluated in the emergency room, will facilitate more timely treatment of infections. It is not required for all patients.

Adult Smoking Cessation Advice
Smoking has been linked to pneumonia. Quitting smoking may help prevent or reduce risks for pneumonia infection.

Initial Antibiotic Within 6 Hrs of Arrival
Providing the appropriate antibiotics within this timeframe has been shown to cure bacterial pneumonia quickly and reduce the possibility of complications.

Antibiotic Selection
Choosing the most appropriate antibiotics has been shown to improve patient outcomes.

Influenza Vaccination
Influenza (flu) shots are highly effective in preventing flu-related pneumonia. Screening for influenza and providing flu vaccine to patients who present with pneumonia symptoms has been shown to reduce the incidence of pneumonia infections.

 

Hunterdon Medical Center Surgical care

Hunterdon Medical Center is a participant in the Surgical Care Improvement Project, a national campaign aimed at reducing surgical complications.

Hunterdon Medical Center has consistently provided quality surgical care by embracing nationally recommended treatments or best practices. Our success in treating surgical patients is measured by the percentage of patients who receive appropriate treatment. The hospital’s goal is to provide all appropriate measures for avoiding post-surgical complications 100% of the time.

The Surgical Care Improvement Project (SCIP) within the Hunterdon Healthcare System consists of quality measures that examine a defined set of treatments for our surgical patients. These measures are reviewed monthly and help reduce the incidence of four types of post-surgical complications: surgical site infection, adverse cardiac events, deep vein thrombosis and postoperative pneumonia.

Surgical Care Improvement Project Measures

 

HMC 2010

HMC  2011

HMC 1st Q 2012

National Average

NJ Average

Prophylactic Antibiotic One Hour Before Surgery

99%

97%

97%

98%

99%

Prophylactic Antibiotic Selection

99%

98%

99%

98%

98%

Prophylactic Antibiotic Discontinue
d Within 24 Hrs

98%

100%

100%

97%

98%

Appropriate Hair
Removal

100%

100%

Discontinued Measure

100%

100%

Appropriate VTE Prophylaxis Ordered

96%

93%

95%

98%

99%

Appropriate VTE Prophylaxis Received

95%

92%

94%

97%

98%

Timely Removal of Urinary Catheter

85%

78%

75%

95%

96%

Beta Blocker during the Peri-operative period when indicated

89%

94%

93%

96%

97%

Peri-operative temperature management

97%

99%

99%

100%

100%

 

Definition of Chart Terms

Prophylactic Antibiotic One Hour Before Surgery
Research has shown that patients who receive an antibiotic within one hour before surgery are less likely to get post-operative infections.

Prophylactic Antibiotic Selection
The goal of Hunterdon Healthcare System physicians is to select antibiotics that are safe, cost effective and appropriate for treating potentially infectious agents. Each type of surgery has specific antibiotics that are acceptable to use to reduce the patient’s risk for infection.

Prophylactic Antibiotic Discontinued Within 24 Hrs
Research has shown that continuing antibiotics beyond 24 hours ­­– 48 hours for cardiac surgery – offers no additional benefit to surgical patients. Furthermore, antibiotics may sometimes cause unwanted side effects, which may interfere with the patient’s recovery.

Appropriate Hair Removal
Using a razor to shave a surgical site may cause cuts that can become infected. Healthcare providers are asked to clip hair or use a depilatory cream in advance to remove it from surgical sites.

Appropriate VTE Prophylaxis Ordered
VTE stands for venous thromboembolism. This is caused by life-threatening blood clots that form in leg, thigh or pelvis, travel to another part of the body and block blood flow to organs such as the lungs. Prophylaxis (preventive) drugs to thwart the formation of blood clots may be prescribed, even for patients who do not have pre-existing blood clotting problems.

Appropriate VTE Prophylaxis Received
This figure accounts for the percent of patients who appropriately received drugs to prevent and treat venous thromboembolism.



New Beginning 4th Q 2014 - 1st Q 2015


Vaccine Screening and Adminstration


HMC 


National Average


NJ Average


Pneumococcal Immunizations (1st Q 2012)


93%


88%


90%


Influenza Immunications


91%


84%


69%


Hunterdon Medical Center Rapid Response Teams

In the event of a concerning change in the patient’s condition, a Rapid Response Team intervenes as quickly as possible to stabilize the patient’s condition to prevent a more serious outcome.

Hunterdon Medical Center’s Rapid Response Teams may be called to assess patients for:

  • Chest pain
  • Change in heart rate
  • Change in systolic blood pressure
  • Change in respiratory rate
  • Closing airway
  • Change in mental status
  • Seizure
  • Failure to respond to treatment

A Rapid Response Team is comprised of a nursing supervisor, critical care nurse, respiratory therapist, intensivist, resident and the patient’s nurse. The team can be at a patient’s bedside in under a minute, bringing the expertise of a critical care unit to every unit in the hospital. The teams are available
24 hours a day, seven days a week.

The goal of all Rapid Response Teams at Hunterdon Medical Center is to prevent the need for more intensive treatment and refer the patient to a critical care unit if necessary. Our Rapid Response Teams have helped cut down on the number of calls for immediate assistance after a patient’s heart or breathing has stopped.

This graph demonstrates the increase in Rapid Response team calls (pink line) and the close to zero inpatient codes ( black line).

Rapid Response Team Success

Hunterdon Medical Center Surgical Infection and Operative Complications Prevention

Many post-operative infections and post-operative complications can be prevented by using proficient surgical and operating room procedures.

The most critical factors in the prevention or post operative infections, although difficult to quantify, are the sound judgment and proper technique of the surgeon and surgical team as well as the general health and disease state of the patient.

According to the New Jersey 2013 Hospital Performance Report, Hunterdon Medical Center scores were among the state's best with perfect post operative infection rates for the following:

  • zero post operative sepsis (infection)
  • zero foreign body left during procedure proficient
  • zero post operative hip fracture
  • zero post operative wound dehiscence

Department of Surgery Selected Indicators

 

 

Bone and Joint Health