Issue link: https://beckershealthcare.uberflip.com/i/1173622
48 QUALITY IMPROVEMENT & MEASUREMENT What keeps IU Health's VP of quality, safety and performance improvement up at night — and makes her get out of bed in the AM By Mackenzie Bean M ichele Saysana, MD, has served as vice president of quality, safety and performance improvement at Indianapolis-based Indiana University Health since 2017. Her biggest takeaway on quality improvement and safety efforts? It's a marathon, not a sprint. "You have to be in it for the long haul," she said. "You need to keep practicing and training." Here, Dr. Saysana reflects on some of her key accomplishments and challenges in her first two years in the role, and shares advice for other safety and quality leaders. Editor's note: Responses have been lightly edited for length and clarity. Question: What safety or quality initiative are you most excited about right now? Dr. Michele Saysana: We recently implemented a new quality initia- tive focused on how to better understand care goals and preferences for patients at the end of life. We've realized we need to have these types of conversations with patients before they come to the hospital for end-of-life care. ese discussions should be happening when patients are visiting their primary care physician or specialist. We're really excited about moving this initiative beyond the walls of our hospital. We're thinking about how to involve not just physicians, but also our nurses, chaplains, social workers, etc. Q: What is the No. 1 challenge you are facing in your role and how are you tackling it? MS: Quality and safety tend to be at the intersection of many differ- ent healthcare priorities, such as payment reform, patient experience and interoperability. e No. 1 challenge is how to connect the dots between all of those different things and help leaders understand that it's not 95 different priorities they have to juggle. It's about making sense of our work in a way that helps all of these things. Every other month, our CMOs, chief nursing officers, patient expe- rience design leaders, and quality and safety leaders formally meet to 'Off-service' patient placements linked to worse outcomes, study finds By Anne-Marie Kommers P atients placed "off-service" in wards specializing in areas of care they do not require have longer hospital stays and a higher chance of being read- mitted within 30 days of discharge, according to a study published in the journal Management Science. Many hospitals place patients "off-service" to provide them with a bed when the ward to which they belong is full. The study's researchers examined 2016-19 data from a large academic medical center in the northeast- ern U.S. They found "off-service" placements added 3,995 patient-days per year in the hospital, equivalent to 11 additional occupied beds per day. Patients placed "off-service" also had lengths of stay that were 22.8 percent longer than those placed in the correct wards. They were 13.1 percent more likely to be readmitted to the hospital within 30 days of initial discharge. The study also found patients placed "off-service" had better outcomes when they were placed in closer phys- ical proximity to their appropriate wards. Surprisingly, placements in wards with patients who have clinically sim- ilar conditions did not make as much of a difference. n Patient death risk increases when RN, nursing support staffing is low By Anuja Vaidya L ow levels of support staffing for nurses, such as licensed practical nurses and nurse's aides, as well as low registered nurse staffing levels are linked to an increase in patient deaths, according to a study published in BMJ Quality & Safety. For the study, researchers from the Columbia University School of Nursing in New York City examined data from a three-campus U.S. academic medical center between 2007 and 2012. Staffing levels were characterized as low if they were below 75 percent of the annual median unit staffing for each staff category and shift type. In all, researchers studied data for 78,303 adult medical admissions. During the study period, nearly 30 percent of patients experienced one or more shifts with low RN staffing, and 64 percent experienced one or more shifts with low nurs- ing support staffing. Researchers found that mortality risk increased with exposure to more low-staffed RN shifts and low-staffed nursing support staff shifts. "The results should encourage hospital leadership to assure both adequate RN and nursing support staffing," study authors concluded. n