Becker's Clinical Quality & Infection Control

34 QUALITY IMPROVEMENT & MEASUREMENT Boosting quality, safety scores hiked staff morale, too, Newark's University Hospital CEO says By Cailey Gleeson W hen former New Jersey Health Commissioner Shereef Elnahal, MD, became president and CEO of Newark, N.J.- based University Hospital in 2019, improving quality and safety became part of his central goals. e 519-bed hospital has seen significant improvement in quality measures, and is on track to meet goals in decreasing catheter-asso- ciated urinary tract infections, hospital-acquired pressure injuries, lengths of stay and decreasing deaths, according to figures provided by Dr. Elnahal. Dr. Elnahal outlined his journey to improve quality and safety at the hospital during the pandemic in a conversation with Becker's and shared tips for other healthcare leaders seeking to do the same. Editor's note: Responses were lightly edited for length and clarity. Question: I know University Hospital has seen significant improvements in different quality measures for various hospital-acquired conditions in recent years. What do you attribute that success to? Dr. Shereef Elnahal: We've had a very diligent Lean A3 transformation at University Hospital, and we branded the initiative, UHCares. A lot of that has been focused on a culture of safety. I noticed substantial chang- es in that culture of safety [since 2018]. Part of it was resetting the tone with staff around psychological safety, in raising safety concerns, which I think has been very helpful, but then you also have to institute real structures and governance around quality improvements. e way that looks is huddles in every unit of the organization, especially our clinical units, that cascade up to the hospitalwide safety huddle that we have every morning to raise concerns and issues that the broader group of leaders can address, up to and including our executive leadership team. We've also had targeted committees and improvement efforts on areas where we knew we had deficiencies, so central line-associated blood- stream infections, catheter-associated urinary tract infections, surgical site infections, and clostridioides difficile. All of those had tremendous improvements over the last couple of years, because they were clearly areas of organizational focus and were buttressed by a multidisciplinary team that used A3 thinking to find out the top contributors and chip away at those contributors every week. And so I'm really proud of that work, mostly because I think the foundational issue which was around willingness and psy- chological safety to raise issues has been the major ticket in allowing us to improve. Q: And when you say "A3 thinking," can you clarify exactly what that entails? SE: e A3 framework is a tool within Lean management that allows you to break down an end state problem into its top contributors us- ing data and critical thinking. So all it is is a methodology for critical thinking and an improvement that doesn't allow you, by its very na- ture, to simply assume why you have a problem, but rather force you through coaching and through catchball discussions, to defend your assumptions. And in the process of folks defending their assump- tions, they use data, and they use evidence to do so. So it's really just a way to implement the scientific method when it comes to quality improvement in hospitals. Cleveland Clinic gets $2.5M for study on cutting antibiotic use among pneumonia patients By Erica Carbajal T he Agency of Healthcare Re- search and Quality has granted $2.5 million to Cleveland Clinic to lead a clinical trial that studies ways to cut the use of broad-spec- trum antibiotics among patients with community-acquired pneumonia, the health system said Dec. 9. "Community-acquired pneumonia is a leading cause of hospitaliza- tions and inpatient morbidity and mortality in the United States," said Michael Rothberg, MD, vice chair of Cleveland Clinic Community Care and co-leader of the five-year grant. "However, determining the type of pathogen that caused the infection can be challenging, leading to the prolonged use of powerful antibi- otics. Most patients do not need these drugs, which can have serious side effects and promote future antibiotic resistance." Pneumonia is typically caused by either bacteria, viruses, or fungi; however, patients are often not test- ed for the type of germ that caused the infection and are treated with an- tibiotics. While antibiotics are meant for bacterial pneumonia, antivirals should be given for viruses and antifungal medications for infections caused by fungi. By identifying the type of pathogen causing a patient's pneumonia, care teams can avoid unnecessary antibiotics and initiate targeted therapy sooner, according to a news release. The multicenter trial will test two approaches to reduce the use of antibiotics in hospitalized patients. The first is the routine use of rapid diagnostic testing upon admission to identify the source of the infec- tion. The second is a "pharmacist-led de-escalation, which involves stop- ping or altering the antibiotics to tar- get a specific bacteria after 48 hours for clinically stable patients who test negative for bacterial pneumonia." n

• Cover