Becker's Clinical Quality & Infection Control

16 QUALITY IMPROVEMENT & MEASUREMENT 'F' to 'A': How this Chicago hospital leaped to top safety grade By Bari Faye Dean I n past years, leaders at St. Bernard Hospital on Chicago's South Side weren't fans of e Leapfrog Group's safety grades that are handed out twice a year. "F" grades in both spring and fall of 2021 had been stinging reminders that the safety net hospital wasn't doing enough to focus on patient safety. By spring 2022, and again in fall 2022, the hospital worked its way up to "C" grades, but leadership had its sights set on the top grade — and its concentrated focus on safety paid off. When Leapfrog released its 2023 Safety Grades report May 3, St. Bernard found out it had achieved the coveted "A" grade. Michael Richardson, BSN, RN, chief quality and patient safety officer, said the hospital pivoted its safety strategy when he came on board in September 2021. at's when the hospital's CEO made a commitment to break down departmental silos in the facility and apply comprehensive and consistent safety measures across the board. "Our CEO wanted to use the Leapfrog survey as a roadmap going forward" for what the hospital needed to do to get its safety score out of the basement. "He wanted a more focused approach, one that would change the direction the hospital was going," Mr. Richardson said, noting the rise from "F" to "C" to "A" took an all-hands-on- deck approach, upgraded safety directives and implementation of technology. "Two years ago, we gave them 'Fs' because they had very bad infection rate data," said Leah Binder, president and CEO of e Leapfrog Group. "ey have vastly improved on all their infections [metrics] plus other measures and now they have earned an 'A.' at's a really big deal." How St. Bernard did it Mr. Richardson looked at the low-hanging fruit regarding the hospital's current safety measures. He zeroed in on medication scanning and healthcare-acquired infection rate challenges. St. Bernard's scanning metrics sat at 70 percent, far lower than Leapfrog's recommended 95 percent. Rates of HAIs were high, as well. He immediately started asking questions such as, "Why aren't nurses consistently cross-checking medication labels and patients?" Turns out, he said, there were Wi-Fi dead spots in some areas of the hospital, medicine bottle barcodes didn't scan well, and, oen, the scanning equipment itself didn't work. "Once we learned this information, we knew we could fix those problems fast. We upgraded the Wi-Fi, fixed the labels and got new scanning equipment," Mr. Richardson said. "en we focused on the individual behavior of the nurses and respiratory therapists." In the past 12 months, St. Bernard's medication barcode scanning statistics are even higher than Leapfrog's benchmark. ey are consistently in the upper nineties. Neglect allegations spur internal review at Boston hospital By Mackenzie Bean L emuel Shattuck Hospital in Boston is conducting an internal review of inpatient deaths in response to allegations of neglect and suboptimal care for patients with mental health disabilities. The review comes after a May 8 report, issued by Massachusetts' Disability Law Center, determined that the state-run hospital failed to properly diagnose and treat a cancerous lesion on a patient's nose for more than a year and half. During this time, the patient was admitted to the hospital's mental health unit. The private, nonprofit advocacy group, which serves as Massachusetts' protection and advocacy agency, found the hospital's failure to provide the patient with appropriate care "constituted neglect and contributed to his painful, untimely death'' in August 2020. After receiving the advocacy group's findings and recommended corrective actions, Lemuel Shattuck Hospital conducted a comprehensive review of the patient's care and "concurred with the clinical concerns identified by DLC's expert," the report said. The Massachusetts Department of Public Health said it has made numerous changes at the hospital since 2020, including hiring a new executive team, recruiting more clinicians to fill gaps in medical staffing and implementing hospitalwide safety huddles. "DPH created a systemwide approach that prioritizes high-quality care and patient safety by restructuring the four public health hospitals, including at [Lemuel Shattuck Hospital]. … We have also strengthened oversight and accountability and bolstered the internal communications process to improve clinical decision-making," the department said in a statement to WGBH. Although the hospital has traditionally reviewed all unexpected deaths to identify opportunities to improve care, Lemuel Shattuck is now developing a process to review all deaths without regard for diagnosis or condition, the department said. The hospital's goal is to review all deaths by July. n

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