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– WASHINGTON –
Public and Private Policy
Medical Errors and Patient Safety

Other Factors And Organizations

  • •   Puget Sound Health Alliance (PSHA)

    Formed at the end of 2004 following recommendations from the King County Health Advisory Task Force, the goal of the Puget Sound Health Alliance is to design and implement an innovative, high quality, and affordable health care system in the Puget Sound region, including King, Pierce, Kitsap, Thurston and Snohomish Counties. These 5 counties account for 60% of annual hospital admissions within Washington State.

    With the appointment of Margaret Stanley, a broadly-experienced and highly-respected healthcare executive, as the Executive Director, the PSHA rapidly achieved credibility and momentum. The goals and guiding principles have led to development of a strategy that emphasizes collaboration, quality and cost reduction of healthcare, and standardization of definitions of clinical quality and data sharing. This step-wise process will undoubtedly culminate in the development of a Regional Health Information Organization (RHIO), although it is unclear if the PSHA will be centrally involved in its creation.

    In 2006, PSHA continues to develop it vision for quality, patient safety, and cost controls with abundant support from healthcare purchasers, employers, providers, and consumers.

  • •   Washington State Hospital Association (WSHA)
    • ◊  Patient safety Initiative started June 14, 2004
      • –  Work In collaboration with physicians, especially WSMA
      • –  Includes Implementation of patient safety goals across all Washington hospitals
      • –  fund program start-up costs, with programmatic detail approved by the Executive Committee and progress reported back to the Board
      • –  continue the initiative into the future, possibly including consideration of longer reaching goals such as an electronic medical record
    • ◊  Safe Tables Learning Collaboratives (TLCs) – The TLC is a secure program for hospitals to standardize processes, share and learn from each other, and further develop patient safety error avoidance. The first meeting on September 22, 2005 addressed ‘Rapid Response Teams’ and nosocomial infections. The 6 areas in which the collaborative will work to reduce nosocomial infections include hand hygiene, ventilator-associated pneumonia, central-line associated infection, surgical site infection, methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococci , and urinary catheter-related infections.
    • ◊  Adoption of JCAHO's 2005 National Patient Safety Goals – The WSHA Board (as a part of the first section of the motion) endorsed the 2005 National Patient Safety Goals established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). All 61 JCAHO-accredited hospitals in Washington will be surveyed for implementation of the 2005 National Patient Safety Goals as of January 2005. In support of the 7 National Patient Safety Goals, and in hopes of extending them to non-JCAHO accredited hospitals, the WHSA President approached all hospital CEOs in a letter of December 9th, 2004 [PDF].
    • ◊  Participation in IHI's 100K Lives Campaign – The WHSA recruited a commitment from all Washington hospitals [.doc File] to participate in the Institute for Healthcare Improvement project. Initial data submission began on June 15, 2005, the anniversary of the announcement of the Patient Safety Initiative.
    • ◊  Publication of August 2004 report – The WSHA published "Quality Initiatives in Washington Hospitals" [PDF]. This excellent report chronicles the activities statewide and within individual hospitals. Some of the examples used in this publication are adapted from the Washington State Medical Association (WSMA) July 2004 whitepaper [PDF] on Patient Safety.
    • ◊  Publication of Safety Measures Crosswalk – The WSHA has also published a WSHA Patient Safety Measure Crosswalk [PDF] in January 2005 that provides details regarding the requirements and recommendations of the six most widespread and accepted quality and patient safety initiatives.
  • •   Washington State Medical Association (WSMA)

    As part of its Patient Safety/Error Reduction Initiative, WSMA is involved in a number of safety activities. These initiatives include:

    • ◊  Patient safety curriculum for physicians [PDF], which is based on the curriculum developed by the Massachusetts Medical Society (MMS) for its member physicians,
    • ◊  Patient safety tips for patients and their families,
    • ◊  Publication and promotion of elimination of dangerous abbreviations in all health care settings.
    • ◊  Promotion of uniform protocols and procedures to prevent wrong site or wrong person surgery, and
    • ◊  Development and promotion of guidelines for office-based anesthesia and surgery. WSMA adopted and disseminated to physicians office-based anesthesia guidelines in 2001.
    • ◊  Collaboration with the WSHA on multiple issues of common ground. Among them, WSMA and WSHA are considering working with Patient Safety Institute (PSI), a not-for-profit organization situated in Plano, Texas. Swedish Medical Center in Seattle tested a wireless data system [PDF] in 2003 with some success. The PSI contracted with the Delaware Health Information Network (DHIN) in Delaware]s efforts to become the nation's first statewide health information and electronic data interchange network for public and private use, thereby enabling medical information at the point of care. Whereas the work in Delaware follows a 1997 state mandate under the supervision of the Delaware Health Care Commission (DHCC – a commission of public/private appointees created by the Delaware General assembly in 1990), collaborative support from WSHA and WSMA may evolve to extend this opportunity in Washington. The Patient Safety Institute also has worked with the Bellingham health care community.
    • ◊  working with Physicians Insurance A Mutual Company to develop error reduction strategies for the outpatient setting. Physicians Insurance A Mutual Company is accredited by the Washington State Medical Association Medical Education Committee to sponsor continuing medical education for physicians.
    • ◊  WSM-ERF Research Initiative

      WSMA has also established a research entity, the Washington State Medical Education and Research Foundation (WSM-ERF), which carries out scientific research and projects in the public interest in the fields of medical science, medical economics, public health, sociology and related areas. WSM-ERF published a white-paper title ‘Patient Safety and Error Reduction Initiatives in the State of Washington and Recommendations for Action’ [white paper [PDF]’ in July 2004. This document provides a summary of activities in Washington in mid-2004 and provides 7 case studies of patient safety initiatives in the State of Washington.

  • •   Qualis Health Quality Improvement Organization (QIO)
    • ◊  100k Lives Campaign – In Washington, Qualis Health has partnered with the Washington State Hospital Association (WSHA), the Washington State Medical Association (WSMA), the Washington State Nurses Association (WSNA), and Virginia Mason Medical Center (VMMC) as northwest nodes for this Institute for Healthcare Improvement (IHI) project. A Qualis Health-sponsored May 2005 Conference on Healthcare Quality Improvement served to energize this project, which began data collection in hospitals on June 15, 2005.
    • ◊  Doctor's Office Quality Information Technology (DOQ-IT)

      Working with the Centers for Medicare & Medicaid Services (CMS) to improve patient care for Medicare beneficiaries, First Choice Health and Qualis Health have collaborated to award a total of $200,000 to ten qualifying small- and rural-practice physician groups to help shrink the digital disparity between small, budget-strapped physician groups and their larger counterparts. Small and rural doctors' offices throughout Washington state were asked to submit applications for new grants (up to $20,000 each), by mid-September 2005.

    • ◊  Centers for Medicare and Medicaid (CMS) Projects

      Qualis Health continues to support several CMS-based projects including the promotion of CMS-sponsored Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Initiative, Surgical Infection Prevention (SIP) collaborative, and multiple other patient safety initiatives.

  • •   Foundation for Health Care Quality (FHCQ)

    The FHCQ is a nonprofit, public-private partnership bridging the concerns of medicine, health insurance, government agencies, employers and consumers. Founded in 1988, the Seattle-based organization has sponsored 3 major state initiatives and has focused on national health information and performance measurement efforts.

    • ◊  Washington Patient Safety Coalition (WPSC) – (see Patient Safety Coalitions)
    • ◊  Clinical Outcome Assessment Program (COAP)

      COAP is a state-approved, physician-led CQIP activity that has addressed Quality Improvement efforts for coronary artery revascularization procedures in Washington State since 1997. The Washington State Health Care Authority (HCA) was intimately involved in the creation of COAP. Since COAP's inception, participation of cardiac hospitals in the state-wide cardiac QI program has been quasi-voluntary with hospital remuneration from HCA medical contracts requiring participation in COAP. COAP's QI activities through 2005 have been directed at all Washington Hospitals performing Coronary Artery Bypass Graft (CABG) surgery or Percutaneous Coronary Intervention (PCI) procedures. QI acivities for valvular cardiac surgery start in 2006. While administrative operations are managed by the FHCQ staff, the COAP registry requires data collection and contributory funding by participating hospitals. Risk-adjusted outcomes (including mortality and multiple peri-procedure adverse events) are monitored as part of the Quality Improvement Program that measures quarterly to 3-year aggregate hospital performance trends. As part of CQIP data protections, COAP QI information is confidential and not available to the public.

    • ◊  Surgical Clinical Outcomes Assessment Program – operations starting in 2005

      Surgical COAP (SCOAP) is a start-up Quality Improvement organization, patterned after the cardiac COAP model, that is physician-directed and that performs Quality Improvement activity on general surgery abdominal surgeries. The SCOAP startup data collection in 2006 will have some grant funding, but most of the data collection burden and funding for operational registry expenses will be borne by participating hospitals.

    • ◊  The Community Health Information Technology Alliance's (CHITA) is an alliance of healthcare technology businesses and organization whose purpose is to support market-place activities and provide leadership that will expand and enhance the use of electronic commerce in the health industry.
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