Healthcare News & Insights

Hospital profile: Step-by-step plan for improving patient care

Barnes-Jewish Hospital in St. Louis wants to be the safest and highest-quality hospital in the country. Pretty lofty goals for a 1,100-bed facility that serves a broad range of patients. Here’s how it’s going about achieving these goals.

As an academic medical center and the safety net for the St. Louis region, Barnes-Jewish Hospital sees any and all kinds of patients and conditions — making its drive for excellence especially tough.

After all, if you specialize in a few things, it’s easier to excel at them because you have a limited focus. Trying to be the best at everything, is a lot more difficult. So the hospital took on one issue at a time.

Step 1

The first step in achieving its goals was to employ “lean management.” This management system was designed to minimize waste, standardize processes and drive continuous improvement.

Standardizing patient care was key. While Barnes-Jewish Hospital standardized its processes for patient care, it allowed tailored intervention per individual patient — when appropriate. This “variation” was allowed because it benefits patients by providing care specific to their needs.

Step 2

The next step involved training the facility’s future providers. The hospital requires residents to have four hours of lean training and then they have to participate in a process improvement project.

One of these projects was for central line-associated blood stream infections (CLABSIs). Previously, the hospital’s seven intensive care units (ICUs) each had its own method for reducing CLABSI. Under the lean system, all ICUs standardized their practices in insertion, maintenance and follow-up.

For example, the clinicians who insert central lines were trained in a simulation to use evidence-based, standard practices, such as being required to wear a gown, gloves and have a sterile field.

The nurses, who maintained the catheters, had a standardized schedule for changing dressings and the hubcaps of the line.

And finally, the clinicians were trained to question the patient’s need for continued use of a central line on a daily basis using a standard checklist.

Thanks to this process improvement project, the hospital experienced a dramatic drop in CLABSIs.

Other projects tackled at the facility included: diabetes medication errors, pressure ulcers and transition of care. To read more about these click here.

Has your facility implemented any quality improvement projects? If so, tell us about them in the space provided below.










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