Livingston, N.J.-based Saint Barnabas Medical Center has made significant strides in quality improvement since implementing its Clinical Excellence and Effectiveness program in 2017.
Opiate prescribing practices are just one indicator of the CE2 program's success. The flagship hospital of West Orange, N.J.-based RWJBarnabas Health decreased narcotics use for bariatric and gynecologic oncology surgery patients by up to 40 percent and halved its sepsis mortality rate in just one year.
"Our goal [with the program] is to find and implement the very best evidence-based care delivery protocols," said Paul Yodice, MD, chairman of Saint Barnabas Medical Center's department of medicine and CE2 program director. "Through the utilization of information technology, coupled with multidisciplinary cooperation and collaboration, we are able to identify, apply and track these best practices more efficiently than ever before."
Dr. Yodice spoke with Becker's Hospital Review about the creation, implementation and benefits of the CE2 program.
Editor's note: This article was lightly edited for style and clarity.
Question: What spurred the development of the CE2 program?
Dr. Paul Yodice: The CE2 program was developed based off of the success we had in implementing our Enhanced Recovery after Colorectal Surgery (ERAS) clinical pathway. Stephen P. Zieniewicz, president and CEO of Saint Barnabas Medical Center, realized the successes demonstrated by the colorectal ERAS program could be applied to other lines of care. He had an analysis performed to determine what areas might most benefit from these efforts with the goal of enhanced patient outcomes, increased patient satisfaction and improved healthcare team collaboration. Our colorectal program saw great success in a very short period of time simply by creating an evidence-based standardized care model, providing preoperative patient education and reducing variation. After seeing the success in colorectal, the leadership team knew we had a great opportunity to implement programs like this in other areas.
Q: What does the program entail?
PY: The program entails a physician-led multidisciplinary team approach. The CE2 team first reviews baseline data and identify opportunities for improvement. We then work with our medical library to access evidence-based literature that we can use in our workgroup. Our team meets regularly for roughly six to eight weeks to develop our pathway. This pathway will involve not only a standardized order set, but also a specific care map that the patient will follow from beginning all the way to post-discharge. A major piece of the programs is not just implementation, but more so sustainability. We have our CE2 team that continues to work with the team managing compliance, data analysis and communication with the entire team to maintain engagement and success.
Q: What care areas did the CE2 team focus on in the program's first year?
PY: Our CE2 model is broken down in waves. Each wave has specific service lines that our team focuses on. On average, our team implements one service line per quarter. These waves are looked at by volume, opportunity dollars, quality indicators and sometimes simply physician desire to move forward. In year one, we focused on septicemia, community-acquired pneumonia, bariatric surgery and gynecological oncology surgery.
Q: What improvements has Saint Barnabas Medical Center seen since implementing the program?
PY: Saint Barnabas Medical Center has seen extremely positive improvements very quickly after implementing these pathways. Each pathway has a specific focus to first and foremost improve quality care. We have seen specific improvements on reducing length of stay, readmissions, opioid usage and hospital-acquired complications, such as infection, blood utilization, obstruction and dehydration. Reducing variation and standardizing protocols has also allowed us to make our delivery of care efficient and less costly, which has also been a substantial benefit to the organization.
Q: What other inefficiencies or care areas does the CE2 team hope to address as the program matures?
PY: As the program continues to evolve and mature, our team is realizing that we can become more efficient in our data collection. Tracking compliance and data is the way we measure the success of our programs, which we hope to further automate. We are working with our IT division to find ways to electronically extract this data. We are also looking at ways to use innovation and technology in our programs. Understanding that patient education is high priority, our team is looking at different ways to educate our patients, such as virtual classrooms, patient applications and videos.