CMO Message: July 2024

July 9, 2024 Chris Thomas

Quality, Patient Safety and FlowQuality is defined by the federal Agency for Healthcare Research and Quality (AHRQ) as “doing the right thing at the right time for the right person and having the best possible result.” Patient safety is defined by the World Health Organization as “the prevention of errors and adverse effects to patients associated with health care.” 

When flow is impaired, the symptoms are increased boarding in our Emergency Center, higher than expected hospital acquired injuries and infections, and higher than expected lengths of stay (LOS)

Improving flow through our ministries will help us to ensure that patients are getting the high-quality care that they deserve by getting them to the right location of care.


Length of stay and O:E to Home: We fell short of our goal at both St. Peter and Centralia hospitals for Length of Stay (LOS) in June. Our O:E (observed to expected) to home remains at around 1.25 (since 2023). With about 75% of our patients discharging home (vs. to skilled nursing facility (SNF), home with home health, or other locations), this means that on average when a patient is expected to stay for 4 days based on their diagnosis, they actually stay for 5 days. That “extra day” isn’t insignificant… it added up to 916 opportunity days for the month of May alone at St. Peter for patients going home. There are additional opportunity days associated with other dispositions as well, but I need your help to bring down our O:E to home (our goal is 1… or less!)

a.      Discuss anticipated length of stay and discharge planning at admission

b.      Have hard discussions with patients, family and the care team around planning for Plan A and Plan B at discharge

c.      Discuss discharges with care team 24-28 hours before discharge to ensure planning (transportation, help at home, etc.)

d.      For patients who are medically ready, discuss and escalate planning around “Why not discharge to home, why not discharge today?”

e.      Ask about your patient’s mobility. Early Progressive Mobility programs are in place on many of our units. Patients who are appropriately mobile early and often in their stay retain functionality that can keep them from needing extended rehab and/or a SNF stay.

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