En BMC, nuestro compromiso con la atención excepcional incluye un compromiso con la alta calidad de la atención y la seguridad del paciente. Esto significa:
- Brindar atención para garantizar los mejores resultados de salud posibles. El objetivo es garantizar que todos los pacientes reciban la mejor atención posible para su afección y tengan el mismo acceso a tratamientos, terapias y atención médica basados en la evidencia.
- Mantener a los pacientes seguros mediante la prevención de daños que pueden ocurrir mientras reciben atención médica. Nuestro objetivo es lograr cero daños a todos los pacientes.
Brindar atención segura y de alta calidad significa no solo evitar daños a los pacientes, sino también brindar atención de manera oportuna, utilizando solo atención basada en evidencia, y garantizar que la atención sea respetuosa y responda a las necesidades y preferencias del paciente. En BMC, estamos comprometidos a cumplir estos objetivos para todos los pacientes, sin excepción.
Todo nuestro personal y médicos, independientemente de su función, desempeñan un papel importante en la prestación de una atención segura y de calidad. Por lo tanto, todos en BMC están autorizados a aportar su experiencia, habilidades y conocimientos únicos para mejorar la atención y prevenir daños al paciente a través de cada interacción diaria. También le recomendamos encarecidamente que participe activamente en todos los aspectos de su atención en BMC, para ayudar a garantizar que se satisfagan sus necesidades.
Si bien BMC se enorgullece de brindar atención segura y de calidad, sabemos que siempre hay margen de mejora, y que mejorar la calidad y la seguridad del paciente depende de la medición regular y el seguimiento de los resultados. Con este fin, Boston Medical Center cuenta con un sólido programa de calidad y seguridad del paciente que identifica nuestras áreas de fortaleza y nuestras áreas de mejora, y utiliza métodos basados en la evidencia para realizar y mantener mejoras en todas las áreas del hospital.
Quality: External Facing Metrics
Mortality
What the measure means: The mortality rate looks at how many patients die in the hospital compared with the expectation of continued survival, which depends on how severe their conditions are.
BMC Performance:
| Measure | BMC 7/1/2019-6/30/2022 | National Average* |
|---|---|---|
| 30 day adjusted heart attack mortality rate | No different than national rate | 12.6% |
| 30 day adjusted heart failure mortality rate | No different than national rate | 11.8% |
| 30 day adjusted pneumonia mortality rate | Better than the national rate | 18.2% |
| 30 day adjusted stroke mortality rate | No different than national rate | 13.9% |
| 30 day adjusted chronic obstructive pulmonary disease mortality rate | No different than national rate | 9.2% |
*Source: Center for Medicare and Medicaid Services/Hospital Compare
What we are doing to improve:
- Reviewing all mortality cases to ensure high quality care was given.
- Improving the timeliness of early recognition and treatment of sepsis, both when present on admission and when it develops after admission.
- Review overall mortality data to identify areas of focus and potential opportunity to improve care delivery.
Readmissions
What the measure means: Our goal is that once a patient is discharged from a hospital stay, they will have a plan of care and any needed outpatient services that will help ensure they will not need to return to the hospital within a month for an unplanned visit. This measure looks at how many patients do need to return for a second inpatient stay within 30 days.
BMC Performance:
| Measure | BMC 7/1/2019-6/30/2022 | National Average* |
|---|---|---|
| 30 day adjusted heart attack readmission rate | No different than national rate | 14.0% |
| 30 day adjusted heart failure readmission rate | No different than national rate | 20.2% |
| 30 day adjusted pneumonia readmission rate | No different than national rate | 16.9% |
| 30 day adjusted chronic obstructive pulmonary disease readmission rate | No different than national rate | 19.3% |
| 30 day adjusted readmission rate following elective total hip replacement and/or total knee replacement surgery | No different than national rate | 4.3% |
| 30 day adjusted Hospital-Wide All Cause Unplanned readmission rate | No different than national rate | 14.6% |
What we are doing to improve:
- Ensuring timely outpatient contact with providers for patients with conditions that make them more likely to have to return to the hospital.
- Discharging patients with easy-to-understand instructions, using their preferred language, pictures, charts, etc.
- Arranging outpatient care and services to meet patient needs in their community.
Quality: Internal Facing Metrics
Hand Hygiene
What the measure means: Proper hand hygiene is a necessary action to help stop the spread of germs. Staff and providers conduct weekly observations of hand hygiene across the hospital to identify performance.
BMC Performance:
What we are doing to improve:
- Hand sanitizer is located inside and outside patient rooms for easy access for staff and visitors. Dispensers are routinely monitored to make sure they are filled and working.
- Sinks are located inside or close to patient rooms for times when soap and water handwashing is required. Soap dispensers are routinely monitored to make sure they are filled and working.
- If needed, staff are encouraged to remind each other to complete hand hygiene.
- Patients and visitors are encouraged to ask staff and providers if they have used hand hygiene.
- Staff and providers receive regular education on proper hand hygiene techniques.
- For specific hand hygiene needs, signs are posted on patient doorways.
- All units receive regular reports of their performance. Leadership immediately acts on any identified gaps in compliance.
Patient Safety
Taking care of sick patients requires many people and systems to work together to give the best and safest care possible. At BMC, we work hard every day to keep patients safe from harm. On very rare occasions, something happens that was not intended. We study these events to learn how to make our systems safer. We collect information on safety events and use this information to make improvements.
Hospital Acquired Infections
What the measures mean: When patients are sick, they may need to have devices, such as urinary catheters or central venous lines to help them get better. These devices have some risks, such as infection. While infections are largely preventable, they may happen in some complex patient situations, despite meticulous care and treatment.
Likewise, other treatment to help patients return to health, such as antibiotics, also have some associated risks. For example, Clostridioides difficile (C-diff) is a type of bacteria that may be associated with antibiotic use.
BMC Performance:
| Measure | BMC 01/01/22-12/31/22 | National Ratio* |
|---|---|---|
| Central line-associated bloodstream infections in intensive care units and select other patient units | No different than national rate | 1.0 |
| Catheter-associated urinary tract infections in intensive care units and select other patient units | No different than national rate | 1.0 |
| Surgical site infection from colon surgery | No different than national rate | 1.0 |
| Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections | No different than national rate | 1.0 |
| Clostridium difficile intestinal infections | Better than national rate | 1.0 |
*Infections are reported using a standardized infection ratio (SIR). The SIR compares the actual number of infections at a hospital to a national benchmark based on data reported to the National Healthcare Safety Network (NHSN).
What we are doing to improve:
- Ensuring high compliance with proper hand-washing, before and after patient care.
- Making every attempt to not use these devices whenever possible and if needed, remove them as soon as possible.
- Always using the best possible technique to put devices in.
- Consistent use of best possible care for maintaining devices.
- Learning from each situation in which an infection occurs to continually improve our system of care.
- Careful attention to ensuring best practices for antibiotic stewardship.
Patient Safety Indicators (PSI-90)
What the measures mean: PSI-90 is a group of measures that relate to a set of potentially preventable events that are associated with harmful outcomes for patients, such as pressure injuries, in-hospital falls with hip fracture, post-operative sepsis, respiratory problems, kidney injury and wound separation, peri-operative blood clots or bleeding.
What we are doing to improve: Using several best practices for prevention of the complications in the PSI-90 measure group, BMC provides care that will help patients avoid these harms. For example, to prevent blood clots in the lung or large veins after surgery, patient risk levels are identified and medicine may be given for prevention.
Perinatal Care
Doctors and hospitals can improve chances for a safe delivery and a healthy baby by providing care that will promote optimal outcomes.
What the measure means: Early elective delivery is defined as delivery by induction of labor without medical necessity followed by vaginal or caesarean section delivery or a delivery by caesarean section before 39 weeks gestation without medical necessity.
BMC Performance:
| Measure | BMC 07/01/22-06/30/23 | State Rate | National Rate |
|---|---|---|---|
| Percentage of mothers whose deliveries were scheduled too early (1-2 weeks), when a scheduled delivery wasn’t medically necessary | Better than State and National rates | 0% | 2% |
What we are doing to improve: Interventions are in place to only perform induction of labor and caesarean delivery at the optimal time for safe care, unless medically necessary to perform earlier.
Healthcare Personnel Influenza Vaccination
Flu is a contagious disease that spreads around the United States every year, usually between October and May. While anyone can get the flu, but it is more dangerous for some people than others. Each year, thousands of people in the US die from the flu and many are hospitalized. Flu vaccine prevents millions of illnesses and flu-related visits to the doctor every year.
Healthcare staff and providers promote preventative behavior through role modeling and by providing education about preventative services.
BMC Performance:
| Measure | BMC 10/01/22-03/31/23 | MA Adherence Rate | National Adherence Rate |
|---|---|---|---|
| Influenza Vaccination Coverage among Healthcare Personnel | Change to Better than national rate | 96% | 81% |
What we are doing to improve:
- Every year in October, Influenza vaccine is readily available to staff and providers.
- Adherence data is consistently monitored and staff are personally engaged for compliance.
Accreditation & Regulatory Compliance
State and federal agencies, as well as medical specialty societies, require that health care systems meet certain essential criteria to maintain accreditation, specialized certifications, and licensure. The Joint Commission surveys BMC every three years for overall hospital/ambulatory accreditation. In addition, the hospital goes through several accreditation/regulatory visits each year. The regulatory compliance division staff also work to coordinate the institutional response to device recalls.
Center for Medicare and Medicaid Services
BMC is certified as a Medicare and Medicaid hospital provider. The Massachusetts Department of Public Health carries out certification surveys on behalf of CMS.
The Joint Commission
BMC is accredited by The Joint Commission’s Hospital Accreditation Program, an independent nonprofit organization that evaluates healthcare organizations on specific quality and patient safety standards.
Comprehensive Stroke Certification (CSC) Joint Commission
BMC is recognized as a hospital that has the specific services, resources, staff expertise, and training required to treat complex stroke.
Commission on Cancer
BMC’s Cancer Center is accredited by the American College of Surgeons Commission on Cancer. Accreditation recognizes the Cancer Center’s commitment to comprehensive and patient-centered care, a multidisciplinary approach, clinical trial access, lifelong patient follow-up, psycho-social support, and continuous quality improvement.
Massachusetts Department of Public Health (MDPH)
BMC complies with all regulations under Massachusetts general law related to hospital licensure and healthcare facility reporting, including the reporting of serious reportable events (SREs).
QI Hub: Quality Improvement Training
Jointly provided by the Department of Quality and Patient Safety and the Barry M. Manuel Continuing Medical Education Office, the QI Hub is the Boston Medical Center Health System’s educational home for continuous professional development in process and quality improvement.
Relevant reading: