Preventable readmissions, HAI account for 40 percent of care costs

Forty percent of every dollar spent on healthcare is wasted or spent on preventable complications, said Karen Feinstein, PhD, president and CEO of the Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative. Feinstein spoke at the Maine Health Management Coalition 2011 Annual Symposium at the University of Southern Maine in Portland on Nov. 10, discussing ways to make healthcare safer, more reliable and more efficient.

The Pittsburgh Regional Health Initiative (PRHI) is a not-for-profit, regional coalition that was formed in 1997. The organization works toward dramatic quality improvement in the healthcare industry and believes that is the best cost-containment strategy.

[Also: HAIs add millions to health system costs, harm patients]

Throughout the past 12 years, PRHI has applied successful industrial engineering processes — such as Toyota’s LEAN production — toward improving healthcare performance. They call their own method Perfecting Patient Care (PPC).

“We’ve been successful in everything from reducing falls to helping improve the retention of nurses, to speeding up the flow of patients in emergency rooms, reducing waiting time in emergency rooms; so many different areas within the hospital,” said Feinstein.

PPC focuses foremost on meeting patient need and clinical care improvement. Frontline clinical teams perform all research, applying daily problem-solving methods and work on process improvement techniques.

According to Feinstein, one of the biggest problems to tackle in order to contain costs was preventable hospital re-admission. With that in mind in its early stages, PRHI began by working to decrease and eliminate infections in 30 participating hospitals, eventually reducing them by 68 percent.

“If you want to reduce preventable hospital admissions, which would be the big cost saver, you have to make sure that if people do get hospitalized, they don’t get injured, particularly with an infection, and most particularly with a surgical-site infection,” said Feinstein. “The re-admission rate with surgical site infections is at 60 percent within 30 days. That’s astonishing.”

PPC also focuses on improving other cost- and time-saving issues, including nurse retention and turnover rates, transportation problems and equipment room disorganization.

Feinstein has high hopes for the future of PPC and for quality improvement, but says she is worried that health professionals in their graduate education get no exposure to these core industrial engineering processes and to the safety science foundation that makes other complex industries so safe.
She said much of what PRHI does is in the continuing education and on-the-job-coaching realm, but that it would be fortified substantially by bringing these skills into graduate professional education.

“Out ultimate goal, if you ask me, would be building this into the education and rewards system for every health professional,” said Feinstein. “And once you do that I think patients would be much better served.”