Empirical Outcomes

Heart Failure (HF) Readmission Rates: Comparing All Valley Hospital Patients to Patients Managed by APN/RN Team in Outpatient HF Program 

Valley Medical Group (VMG) APPs and The Valley Hospital (TVH) RNs continue to demonstrate favorable improvements in heart failure readmission rates for patients managed in the heart failure clinic. At TVH, heart failure readmission rates overall were below the Medicare (CMS) benchmark in 2023. However, patients who were treated in the heart failure clinic experienced significantly lower rates of readmission due to timely and expert care from our APPs, nurses, and nursing staff. 

 2023 Central Line Day Comparison: Actual vs. Predicted

Based on hospital patient days and patient acuity, the National Healthcare Safety Network predicts how many central line days would be expected in a patient population. TVH’s continued exceptionally low rate of line days reflects nursing excellence as nurses advocate for appropriate indications for central line placement and discontinuation utilizing P.I.T.C.H.2 Criteria.

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Central Line Associated Blood Stream Infections (CLABSI) Events (2021 – 2023) 

The Hospital Acquired Infection (HAI) Taskforce is a nurse-driven workgroup charged with maintaining a downward trend of CLABSI occurrences following a peak observed during the pandemic. Using a multi-disciplinary approach in partnership with our RN Infection Preventionists, the committee implemented and maintained key best practices in 2023 to sustain reductions:  

• Identification and education of unit-based CLABSI Champions 

• Workshops conducted by Nursing Professional Development team and Clinical Practice Specialists 

• Education on utilization via P.I.T.C.H.2 Criteria, central line care and maintenance, CHG baths, and Central Line Huddles 

• Implementation of electronic culture huddle ("CUDDLE") forms for tracking discussions about appropriateness of cultures before collection 

• Utilization of daily CHG baths, CHG-imbedded site scrub, and Kurin blood culture kits

• Introduction of electronic central line checklist for real-time documentation

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Catheter Associated Urinary Tract Infection Events (2021 – 2023) 

The Hospital Acquired Infection (HAI) Taskforce and RN Infection Prevention Team also focused on maintaining a downward trend of catheter associated urinary tract infection (CAUTI) occurrences following a peak observed during the pandemic. Using a multi-disciplinary approach, the team implemented and maintained key best practices in 2023 to sustain reductions. 

• Identification and education of CAUTI Champions 

• In-person simulations for CAUTI prevention 

• Education on urinary catheter care and maintenance 

• Initiative of Urinary Catheter Huddles  (“CUDDLES”) to review HOUDINI protocol for appropriateness of catheter and urine cultures 

• Infection Prevention and Infectious Disease “Diagnostic Stewardship” continued to focus on reviewing all urine culture orders for appropriateness before proceeding with the test 

• Continued surveillance and deep dives by interdisciplinary teams

• Frontline staff engagement in a culture of Zero Harm 

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 Fall Rates per 1,000 Patient Days in 2023 – Impact of AUGi

This year we expanded the rollout of augmented intelligence (AUGi) to additional nursing units and further reduced both falls and unassisted falls. AUGi harnesses innovative artificial intelligence technology to provide timely alerts to nursing staff to identify patients who are at imminent risk of falling. This technology facilitated improved rounding compliance, created more actionable alerts for nursing staff, and helped to prevent unwanted chair or bed exits to reduce fall-related harm. Rates of total falls and unassisted falls were significantly lower on units with AUGi implementation.  

Other strategies to reduce falls include: 

• Reinforced use of the Bedside Mobility Assessment Tool (BMAT) through educational simulations, including one-on-one training of more than 500 RNs and PCAs  

• Provided new hire RNs an opportunity to learn from physical therapists during onboarding for mobility education 

• The Falls & Mobility Task Force created an Electronic Fall Audit Tool for standardized rounding in medical-surgical units, with over 1,600 audits completed in 2023

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Reducing Falls with Injury per 1,000 Patient Days – Impact of AUGi 

AUGi technology helps to increase the presence of nursing staff at the patient’s bedside during times when patients are at highest risk of a fall. Patients experience lower rates of injury when staff can assist during falls. As a result, Valley patients experienced significantly fewer falls with injury on units where nurses utilize AUGi technology to enhance patient monitoring. 

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Reducing Telemetry Utilization on 3E and 4E 

Valley uses a nurse-driven discontinuation protocol to discontinue central telemetry monitoring based on a criteria that the ordering provider has to agree to. Patients are often left on the monitor longer than is indicated, causing surges in telemetry, prolonged patient discomfort, reduced patient mobility, unnecessary monitoring and documentation by the primary nurse and an increase in alarm fatigue. Beginning on July 25, 2023, nurses on 3E and 4E trialed a revision to their existing Cardiac/Telemetry Monitoring Assessment in Meditech to help them evaluate if a monitor can be removed from the patient. During this trial, the team reduced the number of days on telemetry past indication protocol from 70% in Q2 2023 to less than 60% in October.  

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Reducing Total Time of Pediatric GI Infusions 

A group of pediatric nurses identified gaps in their infusion scheduling process leading to patient chair times that exceeded four hours. Utilizing the Expanse Oncology module, they emulated the same infusions infrastructure in their scheduling process. Since adopting infusion and scheduling functionality as well as developing a criteria for accelerated infusion candidates, the team has reduced the total time of pediatric GI infusions from four hours in August 2022 to two and a half hours by the end of July 2023.

2023 Ability to Get Desired Appointment Patient Experience Scores - Advanced Practice Provider (APP) vs. Press Ganey Mean Performance

Based on Press Ganey patient experience surveys, VMG APPs continue to demonstrate a favorable and positive impact on patient perceptions of access to care as compared to mean performance for all Press Ganey providers nationwide.

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2023 Patient Experience Overall Score for Care Provider: Advanced Practice Provider (APP) vs. Press Ganey Mean

Based on Press Ganey patient experience surveys, Valley Medical Group APPs are rated favorably overall for questions related to the “Care Provider” as compared to mean performance for all Press Ganey providers nationwide.

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2023 Valley Home Care Quality Indicators

Based on data from the Centers for Medicare and Medicaid Services (CMS), Valley Home Care (VHC) demonstrates nursing excellence and exceeds both national and statewide performance on patient reported outcomes related to communication and delivering care in a professional manner. VHC patients also had a higher rate of being discharged to the community after an episode of home care services, an essential indicator of quality and a goal for most home health agencies, patients, and their families.

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2023 Valley Hospice Quality Indicators 

Based on data from the Centers for Medicare and Medicaid Services (CMS), Valley Hospice demonstrated leadership across three pivotal quality indicators, surpassing both national and statewide performance. Notably, the nursing and social work teams at Valley Hospice substantially teams at Valley Hospice substantially provided more visits in patients’ homes during the final three days of life, offering invaluable support to patients and their families during this challenging period. Families benefitted from enhanced training to better care for and understand the needs of their loved ones, while also receiving greater emotional and spiritual support from the Valley Hospice team. Through their collective efforts, Valley Hospice infused end-of-life-care with dignity and compassion, elevating the standard of care for all involved.